Acute major airway injuries: clinical features and management

Objective: Patients with an acute major airway injury are coming at our att ention 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 fo r 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-traum atic (three blunt traumas, five penetrating traumas). The cervical trachea was involved in 13 cases tone associated to an incomplete esophageal transe ction and two associated to laryngeal injuries), the thoracic trachea in si x 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 w as achieved through a new approach which provides for a small collar incisi on and a longitudinal tracheotomy, Results: All the patients were discharge d healed with a normal patency of the airway. At a mean follow up of 49 mon ths (range of 9-122 endoscopy showed a perfect healing process of the lesio ns. One patient, treated in a conservative fashion, required endoscopic las er Nd-YAG removal of a granuloma, Conclusion: Early diagnosis and surgical repair are the goals to persescute to achieve the best outcome in this pote ntially lethal lesions, The surgical approach should be the thoracotomy if the trauma involves the 1/3 inferior trachea and/or a mainstem. the cervico tomy in the case it was injured the 2/3 superior trachea and the larynx. Po sterior tracheal wall tears may be repaired via the new transcervical/trans tracheal technique. The conservative treatment should be reserved to those patients with minimal signs and symptoms. anti with an adequate potency of the airways. (C) 2001 Elsevier Science B.V. All rights reserved.