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[Trauma of the Membranous Trachea Managed by the ENT-Surgeon]
K W Delank1, F Schmäl, W Stoll
1HNO-Klinik, Klinikum Ludwigshafen/Rhein. delankw@klilu.de
Background:
Isolated perforations of the membranous trachea are extremely rare but potentially life-threatening complications of endotracheal intubations and minimally invasive tracheostomy techniques. Most of the case-reports have been written by thoracic surgeons or anesthesiologists but both the diagnostic procedures and the therapy are not standardized. The aim of this study was to evaluate the position of the ENT-surgery in the management of these lesions.
Patients And Methods:
Over a period of 6 years we treated 5 females, 3 males and 3 children with iatrogenic lacerations of the posterior tracheal wall. The lesions were complications of percutaneous tracheostomies or emergent intubations. The charts and videoprints of each patient were reviewed.
Results:
Clinical presentation was marked in all patients by the characteristical symptoms of paratracheal air leakage, i.e. pneumothorax, emphysema or airway obstruction. In 6 patients the onset of the symptoms occurred with a significant delay until to 2 days after the lesion was originated. Perforations were located at the distal third (8) and at the medial third (2) of the trachea or the subglottic area (1) and had a vertical shape with a length of 0.3-5.5 cm. Surgical repair using a transtracheal cervical approach or an endoscopical procedure was performed in 8 cases. 3 lesions having a length below 2 cm were treated nonoperatively. Outcome was excellent in all patients but a certain percentage of them claimed cough and dysphonia one or more years after the acute phase.
Conclusions:
Because of their life-threatening character perforations of the membranous trachea must be diagnosed as soon as possible. However, the clinical presentation is not obvious in many cases. For the exact detection of the perforations rigid endoscopy is superior to flexible technique. The early surgical repair is recommended for the majority of the cases. Therefore, the transtracheal approach and endoscopical procedures are favorized. Moreover, these methods used routinely in ENT-surgery are also appropriate for lesions of the distal part of the membranous trachea and can be an alternative to the more invasive thoracotomy. Conservative treatment strategies should be limited to selected patients with small lacerations.
Insights
Iatrogenic tracheal perforations are rare but serious. Early diagnosis with rigid endoscopy and surgical repair via transtracheal or endoscopic approaches are recommended for most cases, with conservative treatment for small lesions.
Area of Science:
- Otolaryngology
- Thoracic Surgery
- Gastroenterology
Context:
- Iatrogenic perforations of the membranous trachea are rare, life-threatening complications of endotracheal intubation and tracheostomy.
- Diagnostic and therapeutic approaches for these tracheal injuries are not standardized.
- Most case reports are from thoracic surgeons or anesthesiologists, highlighting a need to define the role of ENT surgery.
Purpose:
- To evaluate the role and efficacy of Ear, Nose, and Throat (ENT) surgery in managing iatrogenic posterior tracheal wall lacerations.
- To assess diagnostic methods and treatment outcomes for tracheal perforations.
Summary:
- This study reviewed 11 patients (5 female, 3 male, 3 children) with iatrogenic tracheal lacerations resulting from percutaneous tracheostomies or emergent intubations.
- Symptoms included paratracheal air leakage, pneumothorax, emphysema, or airway obstruction, with delayed onset in some cases.
- Rigid endoscopy is superior for diagnosis. Surgical repair (transtracheal or endoscopic) was performed in 8 cases, while 3 small lesions were managed nonoperatively. All patients had excellent outcomes, though some experienced long-term cough or dysphonia.
Impact:
- Highlights the effectiveness of ENT-based surgical techniques (transtracheal and endoscopic approaches) as alternatives to thoracotomy for managing tracheal perforations.
- Emphasizes the importance of early diagnosis, with rigid endoscopy being the preferred method.
- Suggests that conservative management should be reserved for select patients with small lacerations.