Management of Complete Cricotracheal Separation: A Case Report From a Level 1 Trauma Center

Complete cricotracheal separation is a rare and severe form of laryngeal trauma that most clinicians encounter infrequently, resulting in limited experience with its management. This report discusses the intricate management of a patient with complete cricotracheal separation following a traumatic incident. We present this case to highlight the challenges in the diagnosis and airway management of complete cricotracheal separation. The patient was transferred to our level 1 trauma center with a secured airway via an endotracheal tube from the referring hospital, where they experienced respiratory distress during an extubation attempt before transfer. Respiratory distress may be due to an air leak in the trachea upon deflation of the endotracheal tube cuff. