BLUNT LARYNGOTRACHEAL TRAUMA IN CHILDREN

Objectives: To demonstrate the diverse causes and manifestations of bl unt laryngotracheal trauma in children, and to recommend an appropriat e treatment protocol for these patients. Design: A retrospective revie w of the medical records of patients treated at a tertiary care childr en's hospital for blunt laryngotracheal trauma during the 12 years bef ore March 1, 1995, was performed. Clinical signs and symptoms, mechani sms of injury, and the results of laryngoscopy were included. Patients : The study included 23 patients ranging from 21/2 to 181/2 years of a ge. The medical records of patients who had sustained an injury as a r esult of penetrating trauma, intubation, or foreign body were excluded . Results: Four patients urgently required tracheotomies; 2 of these p atients required subsequent reconstrutive airway procedures. One child required a microlaryngoscopy with relocation of the arytenoid cartila ge. The remaining 18 patients were treated conservatively with continu ous pulse oximetry, cool mist room air, and serial flexible fiberoptic laryngoscopy. The 18 patients were discharged from the hospital after 24 to 48 hours of observation without sequelae. Conclusions: The sign s and symptoms of blunt laryngotracheal trauma in children are not alw ays specific to the extent or type of injury. A prompt diagnosis and t reatment plan are needed to prevent potentially catastrophic complicat ions. Patients with obvious airway compromise require immediate interv ention. Those without acute airway symptoms often can be treated conse rvatively, provided that flexible fiberoptic laryngoscopy confirms a s afe airway.