Discussion
Osteochondroma (Exostoses) is the commonest benign bone tumor2. These are cartilage-capped bony projections arising on the external surface of the bone and containing a marrow cavity that is continuous with that of the underlying bone3. The majority of lesions are solitary, and around 15% are multiple as a part of Hereditary multiple exostoses (HME) syndrome. The patient usually presents in childhood with bony swelling in limbs, causing deformity, and sometimes symptoms related to compression of surrounding structures. Around 50% of patients present by the age of 5 years and 80% by 10 years of age1. Our patient had multiple large swelling over upper limbs, lower limbs, and chest wall since the age of 2 years, which were gradually increasing in size. He presented with difficulty in breathing and stridor on supine position due to compression of trachea by large suprasternal exostoses mass. The patient’s father also had similar bony swellings over limbs, which supports our diagnosis of Hereditary multiple exostoses (HME).
The use of extracorporeal circulation in management of airway obstruction was first reported by Onozawa et al in 1999, in a patient with thyroid carcinoma4. The use of CPB before induction of GA for surgeries of large neck or mediastinal masses compressing airways has been reported5,6. With the induction of GA, there is a loss of respiratory muscle tone and decrease functional residual capacity which in patients with already compromised airways may lead to respiratory collapse and death6. The tip of the ET tube can injure our patient’s trachea at the site of maximal compression leading to catastrophe.
We have managed our case successfully while avoiding catastrophic events by instituting femoro-femoral CBP under LA preceding to the induction of GA.