Conservative management of iatrogenic membranous tracheal wall injury: a discussion of 2 successful pediatric cases.

IMPORTANCE Management of pediatric tracheal injuries is a controversial topic not well documented in the otolaryngology literature. OBJECTIVES To present our case outcomes in 2 pediatric patients with tracheal injury and to review the literature on surgical vs conservative management of tracheal injuries in the pediatric age group. DESIGN Case series and literature review. SETTING Tertiary referral pediatric hospital. MAIN OUTCOME MEASURES Morbidity and mortality outcomes. RESULTS The 2 tracheal injuries in the case studies were successfully managed with intubation, antibiotics, and careful monitoring without morbidity related to the tracheal injury. CONCLUSIONS AND RELEVANCE A high level of clinical suspicion is necessary for the diagnosis of tracheal injuries. Both conservatively and surgically managed patients require serial chest and lateral neck plain radiographs to follow resolution of pneumomediastinum and pneumothorax. Both require surveillance of the airway with operative laryngoscopy and bronchoscopy, in addition to long-term follow-up. Surgical repair of trachea rupture, although resulting in shorter intubation, may require tracheotomy. Promising results have been reported in the literature for conservative management with a relatively small risk of airway stenosis without the complications associated with intrathoracic repair. Conservative management should be considered in the management of tracheal injuries in the pediatric population.