Tracheostomy related tracheal tear is a serious complication that may
follows surgical or percutaneous tracheostomy. Pediatric populations
carry higher risk because of the anatomical differences. It needs
immediate diagnosis as may leads to life threatening outcomes such as
pneumothorax, respiratory distress, extensive subcutaneous emphysema and
pneumomediastinum. The best way to diagnose and discover tracheal tear
is by tracheobronchoscopy. If the diagnosis established prompt
management and treatment should be performed. Objective The aim of this
article is to review tracheal tears and to help in their diagnosis and
management with assistance of clinical and radiological findings.
Methods and Materials A literature review of PubMed , ovid Medline and
cochrane collaboration databases was done using the terms pediatric ,
tracheostomy , tracheal tear. Discussion Tracheostomy related tracheal
tear occurs infrequently and less commonly than intubation related
tracheal tear. Mostly it is related to tracheostomy placement, using
cuffed tubes and overinflation of the cuff or the tear directly follows
traumatizing tracheostomy tube introducer insertion. The tear due to
tracheostomy mostly located proximal to carina and distal to insertion
of point of tracheostomy. Symptoms and complications of the tear may
occur intraopertivly or postoperatively(5). Gold standard method for
diagnosis will be established by flexible or rigid tracheobronchoscopy
which helps in determining the site, size, extension of the tear and its
location with respect to the carina that are essential to document.
Imaging studies like CT scan which also helps in establishing the
diagnosis of tear and some of it is complications such as pneumothorax,
pneumonia, pneumomediastinum and mediastinitis. Treatment can be
conservative for small uncomplicated wound in stable patient. For larger
complicated tears and unstable patient surgical treatment is the gold
standard. Conclusion Treatment choices depend on tear site , size,
extension of the tear and the status of the patient. Conservative
management is sufficient for stable patients with small tears . On the
other hand , surgical management is essential for unstable patients and
large complicated wounds.