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Watts E, Little L, Bewick J, Chin J, Jonas N. Successful management of an unstable paediatric laryngeal injury in a low-resource setting. Trop Doct 2023; 53:288-290. [PMID: 36654497 DOI: 10.1177/00494755221131686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Laryngeal injury is rare but has a very high mortality rate. Compared to adults, laryngeal injury in children is more uncommon due to both behavioural and anatomical reasons. Severe laryngeal injury may require surgical repair, intensive care support and tracheostomy care, all of which are difficult to achieve in a low resource setting. We report a case of successful management of laryngeal trauma in a child involving an emergency tracheostomy insertion, open repair of thyroid cartilage fracture, tracheal stenting and successful decannulation after 8 weeks post-injury with full recovery.
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Affiliation(s)
- E Watts
- Department of Surgery, Hopitaly Vaovao Mahafaly (The Good News Hospital), Mandritsara, Madagascar
| | - L Little
- Department of Surgery, Hopitaly Vaovao Mahafaly (The Good News Hospital), Mandritsara, Madagascar
| | - J Bewick
- Department of Paediatric Otolaryngology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Jwe Chin
- Department of Surgery, Hopitaly Vaovao Mahafaly (The Good News Hospital), Mandritsara, Madagascar.,Department of Anaesthesia, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - N Jonas
- Department of Paediatric Otolaryngology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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2
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Arens C, Müller AH. [Management of blunt and penetrating laryngeal trauma]. HNO 2023; 71:28-34. [PMID: 36264298 DOI: 10.1007/s00106-022-01238-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 01/18/2023]
Abstract
Patients presenting with laryngotracheal trauma can be in a life-threatening situation. Early recognition of the severity of the injury and, if necessary, surgical intervention within the first 24-48 h increases the chance of achieving a good functional late result. Preservation or restoration of voice and swallowing function is the long-term therapeutic goal. Precise assessment of the extent of the injury can be achieved using a combination of computed tomography and flexible laryngotracheoscopy. Symptoms often do not reflect the extent of the injury, which can vary from endolaryngeal hemorrhage to complete laryngotracheal separation. Conservative treatment consists of observation with symptomatic therapy. On the other hand, surgery may include endolaryngeal repair and/or transcervical reconstruction; securing the airways is of utmost importance.
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Affiliation(s)
- Christoph Arens
- Zentrum für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen, Klinikstraße 33, Ebene 1, 35392, Gießen, Deutschland.
| | - Andreas H Müller
- Klinik für HNO-Heilkunde/Plastische Operationen, SRH Wald-Klinikum Gera, Straße des Friedens 122, 07548, Gera, Deutschland.
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Management of paediatric laryngotracheal trauma. The Journal of Laryngology & Otology 2022; 136:1125-1129. [DOI: 10.1017/s0022215121003972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Objective
To summarise and describe the clinical presentations, diagnostic approaches and airway management techniques in children with laryngotracheal trauma.
Methods
The clinical data related to laryngotracheal trauma diagnosed and treated at the Beijing Children's Hospital, between January 2013 and July 2018, were retrospectively reviewed. Disease diagnosis, treatment, management and outcomes were analysed.
Results
A total of 13 cases were enrolled, including 7 cases of penetrating laryngotracheal trauma. The six cases of blunt laryngotracheal trauma were caused by collisions with hard objects. In all cases, voice, airway and swallowing outcomes were graded as ‘good’, except for one patient who had residual paralysis of the vocal folds.
Conclusion
Flexible fibre-optic laryngoscopy and computed tomography can play an important role in diagnosing laryngotracheal trauma. The airway should be secured and, if necessary, opened by tracheal intubation or tracheostomy.
