Management of traumatic laryngotracheal separation: Case series and review

Abstract

Laryngotracheal separation injuries are a rare but serious condition, as survival from such injuries relies on proper airway management. As a result, recommendations for management have been based on small case reports and expert opinion. We reviewed our last 10 years of experience with managing laryngotracheal separation injuries and identified 6 cases for chart review. Awake tracheostomy or videolaryngobronchoscopy was used in each case to initially obtain the airway. Surgical repair was then performed immediately using nonabsorbable monofilament suture or a miniplate, and a low fenestrated tracheostomy was placed. All of our patients who followed up were decannulated, eating regular diets, and had satisfactory voice quality at 3 months postoperatively. Review of the literature revealed that, while management strategies have changed over time, treatment still varies widely depending on surgeon preference and the details of each injury. Outcomes from our series suggest that our described techniques and management strategies can be used with good outcomes. We believe that this is due to securing a safe airway, early surgical intervention with no unnecessary tissue dissection, effective reconstruction of the airway, and the fenestrated tracheostomy technique.

Anesthesia Management of Trachea Reconstruction in a Patient with Traumatic Neck Closed Tracheal Complete Rupture

“…The fracture above the level of tracheal carina can form obvious mediastinal emphysema due to gas entering the mediastinum, resulting in blocked venous return and reduced cardiac output, leading to different degrees of cardiopulmonary dysfunction, such as delayed diagnosis and rescue. It will endanger patients' lives [10]. Once cervical tracheal rupture is diagnosed, airway reconstruction should be performed actively to ensure airway integrity and continuity.…”

Management of Dog-Related Penetrating Laryngotracheal Trauma in a Pediatric Patient

“…Penetrating laryngotracheal trauma is the most common cause of death in patients with head and neck trauma second only to an intracranial hemorrhage [3,4]. Given the potential for near-complete tracheal transection to become complete, extreme care must be taken when securing the airway, especially in a prehospital setting.…”

“…Sidell 2011 utilized the National Trauma Data Bank to evaluate 1.9 million cases from 2002-2006, of which 633 were laryngeal trauma events with 69 cases involving pediatric laryngeal injury [2]. Severity can vary widely, with the grading scale for laryngotracheal injuries ranging from I to V; grade I represents minor hematoma or laceration without fracture while grade V represents complete separation [3].…”

Laryngeal trauma: a review of current diagnostic and management strategies

“…The scale was further modified by Fuhrman and colleagues to include laryngotracheal separation (Table 1), and again by Verschueren in 2006 to include computed tomography (CT) guidance in staging (Fig. 1) [2 ▪ ,3,4,5,6 ▪▪ ,7–20].…”