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Complete Tracheal Transection in a 3-Year-Old after Blunt Neck Trauma: A Case Report

Cameron R. Smith
Cameron R. Smith
, 
Gijo Alex
Gijo Alex
, 
Fernando Zayas-Bazan
Fernando Zayas-Bazan
, 
William O. Collins
William O. Collins
 and 
Sonia D. Mehta
Sonia D. Mehta
   | Aug 10, 2020
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Article Category: Case report
Published Online: Aug 10, 2020
Page range: 4 - 10
DOI: https://doi.org/10.2478/rjaic-2020-0003
Keywords
© 2020 Cameron R. Smith et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1

Computed tomography images demonstrating the position of the endotracheal tube in the superior segment of the trachea (A), the injury to the tracheal wall (B), and the distal end of the endotracheal tube free in the mediastinum and the distal segment of the trachea (C). The patient's trachea was completely transected at the C7T1 level.
Computed tomography images demonstrating the position of the endotracheal tube in the superior segment of the trachea (A), the injury to the tracheal wall (B), and the distal end of the endotracheal tube free in the mediastinum and the distal segment of the trachea (C). The patient's trachea was completely transected at the C7T1 level.

Fig. 2

Photograph of the distal end of the endotracheal tube free in the mediastinum after incision. The patient's injury did not cause destruction of the tracheal rings and all other nearby structures were intact.
Photograph of the distal end of the endotracheal tube free in the mediastinum after incision. The patient's injury did not cause destruction of the tracheal rings and all other nearby structures were intact.

Fig. 3

Intraoperative findings. The distal segment of the trachea after retrieval from behind the sternum with stay sutures in place (A). The tracheal ends as the anastomosis is beginning (B). Note the clean end of the trachea without any tissue destruction. The completed anastomosis (C).
Intraoperative findings. The distal segment of the trachea after retrieval from behind the sternum with stay sutures in place (A). The tracheal ends as the anastomosis is beginning (B). Note the clean end of the trachea without any tissue destruction. The completed anastomosis (C).

Fig. 4

Endoscopic view of the tracheal anastomosis 1 week postoperatively, which showed bilateral true vocal cord mobility, glottic edema, and a well-healing tracheal anastomosis.
Endoscopic view of the tracheal anastomosis 1 week postoperatively, which showed bilateral true vocal cord mobility, glottic edema, and a well-healing tracheal anastomosis.

Fig. 5

Endoscopic view of the glottis (A) and tracheal anastomosis (B) 2 weeks postoperatively. The patient was discharged home 19 days after admission.
Endoscopic view of the glottis (A) and tracheal anastomosis (B) 2 weeks postoperatively. The patient was discharged home 19 days after admission.

Fig. 6

Endoscopic view of the glottis (A) and tracheal anastomosis (B) 3 weeks postoperatively, at which time her glottic edema had mostly resolved and her tracheal anastomosis was healing well.
Endoscopic view of the glottis (A) and tracheal anastomosis (B) 3 weeks postoperatively, at which time her glottic edema had mostly resolved and her tracheal anastomosis was healing well.

Schaefer-Fuhrman laryngeal injury classification

GradeDescriptionRecommendations
1Minor endolaryngeal hematoma or laceration, no detectable fractureConservative (humidified oxygen, observation)
2Edema, hematoma, minor mucosal injury without exposed cartilage, non-displaced fracture on CTConservative treatment vs. tracheostomy, panendoscopy
3Massive edema or hematoma, mucosal tears with exposed cartilage, vocal cord immobility, displaced fracturesTracheostomy, panendoscopy, exploration, and repair
4As with Grade 3, but with severe mucosal disruption, multiple fractures, disruption of anterior commissure, unstable laryngeal frameworkTracheostomy, panendoscopy, exploration, and repair with possible stent placement
5Complete laryngotracheal separationEmergent tracheostomy, exploration, and repair
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