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

Abstract

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.

Presence of pneumomediastinum after blunt trauma in children: what does it really mean?

“…In this presentation, further imaging is not necessary, as the clinical scenario dictates a need for urgent surgical intervention. A second mechanism of presentation is the stable polytrauma trauma patient with pneumomediastinum, in whom the mechanism of injury (ie, high-velocity crash) and nature of coexisting injuries necessitate further workup to determine the presence of aerodigestive injury [5,6]. It is noteworthy that in the current study, the absence of delayed injury and the high number of radiographic studies and negative tests performed in the multiply injured group suggest that we may be overinvestigating the finding of pneumomediastinum in the absence of clinical markers of concern such as cardiorespiratory instability.…”

Massive Tracheal Rupture in Blunt Chest Trauma: Reconstruction with Autologous Pericardium

“…The kinetics of tracheal blunt trauma originate from two major mechanisms, from external compression applied directly to the anterior of the neck or chest, with a closed glottis, crushing cartilage and the transmission of this force to the rear wall, as was the case of our patient. The second mechanism of blunt tracheal damage are chest deceleration forces, that can result as a shear effect in the posterior fixed points of the airway, like the carina [4,[7][8][9].…”

Blunt posterior tracheal laceration and esophageal injury in a child

“…It is suggested in one study that blunt tracheal injury has an incidence between 0.34% and 1.5% of all trauma patients [1]. It is believed that children may be relatively well protected from the phenomenon of blunt cervical injury because of their relatively short neck and proportionally large head and thorax; however, once this injury occurs, the small size of the larynx in relationship to the epiglottis and arytenoids, as well as the factors mentioned previously, can make it extremely difficult to gain access to the airway [2].…”

“…The presentation of these injuries ranges widely from nearly asymptomatic lesions that can be safely managed with observation to complete tracheal transection presenting with cyanosis, hypoxemia, acidosis, and profound respiratory distress [2]. This particular case fits the pattern of a classic "handlebar injury" [3] with direct force applied to the anterior trachea that results in deformation of the cartilaginous rings and laceration of the posterior wall of the trachea.…”