Management of Laryngotracheal and Tracheobronchial Injuries

Laryngotracheal and tracheobronchial injuries are uncommon, and their successful diagnosis and management often require a high level of expertise. This paper aimed at retrospective analysis of a thoracic surgeon's experience in the diagnosis and management of traumatic injuries to the larynx, trachea and major bronchi. Forty one patients with major airway trauma were managed from March 1994 to November 2008. Their demographic characteristics including age, gender, mechanisms and locations of injuries, associated other organ injuries as well as surgical airway managements and the outcomes were recorded. Seven patients had re-implantation of the main bronchus, and one patient had a repair of the right upper lobe bronchus with concomitant bilobectomy. In cases of tracheal injury, 16 patients had a primary repair of trachea. However, seven patients with tracheal injury first conservative approaches, but 4 of them were later subjected to sleeve resection of trachea. In patients with laryngotracheal injuries, and in a patient with thermal injury, Montgomery T-Tube was used with or without repair and/or reconstruction. Four patients died, but no significant morbidity was seen in others. The analysis of the cases suggests that laryngotracheal and tracheobronchial injuries require early correct diagnosis, skillful management, and prompt individualized surgical airway repair.