Complete cricotracheal transection due to blunt neck trauma without significant symptoms

Abstract

Laryngotracheal injuries are relatively rare but their mortality rate is fairly high. Complete disruption of trachea is extremely rare and a systematic approach is needed for early diagnosis and favourable outcome. The patients symptoms and physical signs do not necessarily correlate with the severity of the injuries and this case report highlights it. This is a case report of 25-year-old man who arrived to the emergency department 8 h after a motor accident in which a rope was wrapped around his neck. Because of the good general and respiratory condition of the patient on admission, the pathognomonic signs of laryngeal injury were not noticed. A computed tomographic scan showed distortion of cricotracheal framework. Flexible bronchoscopy showed cricotracheal transaction. Immediately, the endotracheal tube was advanced distal to the transection site under bronchoscopic guide and then after neck exploration primary end-to-end cricotracheal anastomosis was performed.

Combined tracheoesophageal transection following a life-threatening clothesline-type blunt neck trauma: A case report

“…Disruption of the trachea in blunt neck trauma such as clothesline types injuries, result from the shearing force caused by rapid deceleration [ 3 ]. Manifestations of tracheal transection subsequent to non-penetrating trauma are nonspecific [ 12 ]; moreover, intact peritracheal tissue sustains airway column, so it would be difficult to discover tracheal transection in patients with blunt trauma to the neck [ 2 , 3 , 13 ].…”

“…In our case, the patient's airway had been stabilized using this method [ 6 ]. Afterwards, the trachea should be repaired primarily by end-to-end interrupted simple suture [ 2 ]. Early surgical repair reduces the risk of subglottic stenosis and ameliorates the airway, in addition to voice outcomes [ 16 ].…”

“…Blunt neck trauma is an uncommon, life-threatening injury that may lead to tracheoesophageal transection [ 1 ]. As the signs of the injury may be vogue and nonspecific, close attention is required not to miss any aerodigestive injuries [ 2 ]. Progressive subcutaneous emphysema is a prominent sign that indicates significant trauma to the aerodigestive tract.…”

Delayed Diagnosis of Complete Tracheal Transection

“…Signs and symptoms may be subtle in tracheal injuries and also relatively non-specific correlating poorly with the severity of the underlying injuries. Intact peritracheal tissue may provide a life-saving conduit for gas exchange through the disruption [4]. Most common presentations are respiratory distress, dyspnea, poor gas exchange and hemoptysis [5].…”

Multidetector CT of Laryngeal Injuries: Principles of Injury Recognition

“…Patients with cricothyroid or cricotracheal disruption who reach the hospital alive may be deceptively asymptomatic owing to maintenance of an airway through the soft tissues surrounding the ruptured segment (43,44). Subsequently, airway obstruction may become apparent on neck extension or lying supine.…”