Tracheal demolition after traffic accident in suicidal intent

Introduction:

Tracheal demolition is rare and associated with high mortality. Airway management at the scene of the accident and in the clinic poses a challenge. If the patient stabilizes, adequate surgical care is crucial for a positive outcome.

Method:

We demonstrate the case of a 53-year-old patient who was treated after traffic accident in suicidal intent in our clinic. The awake and spontaneously breathing patient presented with pronounced emphysema and dysphonia. In the polytrauma scan, the suspicion of complete tracheal demolition just below the cricoid cartilage level was confirmed.

Results:

Fiber optic awake intubation was carried out with tracheotomy stand by in the operating room. In operative exploration, the tracheal demolition with clinically suspected bilateral lesion of the recurrent laryngeal nerve was confirmed. We performed an operative reconstruction of the trachea with an end-to-end anastomosis. Furthermore, the temporary low tracheotomy was performed. After a normal course, the trachea healed without stenosis four weeks after surgery. We were able to decanulate the tracheostomy despite persistant bilateral recurrent nerve damage with good respiration.

Conclusions:

The prognosis of patients with tracheal injuries is linked to the early diagnosis and interdisciplinary trauma management. The surgical treatment is performed according to the extent of the tracheal lesion and requires the cooperation of an interdisciplinary team.

Publication History

Publication Date:
23 April 2019 (online)