Treatment dilemmas in laryngotracheal trauma

The first step in trauma care is establishing an adequate airway. With laryngotracheal injuries the airway itself is injured, making this primary task more difficult. Several areas of management for patients with laryngotracheal trauma are controversial, and treatment dilemmas exist. These dilemmas include initial airway management, indications for computed tomography, operative approach, and utilization of stents. This institution has utilized a standard protocol which addresses each of these management dilemmas for the past 3 years. Twenty-one patients are reported. Voice results were good in 13, fair in six, and poor in two. Airway results were good in 16, fair in three, and poor in two. Complications included two wound infections and one death. The protocol and management dilemmas for these injuries are discussed in detail.