Clinical features and management of closed injury of the cervical trachea due to blunt trauma

Abstract

BackgroundWe retrospectively reviewed the presentation, diagnosis, treatment, and outcomes of patients with closed injury of the cervical trachea. We evaluated factors that improve diagnosis and treatment, reduce mortality, and avoid tracheal stenosis.MethodsWe reviewed the clinical data of 17 patients with closed injury of the cervical trachea. All patients underwent CT scanning or endoscopy, tracheal exploration, low tracheotomy, and tracheal repair.ResultsIn 12 patients, breathing, phonation, and swallowing functions had returned to normal at 2 weeks. In three patients, breathing and swallowing functions had recovered at 2 weeks, but hoarseness continued. In two patients, tracheal stenosis prevented extubation and required further surgery; in these patients breathing and swallowing functions had recovered at 6 months.ConclusionsClosed injury of the cervical trachea may cause airway obstruction and is potentially life-threatening. Early diagnosis and repair to restore structure and function are important to ensure survival and avoid tracheal stenosis.

Prehospital tracheotomy in a case of avulsion of the larynx with a comminuted fracture of the jawbone

“…Fractures of the larynx are rare injuries with an incidence rate of one in 30,000 because the larynx is relatively protected by the sternum and the mandible [1-4]. Typically, the massive traumatic impact required to cause laryngeal fracture usually results in additional injuries such as midfacial fractures, fractures of the body of cervical vertebra, and craniocerebral trauma; in addition, the patients commonly develop pneumothorax [2,4,5]. Overall, the patient population shows a high rate of mortality [2,4].…”

“…Typically, the massive traumatic impact required to cause laryngeal fracture usually results in additional injuries such as midfacial fractures, fractures of the body of cervical vertebra, and craniocerebral trauma; in addition, the patients commonly develop pneumothorax [2,4,5]. Overall, the patient population shows a high rate of mortality [2,4]. The presenting symptoms include dyspnea, hoarseness, aphonia, hemoptysis, and pain during swallowing; massive cervical subcutaneous emphysema, which is frequently progressive, is the most apparent characteristic [2-4].…”

“…Overall, the patient population shows a high rate of mortality [2,4]. The presenting symptoms include dyspnea, hoarseness, aphonia, hemoptysis, and pain during swallowing; massive cervical subcutaneous emphysema, which is frequently progressive, is the most apparent characteristic [2-4]. The patient often only tolerates a seated position [1,3].…”

“…The patient often only tolerates a seated position [1,3]. In the presence of a ‘cannot intubate’ situation, i.e., invisible glottis, such as in cases of massive bleeding, an endotracheal intubation should not be forced, because the manipulation of the fragments of bones or cartilages can lead to complete obstruction and asphyxiation [1,2,4,5].…”

Tracheal perforation due to suicid attempt

“…[4] Cervical lateral radiography, PA lung and lateral chest X-ray have to be preferred in diagnosis at the first stage and subcutaneous emphysema, pneumomediastinum, and pneumothorax may be observed on chest X-ray. [5,6] Other techniques utilized for diagnosis include cervical CT, thoracic CT and bronchoscopy.…”