Lacerations of the cervical trachea in children

Kielmovitch, Izak H.; Friedman, William H.

doi:10.1016/0165-5876(88)90052-3

Cited by 20 publications

(17 citation statements)

References 11 publications

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“…Reece and Shatney reviewed 51 patients and reported an incidence that ranged from 0.34% to 1.5% [19]. Data relating to children are scant, with an incidence ranging from 0.7% to 2.8%, and most often concern children over 8 years of age, due to the protected position of the cervical airway in children of younger age [2,3,5,15,22]. The larynx is situated higher in a proportionally shorter neck, well-protected by the relatively large head, jaw and thoracic cage.…”

Section: Discussionmentioning

confidence: 96%

“…Most often, however, it occurs due to iatrogenic causes, such as intubation or endoscopic procedures [23]. Blunt trauma to the neck is rarely a cause of tracheal injury [2,3,5,15,22]. Gussack et al reported 30,000 adult trauma victims over 5 years, of which, 109 had blunt neck injuries but only 4 suffered a laryngotracheal trauma [9].…”

Section: Discussionmentioning

confidence: 99%

“…A small tear usually presents with a dry hacking cough, followed by a delayed onset of mediastinal and cervical emphysema. The presentation of a large laceration is one of severe coughing, loss of thyroid cartilage prominence, profuse haemoptysis, although this is not usual, and immediate emphysema with shortness of breath and cyanosis [4,10,15,22]. Presenting signs and symptoms, however, can be quite variable and sometimes minimal, even with major lesions, delaying diagnosis [22].…”

Section: Discussionmentioning

confidence: 99%

“…Pneumomediastinum and cervical emphysema are the most sensitive markers of airway rupture [3,4]. A neck CT scan provides definitive information, unless clinical deterioration makes immediate panendoscopy (laryngeal, tracheal, bronchial and oesophageal) necessary [4,10,13,15]. Endoscopy remains the cornerstone of diagnostic evaluation, although it may worsen air leak at the time of anaesthetic induction [2,3,18,22].…”

Section: Discussionmentioning

confidence: 99%

“…Although blunt trauma of the upper airway is not uncommon, children seldom develop tracheal injury [2,3,5,15,22]. This is mainly because of their specific anatomy of a short neck, protected by their relatively large head and thoracic cage.…”

Section: Introductionmentioning

confidence: 99%

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Management of blunt tracheal trauma in children: a case series and review of the literature

2006

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Blunt tracheal trauma seldom develops in children because of their anatomy and the mobility of the cartilage. It has the potential to be overlooked, either because of the severity of concomitant injuries or because of the unfamiliarity of paediatricians with this type of injury. However, tracheal injury might be lethal due to airway compromise. Early bronchoscopy may be necessary to anticipate complications and prevent permanent dysfunction. We present a retrospective, double-institution case series over a 5-year period, describing five children, aged 3 to 14 years, with tracheal injury after blunt cervical trauma. All patients showed emphysema with pneumomediastinum. After explorative bronchoscopy, all patients were successfully treated with antibiotics and/or supportive ventilation. In summary, minimal lesions due to blunt tracheal trauma could be treated conservatively in children. Since the external signs of tracheal injury are not indicative of the extent of the trauma, a high index of suspicion is warranted in these patients.

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