LARYNGOTRACHEAL DISRUPTION FROM BLUNT PEDIATRIC NECK INJURIES - IMPACT OF EARLY RECOGNITION AND INTERVENTION ON OUTCOME

Blunt and penetrating neck injuries are an infrequent cause of morbidi ty and mortality in the pediatric population. Although less common tha n penetrating injuries, blunt pediatric neck injuries are more often l ife-threatening because of associated laryngotracheal disruption. The authors reviewed their experience with pediatric neck injuries over th e past 5 years. There were nine blunt and 14 penetrating injuries, rep resenting 0.5% of the trauma admissions. There was no significant diff erence in age or gender distribution between the two groups. Blunt ped iatric neck injuries were more often associated with frank respiratory distress at the time of presentation. Massive subcutaneous emphysema and hoarseness were the most common symptoms encountered. AII patients with blunt injury underwent direct laryngoscopy and bronchoscopy (DL and B) and esophagoscopy. DL and B results were positive for eight pat ients; seven patients underwent neck exploration and successful repair of the laryngotracheal injuries. There were two deaths; one of these patients had laryngeal transection, which was not recognized at the ti me of DL and B. The other death resulted from associated tracheobronch ial disruption secondary to massive blunt chest trauma. The patients w ith penetrating neck injuries were more likely to be treated nonoperat ively, to have a shorter stay in the hospital and intensive care unit, and to have a lower injury severity score. There were no deaths in th is group. The authors conclude that ail patients with blunt neck traum a should undergo emergent and meticulous DL and B. Visualization of la ryngotracheal disruption mandates immediate neck exploration and prima ry repair. Copyright to 1995 by W.B. Saunders Company