Transection of the cervical trachea resulting from closed trauma to the neck

Laryngotracheal separation (LTS) is the most immediately life-threatening airway injury. LTS is so rare that very few otolaryngologists have experience with it. LTS is one of the diagnostic and therapeutic challenges in airway diseases and its management remains to be established. We experienced a patient with complete LTS after attempted hanging. A high index of suspicion, adequate imaging, prompt airway establishment and early surgical repair are the most vital factors in managing a patient with LTS.

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“…Sudden airway obstruction may occur by trial of endotracheal intubation, neck extension or coughing [2, 5, 7]. …”

Section: Discussionmentioning

confidence: 99%

Complete Laryngotracheal Separation Following Attempted Hanging

Koo

Rha

et al. 2012

Clin Exp Otorhinolaryngol

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“…17 Orotracheal intubation may be the most expedient option, but, as this technique has further injured and indeed disrupted tenuous airways in the past, 2,18,19 it is best reserved for the uncommon situation in which the larynx looks normal, an experienced clinician is available to perform the intubation and no resistance to the passage of the tube is encountered. 1,14 In this situation a gas induction is preferable, avoiding the need for positivepressure ventilation, 14,19 a smaller endotracheal tube than would normally be used is recommended 7 and cricoid pressure is contraindicated. 19 Extension or flexion of the neck for orotracheal intubation is contraindicated in the patient with a potentially injured cervical spine.…”

Section: Discussionmentioning

confidence: 99%

“…9,11,17 Others have argued that the morbidity of emergency tracheostomy precludes its acceptance as a routine first-line procedure. 6,14,20 Cricothyroidotomy is not recommended following blunt laryngotracheal injuries, as this may further injure the cricoid cartilage or fail to intubate the transected trachea. 6,7,15,19 Awake fibre-optic intubation is attainable 18,21 but may be impossible in the presence of intraluminal blood or distorted anatomy.…”

Section: Discussionmentioning

confidence: 99%

Cricotracheal separation: a review and a case with bilateral recovery of recurrent laryngeal nerve function

McCrystal

Bond

2006

J. Laryngol. Otol.

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Cricotracheal separation (CTS) is an uncommon injury, with a high index of suspicion required to establish the diagnosis. Computerized tomography (CT) plays a role in diagnosis but cannot necessarily be relied upon. Bilateral recurrent laryngeal nerve (RLN) palsies are usually associated with this type of injury. We recently treated a patient with CTS in whom one RLN was intact from the time of the injury and the other nerve recovered within three months. Computed tomography was inconclusive. Early open repair of the injury and frequent follow-up examinations led to successful decannulation after six weeks and excellent short-term voice and airway outcomes. A detailed discussion of this unusual case is followed by a review of the current literature on CTS, with particular emphasis on significant management dilemmas and controversies. Clinical suspicion remains more sensitive than investigations in diagnosing CTS. Permanent bilateral RLN palsies are not inevitable following these injuries.

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“…Dyspnoea and dysphagia are suggestive symptoms if a history can be elicited 2,10 . Dyspnoea varying with neck position is suggestive of severe upper airway obstruction 11 . The mechanism of injury may reflect the likely presence or absence of airway trauma.…”

Section: Discussionmentioning

confidence: 99%

Upper airway trauma

Little

1995

Emergency Medicine

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Twelve cases of injury to the upper airway due to external trauma seen over a seven year period in the emergency department are presented. Four injuries resulted from penetrating trauma and eight from blunt trauma. Active airway management was initially required in seven patients. Two patients died of severe neurological injury despite appropriate airway management. Surgical intervention was undertaken in five of the ten survivors, with good results. One patient was discharged with a tracheostomy. All patients presented with symptoms or signs of airway injury. However, airway injuries are uncommon, patients may present without signs or symptoms and these injuries may be overlooked, with potentially disastrous consequences. Airway trauma should be suspected in all cases of blunt or penetrating trauma to the head, neck or chest. Emphasis should be placed on control of the airway and judicious performance of diagnostic procedures, followed by surgical repair where indicated.

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Transection of the cervical trachea resulting from closed trauma to the neck

Cited by 11 publications

References 5 publications

Complete Laryngotracheal Separation Following Attempted Hanging

Complete Laryngotracheal Separation Following Attempted Hanging

Cricotracheal separation: a review and a case with bilateral recovery of recurrent laryngeal nerve function

Upper airway trauma

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