Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 20 (1), 46-51, discussion 51-2

Acute Major Airway Injuries: Clinical Features and Management


Acute Major Airway Injuries: Clinical Features and Management

A Mussi et al. Eur J Cardiothorac Surg.


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.

Similar articles

  • Traumatic Injury to the Trachea and Bronchus
    R Karmy-Jones et al. Thorac Surg Clin 17 (1), 35-46. PMID 17650695. - Review
    Tracheobronchial injuries are relatively uncommon, often require a degree of clinical suspicion to make the diagnosis, and usually require immediate management. The prima …
  • Conservative and Surgical Treatment of Acute Posttraumatic Tracheobronchial Injuries
    A Carretta et al. World J Surg 35 (11), 2568-74. PMID 21901327.
    Surgery remains the treatment of choice for posttraumatic lesions of the airway. However, conservative treatment based on strict clinical and endoscopic criteria-stable v …
  • Laryngotracheal Trauma
    DJ Mathisen et al. Ann Thorac Surg 43 (3), 254-62. PMID 3548613.
    Laryngotracheal trauma can be an immediately life-threatening injury. Failure to recognize such injuries and promptly secure an airway may have fatal consequences. Failur …
  • Acute Tracheobronchial Injury
    AE Flynn et al. J Trauma 29 (10), 1326-30. PMID 2810406.
    We reviewed our experience with tracheal and bronchial trauma from 1977 to 1988. There were 22 patients with tracheobronchial injuries treated in this period. Seventeen ( …
  • [Surgery of Traumatic Tracheal and Tracheobronchial Injuries]
    E Palade et al. Chirurg 82 (2), 141-7. PMID 21243327. - Review
    Tracheal injuries are altogether rare events and can be divided into three broad categories: tracheobronchial injuries caused by external violence, iatrogenic ruptures of …
See all similar articles

Cited by 11 PubMed Central articles

See all "Cited by" articles

LinkOut - more resources