The Evaluation of Minor Cervical Blunt Trauma in the Pediatric Patient

Abstract

Blunt trauma delivered directly to the neck of the pediatric patient may be associated with significant airway compromise. The external signs are not indicative of the extent or site of the trauma. A high index of suspicion is warranted in all patients with this type of injury. A patient with apparently minor direct trauma to the neck is presented to illustrate the principles of evaluation and treatment of these injuries.

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

“…Blunt tracheal lesions can be the result of different mechanisms: external force applied directly to the anterior neck, with flattening of the cartilage and transmission of force to the posterior wall, resulting in linear lesions (cases 1-4); traction exerted on the carina; compression of the chest with closed glottis (case 5); or rapid deceleration, resulting in shearing forces at the posterior areas of fixation [2,3,12,16,18,21,22].…”

“…The goal is to achieve and maintain an adequate airway and to protect the voice quality [19]. In case of an incomplete rupture (less than one third of the circumference) or of a longitudinal posterior tear with good adaptation of the wound margins, the patient can be managed conservatively, with close observation [2,3,10,16,22]. Treatment with antibiotics is usually instituted, since the anatomic structures are disrupted and secondary bacterial infection is likely to occur [4,10,15,16,21].…”

Pneumomediastinum and Pneumothorax From Blunt Cervical Trauma in Children

“…Minor blunt trauma to the neck in children is a relatively common injury. However, because of the protective larger mandible and shorter neck in children, significant injuries are uncommon 3 . Moreover, the soft and pliable laryngeal and tracheal cartilages in young children probably can sustain greater temporary force than the adolescent or adult airway.…”

“…The choice of endoscopic approach depends on the evaluator's experience. The larynx, trachea, and upper main bronchi may be visualized by either rigid telescopes, with or without bronchoscopes, or by flexible bronchoscopes 3,6 . Avoidance of passing a rigid bronchoscope minimizes further tracheal wall damage.…”

Complete traumatic laryngotracheal disruption—A case report and review

“…Minor trauma to the trachea or larynx of the pediatric patient can cause significant injury, such as laryngotracheal disruption and laryngeal fracture [8,9]. For this reason, blunt neck injuries in the pediatric population, although occurring less frequently than penetrating neck injuries, are often more life-threatening [10].…”