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Chu X, Chen W, Wang Y, Zhu L, Zhang M, Zhang S. ECMO for paediatric cardiac arrest caused by bronchial rupture and severe lung injury: a case report about life-threatening rescue at an adult ECMO centre. J Cardiothorac Surg 2022; 17:142. [PMID: 35668492 PMCID: PMC9169275 DOI: 10.1186/s13019-022-01856-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bronchial rupture in children is a rare but dangerous complication after chest trauma and is associated with increased mortality. Veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) is reported as one of the treatments for this life-threatening complication. CASE PRESENTATION A 4-year-old boy with bronchial rupture and traumatic wet lung complicated by cardiac arrest after chest trauma was admitted to an adult ECMO centre. He experienced two cardiac arrests, one before and one during the operation. The total duration of cardiac arrest was 30 min. V-V ECMO was initiated because of severe hypoxia and hypercapnia during the operation. ECMO was performed for 6 days, and mechanical ventilation lasted 11 days. On the 31st day after surgery, he had recovered completely and was discharged without neurological deficit. CONCLUSION V-V ECMO can be considered for supportive care in children with severe acute respiratory failure after bronchial rupture. In an emergency, V-V ECMO can be carried out effectively in a qualified and experienced adult ECMO centre. However, the application of ECMO in children is different from that in adults and requires more refined management.
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Affiliation(s)
- Xiaoqiong Chu
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, No. 150, Xi Men Street, Taizhou, 317000, China
| | - Weibiao Chen
- Department of Emergency Medicine, Tiantai County Hospital of Chinese Medicine, Taizhou, China
| | - Yafei Wang
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, No. 150, Xi Men Street, Taizhou, 317000, China
| | - Luqi Zhu
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, No. 150, Xi Men Street, Taizhou, 317000, China
| | - Mengqin Zhang
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, No. 150, Xi Men Street, Taizhou, 317000, China
| | - Sheng Zhang
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, No. 150, Xi Men Street, Taizhou, 317000, China.
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Alharbi SM, Najmi AA, Alzahrani MS, Alkathiri AA, Alhelali AA, Alqarni SN. Complete Laryngotracheal Separation Secondary to Blunt Trauma: A Case Report. EAR, NOSE & THROAT JOURNAL 2022:1455613221102869. [PMID: 35570720 DOI: 10.1177/01455613221102869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Complete laryngotracheal separation is a rare life-threatening trauma that may occur due to road traffic accidents. Unfortunately, this injury may be missed if emergency physicians were not aware of its possibility. We present a pediatric patient who had complete laryngotracheal separation and esophageal injury caused by strangulation with a headscarf while riding a four-wheeled motorcycle. The neck on external examination showed only a ligature mark without open wounds. The injury was identified while attempting tracheostomy as the patient had a decreased oxygen saturation and was aphonic. The patient underwent complete airway reconstruction and stenting as well as low tracheostomy with complete reconstruction and anastomosis of the esophagus. The patient was decannulated after a few weeks with the vocal cords in paramedian position and no aspiration. This case demonstrates that early prompt treatment can save the patient's life and result in good functional outcomes.
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Affiliation(s)
- Salmah M Alharbi
- OtorhinoLaryngology-Head and Neck Surgery Department, 48103Asir Central Hospital, Abha, Saudi Arabia
| | - Albaraa A Najmi
- OtorhinoLaryngology-Head and Neck Surgery Department, 48103Asir Central Hospital, Abha, Saudi Arabia
| | - Mohammad S Alzahrani
- OtorhinoLaryngology-Head and Neck Surgery Department, 48134King Fahad Central Hospital, Jazan, Saudi Arabia
| | - Assaf A Alkathiri
- OtorhinoLaryngology-Head and Neck Surgery Department, 48103Asir Central Hospital, Abha, Saudi Arabia
| | - Abdullah A Alhelali
- OtorhinoLaryngology-Head and Neck Surgery Department, Abha Maternity and Children's Hospital, Abha, Saudi Arabia
| | - Saad N Alqarni
- OtorhinoLaryngology-Head and Neck Surgery Department, 48103Asir Central Hospital, Abha, Saudi Arabia
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Complete Tracheal Transection in a 3-Year-Old After Blunt Neck Trauma: a Case Report. Rom J Anaesth Intensive Care 2020; 27:4-10. [PMID: 34056117 PMCID: PMC8158306 DOI: 10.2478/rjaic-2020-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pediatric laryngotracheal injuries from blunt force trauma are rare but can lead to significant morbidity and mortality. In pediatric patients with severe laryngotracheal disruption, extracorporeal membrane oxygenation has been used to improve oxygenation and ventilation until definitive repair can be performed. We describe the case of a 3-year-old girl with blunt neck trauma secondary to an all-terrain vehicle accident in which her neck was clotheslined against a fence, leading to a complete tracheal transection at the C7-T1 level. Emergent extracorporeal membrane oxygenation cannulation was initiated. We discuss the evaluation and management of tracheal injuries and the requisite multidisciplinary team approach. Pediatric patients with laryngotracheal trauma require definitive airway management, which should be performed by skilled personnel.
