Andrea Chirivella Fernandez (Tenerife / ES), Lázaro Javier Fernández López (Tenerife / ES), Jorge Brian Perez Torres (Tenerife / ES), Ana Paz Valdebenito Montecino (Tenerife / ES), Mari Cruz Correa Flores (Tenerife / ES), Ester Ramírez (Tenerife / ES)
INTRODUCTION
Traumatic cervical tracheal injuries carry a significant risk of mortality. Penetrating injuries account for 4.5% of all airway injuries, with 3-6% occurring in the cervical region, and 43% of these are accompanied by esophageal injuries.
OBJECTIVES
This case presentation is focus on penetrating cervical trauma, with a emphasis on the critical aspects of airway protection and early surgical intervention.
PATIENTS & METHODS
A 41 years old female came to emergency department after an alleged assault with a knife. ABCDE revealed four incised wounds on the neck, zone 1 and 2, left anterior triangle, accompanied by air leakage, oedema and venous bleeding. Orotracheal intubation was performed. Right pneumothorax, shown on an X-ray, lead to the placement of a chest tube with moderate hematic drainage.
A sternocleidomastoid left cervical incision was made. Left thyroid lobe was injured and therefore resected to provide proper tracheal exposure. Careful identification of the esophagus and preservation of the left laryngeal recurrent nerve were successfully achieved. Injuries to esophagus were excluded by methylene blue instillation and intraoperative endoscopy. A wide tracheal opening, exposing the endotracheal tube balloon, was noted. The gap was repaired with a single layer of absorbable suture. Drainages were left in place. The patient was discharged within a week without complications.
RESULTS
Endotracheal intubation with ventilation distal to the injury is mandatory for patients with aerodigestive tract injuries. Surgical treatment usually leads to favorable outcomes in 90% of patients. In contrast, a conservative approach may lead to missed visceral injuries and a higher mortality rate.
CONCLUSION
Despite respiratory airway trauma's high lethality, favorable outcomes can be expected following surgical treatment. Restoring airway integrity, maintaining vocal function, and avoiding permanent tracheostomy should be the objective of manage.
NO
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