Outcome of tracheobronchial injuries: a long-term perspective

Tracheobronchial injuries are relatively uncommon, and few data are available on the long-term effects of their treatment.

All injuries involving the larynx and trachea, trachea alone, and mainstem bronchus (MSB) treated by one surgeon were followed if they survived 48 hours.

Sixty patients were treated from 1976 to 2001 for blunt and penetrating injuries: 6 laryngotracheal injuries, 27 tracheal wounds, and 27 injuries to the mainstem bronchus. Follow-up ranged from 1 to 26 years. One of six laryngotracheal wounds had a good result. One required tracheal resection and one required permanent tracheostomy. Patients who survived tracheal resection and end-to-end anastomosis had good outcomes; two had granulomata caused by permanent suture use. One patient treated by primary repair developed stenosis requiring resection. Fourteen patients with MSB injury were treated by pneumonectomy, eight of whom survived. Three developed stump leak/empyema and three had cor pulmonale on long-term follow-up. Ten patients had repair of blunt MSB injuries; two developed bronchial stenosis requiring pneumonectomy.

Laryngotracheal and MSB injuries often had less than optimal outcomes on long-term observation. Tracheal injuries treated by resection and end-to-end repairs had excellent outcomes. The data should be useful in counseling patients/families and planning follow-up strategies for patients with tracheobronchial injuries.