Tracheobronchial Trauma

Tracheobronchial injuries are uncommon, occurring in less than 1% of all patients following injury. However, the incidence is higher in specific subsets, notably up to 8% following penetrating neck injury and up to 2% following high energy blunt chest and/ or focal cervical injury. In the majority of cases tracheobronchial injury presents as immediately life threatening injuries, but in up to 1/5 of cases they manifest in a more occult fashion with late onset of hemoptysis, recurrent pneumonia and/or “asthma.” Diagnosis often requires a high degree of clinical suspicion. Initial management is based on immediate securing of the airway, which often requires bronchoscopic assistance. Subsequent repair must take into account the severity of associated injuries and exact location and degree of airway disruption. Repair strategy must include a coordinated plan with anesthesia, including possible cross field ventilation. The majorities of patients who survive to undergo treatment do well, but must be followed for late complications, notably stricture formation.