[Rupture of larynx or trachea resulting from injuries sustained at birth]

Four newborn boys developed respiratory insufficiency and pneumothorax, pneumomediastinum or subcutaneous emphysema as the result of a laryngeal or tracheal rupture. These ruptures were due to birth injuries after difficult labour resulting from shoulder dystocia or a large lymphangioma and to a birth weight of at least 4500 g. The three children with shoulder dystocia also had a clavicular fracture, a Horner's syndrome, Erb paralysis or phrenic nerve paresis. Treatment consisted of surgical repair followed by a few days' intubation. The children with a shoulder dystocia recovered well, although in one of them a tracheal stenosis had to be resected a few months later. The child with the lymphangioma died from a bifurcation embolus. In newborns with respiratory insufficiency and pneumomediastinum or subcutaneous emphysema after a difficult delivery an emergency laryngotracheoscopy has to be performed to exclude rupture of larynx or trachea.