Airway management in laryngotracheal injuries from blunt neck trauma in children

Abstract

Pediatric laryngotracheal injuries from blunt neck trauma are extremely rare, but can be potentially catastrophic. Early diagnosis and skillful airway management is critical in avoiding significant morbidity and mortality associated with these cases. We present a case of a patient who suffered a complete tracheal transection and cervical spine fracture following a clothesline injury to the anterior neck. A review of the mechanisms of injury, clinical presentation, initial airway management, and anesthetic considerations in laryngotracheal injuries from blunt neck trauma in children are presented.

Management of traumatic laryngotracheal separation: Case series and review

“…Surgical The creation of a tracheostomy is not universal but is frequently done. 17,22,23 Although the details of each of our cases varied, the airway management and repair techniques used were similar. The decision for initial airway management in these patients should revolve around performing the safest possible intervention to obtain a stable airway in each situation.…”

“…The level of detail provided concerning the specifics of the airway management and surgical techniques and reconstruction vary widely. 6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The results are summarized in Table 1. Management strategies have not unsurprisingly evolved throughout the years.…”

Operative Management of Vocal Fold Avulsion Following Pediatric Laryngotracheal Separation

“…Patient and parent counseling should include a discussion of these goals and the expectations at each stage of treatment. While the majority of the existing body of literature regarding pediatric laryngeal injury focuses on the acute management of life-threatening sequelae, 7 this case also demonstrates the importance of addressing more subtle endolaryngeal injuries at the time of the initial intervention so as to achieve better long-term quality-of-life outcomes.…”

Traumatic Pediatric Tracheal Rupture After Blunt Force Sporting Injury: Case Report and Review of the Literature

“…A number of assessment and management pathways have been suggested for pediatric laryngotracheal disruption. 2,5,6 Subcutaneous emphysema is a hallmark finding of severe tracheal injury 7,8 and is common in pediatric laryngotracheal injury from blunt trauma, occurring in approximately 85% of reported cases. 2 Its presence is associated with more severe injuries involving the membranous posterior tracheal wall and subsequent requirement for open repair.…”

“…Endotracheal intubation via direct laryngoscopy or with fiberoptic assistance, using a smaller ETT has been described as a safe method of securing the airway, but runs the risk of aggravating an existing injury. 5 Extracorporeal membrane oxygenation (ECMO) has been reported in the literature to provide emergency respiratory support in cases of traumatic tracheal injury, however these cases generally occur in traumatic complete tracheal transections, where an endotracheal tube cannot be passed into the distal stump of the trachea. [13][14][15][16] ECMO was not required in the resuscitation management of our patient as the airway was adequately secured under direct vision with awake fiberoptic endoscopy and ventilation was satisfactory through the endotracheal tube placed distal to the injury.…”