External laryngotracheal trauma in children

External laryngotracheal trauma in the paediatric population, although rare , presents a diagnostic and therapeutic dilemma for the attending surgeon. The purpose of this study was to evaluate the clinical profile, treatment a nd outcome and to establish a simple, effective management protocol in this emergency. A retrospective case series was studied. There were 12 patients aged 2-14 years in this series, eight of them (67%) having closed injuries . Their clinical presentation was correlated to conservative management, tr acheostomy and surgical intervention. In the open injury group all the pati ents (100%) underwent tracheostomy, upper endoscopy and neck exploration. O ne patient (25%) in this group developed subglottic stenosis. In the closed injury group, seven patients (88%) had tracheostomy with upper endoscopy, and two of them (25%) had neck exploration in addition. One patient (13%), however, developed glottic stenosis. The patients with stenosis underwent m ultiple surgical interventions prior to final decannulation. There was no m ortality. Breathing difficulty/stridor were the commonest clinical presenta tions in children with acute external laryngotracheal trauma. Tracheostomy and early surgical intervention appeared to be the treatment of choice. A p rotocol with major and minor criteria of clinical presentation is suggested for effective management. (C) 1999 Elsevier Science Ireland Ltd. All right s reserved.