HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Alfredo Mussi Carlo Alberto Angeletti Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mussi, A. Articles by Angeletti, C. A. Search for Related Content PubMed PubMed Citation Articles by Mussi, A. Articles by Angeletti, C. A. Related Collections Trachea and bronchi

Eur J Cardiothorac Surg 2001;20:46-52
© 2001 Elsevier Science NL

Acute major airway injuries: clinical features and management

Division of Thoracic Surgery, Cardiac and Thoracic Department, University of Pisa, Pisa, Italy

Received 10 October 2000; received in revised form 17 January 2001; accepted 21 March 2001.

Corresponding author. Tel.: +39-050-995211/995230; fax: +39-050-577239
e-mail: m.ambrogi{at}med.unipi.it

Objective: Patients with an acute major airway injury are coming at our attention with increasing frequency. Despite of its nature, post-traumatic or iatrogenic, these lesions may be life-threatening. An early diagnosis and a prompt treatment reduce morbidity and mortality. Materials and methods: In the last 10 years, on a total of 55 patients treated in our institution for benign lesions of the major airway, 20 were with an acute injury; eleven females and nine males with a mean age of 58 years (range of 24–92). Twelve lesions were iatrogenic (orotracheal intubation) and eight were post-traumatic (three blunt traumas, five penetrating traumas). The cervical trachea was involved in 13 cases (one associated to an incomplete esophageal transection and two associated to laryngeal injuries), the thoracic trachea in six cases (four extended to the right mainstem one and to the left). Sixteen patients underwent immediate surgical repair (13 direct sutures of the tear and three complex restorations of the airway): 11 by cervicotomy and five by thoracotomy. In six cases the suture of a posterior tracheal wall tear was achieved through a new approach which provides for a small collar incision and a longitudinal tracheotomy. Results: All the patients were discharged healed with a normal patency of the airway. At a mean follow up of 49 months (range of 9–122) endoscopy showed a perfect healing process of the lesions. One patient, treated in a conservative fashion, required endoscopic laser Nd-YAG removal of a granuloma. Conclusion: Early diagnosis and surgical repair are the goals to persecute to achieve the best outcomes in this potentially lethal lesions. The surgical approach should be the thoracotomy if the trauma involves the 1/3 inferior trachea and/or a mainstem, the cervicotomy in the case it was injured the 2/3 superior trachea and the larynx. Posterior tracheal wall tears may be repaired via the new transcervical/transtracheal technique. The conservative treatment should be reserved to those patients with minimal signs and symptoms, and with an adequate patency of the airways.

Key Words: Tracheobronchial • Laryngeal • Post-intubation • Trauma • Injury • Treatment

This article has been cited by other articles:

				A. Gomez-Caro Andres, F. J. Moradiellos Diez, P. Ausin Herrero, V. Diaz-Hellin Gude, E. Larru Cabrero, E. de Miguel Porch, and J. L. Martin De Nicolas Successful Conservative Management in Iatrogenic Tracheobronchial Injury Ann. Thorac. Surg., June 1, 2005; 79(6): 1872 - 1878. [Abstract] [Full Text] [PDF]