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7
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Challenging tracheal resection anastomosis: Case series. Auris Nasus Larynx 2020; 47:616-623. [PMID: 32035696 DOI: 10.1016/j.anl.2020.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/21/2019] [Accepted: 01/21/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study was conducted to review our experience in Otorhinolaryngology Department, Mansoura University Hospitals, Egypt, in the last 2 years in the management of high-risk patients who underwent cricotracheal resection due to different pathologies. METHODS This case series included nine patients with severe, grade III or IV subglottic / cervical tracheal stenosis. These patients were considered high risk patients due to unusual pathology / etiology of stenosis or associated surgical field morbidity. Four patients had recurrent stenosis after previous unsuccessful cricotracheal resection, three patients had subglottic stenosis due to external neck trauma which compromised the surgical field. One patient had upper tracheal neoplasm, and in 1 patient there was upper tracheal stenosis associated with tracheo-esophageal fistula. RESULTS Successful decannulation was achieved in all patients (n = 9) without any reported major intraoperative or postoperative compilations. CONCLUSION Cases of subglottic / upper tracheal stenosis due to uncommon pathologies like neoplastic lesions, external neck trauma compromising the surgical field and revision cricotracheal resection, can be successfully managed by cricotracheal resection. However, a highly skilled team, well familiar with these surgeries, is mandatory to achieve an optimum outcome.
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Jitpakdee P, Steele T, Bhuskute A, Setabutr D. Pediatric laryngotracheal separation following a go-cart injury. Int J Pediatr Otorhinolaryngol 2016; 85:166-9. [PMID: 27240517 DOI: 10.1016/j.ijporl.2016.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/19/2016] [Accepted: 03/19/2016] [Indexed: 11/18/2022]
Abstract
Less than one percent of trauma admission cases are categorized as pediatric neck trauma [13]. Nevertheless, due to an increasingly mobile society, there has been an increasing frequency of pediatric neck trauma with motor vehicle accidents being the most common mechanism of injury [8]. We present a case of laryngotracheal separation from a blunt, clothesline injury to the neck in a pediatric patient. We also review the literature and discuss the benefit of balloon airway dilation and its assistance in the management of laryngeal trauma and its resultant effects.
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Affiliation(s)
- Polpatt Jitpakdee
- Chulabhorn International College of Medicine, Thammasat University, Department of Otolaryngology-Head and Neck Surgery, Pathum Thani, Thailand
| | - Toby Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, CA USA
| | - Aditi Bhuskute
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, CA USA
| | - Dhave Setabutr
- Cohen's Children's Medical Center, Hofstra University School of Medicine | Northwell Health, Division of Pediatric Otolaryngology, New Hyde Park, NY, USA.
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9
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Chatterjee D, Agarwal R, Bajaj L, Teng SN, Prager JD. Airway management in laryngotracheal injuries from blunt neck trauma in children. Paediatr Anaesth 2016; 26:132-8. [PMID: 26530711 DOI: 10.1111/pan.12791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2015] [Indexed: 12/27/2022]
Abstract
Pediatric laryngotracheal injuries from blunt neck trauma are extremely rare, but can be potentially catastrophic. Early diagnosis and skillful airway management is critical in avoiding significant morbidity and mortality associated with these cases. We present a case of a patient who suffered a complete tracheal transection and cervical spine fracture following a clothesline injury to the anterior neck. A review of the mechanisms of injury, clinical presentation, initial airway management, and anesthetic considerations in laryngotracheal injuries from blunt neck trauma in children are presented.
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Affiliation(s)
- Debnath Chatterjee
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rita Agarwal
- Department of Anesthesiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Lalit Bajaj
- Department of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarena N Teng
- Department of Anesthesiology, Ochsner Hospital for Children, New Orleans, LA, USA
| | - Jeremy D Prager
- Department of Otolaryngology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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