Complications of laryngotracheal disruption.

Abstract

AbstractOwing to the increased use of automobiles, minibikes, motorcycles and other devices for recreational activities, we are now seeing a growing number of severe head and neck injuries. In this paper we will discuss a rare and often fatal injury of the neck, namely, traumatic laryngotracheal separation. There are isolated reports in the literature of heroic efforts to save the lives of such patients, but little has been said regarding surgical repair of the injury and possible late complications.Seven case reports of laryngotracheal avulsion injuries are presented with emphasis placed on the methods of repair of the acute injury and reconstruction of late complications. The etiology of the injury in all cases was a severe localized blow to the extended neck at the level of the cricoid cartilage. Most patients arrived in the emergency room near death, showing obvious signs of upper airway obstruction. A rapid tracheostomy was responsible for saving their lives. In most cases the avulsed trachea was repaired primarily over an internal stent. Associated laryngeal and cricoid fractures were reduced and immobilized. A thorough exploration of the neck was done in most of these patients, and injury to the recurrent laryngeal nerves was commonly noted. Late sequelae depended on the type and extent of associated injuries, the type of repair performed, and timing of the definitive reconstruction. The most satisfactory results were obtained in patients receiving early reconstruction with the use of an internal stent. Equally as important in determining a favorable result following reconstruction was an accurate preoperative and operative assessmet of the extent of injury. Despite optimal early treatment of the acute injury, some patients will remain disabled either from a compromised airway or a poor voice. Additional surgical intervention is possible in most cases, and the variety of problems encountered taxes the versatility of the surgeon.