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External laryngotracheal trauma in children
1Department of ENT, Christian Medical College and Hospital, Vellore, Tamilnadu, India. kurien123@hotmail.com
Insights
Acute external laryngotracheal trauma in children is rare but challenging. Tracheostomy and early surgery are key treatments, with a proposed protocol to guide management for better outcomes.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Otolaryngology
Background:
- External laryngotracheal trauma in children is uncommon.
- It poses significant diagnostic and therapeutic challenges for surgeons.
Purpose of the Study:
- To analyze the clinical characteristics, treatments, and outcomes of pediatric external laryngotracheal trauma.
- To develop a straightforward and effective management protocol for this emergency.
Main Methods:
- A retrospective case series involving 12 pediatric patients (ages 2-14).
- Analysis correlated clinical presentation with conservative management, tracheostomy, and surgical interventions.
- All open injury cases underwent tracheostomy, upper endoscopy, and neck exploration.
Main Results:
- Breathing difficulty and stridor were the most frequent symptoms.
- In open injuries, 25% developed subglottic stenosis; in closed injuries, 13% developed glottic stenosis.
- No mortality was observed; tracheostomy and early surgical intervention were crucial.
Conclusions:
- Tracheostomy and prompt surgical intervention are recommended for acute external laryngotracheal trauma in children.
- A management protocol based on clinical presentation criteria is proposed for effective emergency care.
Abstract:
External laryngotracheal trauma in the paediatric population, although rare, presents a diagnostic and therapeutic dilemma for the attending surgeon. The purpose of this study was to evaluate the clinical profile, treatment and outcome and to establish a simple, effective management protocol in this emergency. A retrospective case series was studied. There were 12 patients aged 2-14 years in this series, eight of them (67%) having closed injuries. Their clinical presentation was correlated to conservative management, tracheostomy and surgical intervention. In the open injury group all the patients (100%) underwent tracheostomy, upper endoscopy and neck exploration. One patient (25%) in this group developed subglottic stenosis. In the closed injury group, seven patients (88%) had tracheostomy with upper endoscopy, and two of them (25%) had neck exploration in addition. One patient (13%), however, developed glottic stenosis. The patients with stenosis underwent multiple surgical interventions prior to final decannulation. There was no mortality. Breathing difficulty/stridor were the commonest clinical presentations in children with acute external laryngotracheal trauma. Tracheostomy and early surgical intervention appeared to be the treatment of choice. A protocol with major and minor criteria of clinical presentation is suggested for effective management.