Tracheobronchial injuries in children

Management of traumatic tracheobronchial separation in a teenager using a fabricated extra-long endotracheal tube

“…Our patient's mechanism of injury was a fall from a height of 20 feet, which is consistent with reported causes of TBS such as extensive neck extension and falls from height [3]. This likely resulted in traction and shearing at the carina and pressure against a closed glottis [5][6][7][8].…”

“…Our patient had a tracheobronchial defect just distal to the takeoff of the right main bronchus. Eighty percent of TBS lesions in children due to blunt trauma occur in the main bronchi and tends to affect mainly the right bronchus because the left bronchus is protected by the aorta [5,18]. The tracheal injury in our patient was anastamosed directly using a running polydioxanone suture, which we feel is the most inert substance for the airway, and provides a strong, tight closure.…”

“…The most common causes of TBS are motor vehicle collisions, sports and domestic accidents, extensive neck extension, falls from height and iatrogenic causes such as traumatic intubation or vigorous external cardiac massage [3,4]. Proposed mechanisms for TBS in blunt trauma include: (1) decrease of the anteroposterior diameter of the thorax with widening of the transverse diameter leading to traction at the carina, (2) rapid deceleration causing shearing at the cricoid and carina, (3) sudden increase in pressure against a closed glottis, and (4) direct tracheal trauma with rupture [5][6][7][8]. The thoracic cavity is more compressible in children than in adults, which allows forces to be transmitted to the trachea without injury to surrounding tissues [9].…”

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

“…Surgery usually consists of limited debridement of mucosa and cartilaginous fragments, and the restoration of airway continuity with a primary end-to-end-anastomosis. Stents may be necessary when massive mucosal disruption or comminuted laryngeal skeletal fractures are present or when the anterior commissure or true vocal fold margins are involved [5,11,12,15]. The results are satisfactory in over 90% of cases [11].…”

Iatrogenic tracheal rupture in children: A retrospective study

“…5,6 There are also reports about spontaneous tracheal ruptures as a complication of difficult delivery. 7 In our study, by contrast, iatrogenic lesions during intubation were the main cause of tracheal injury.…”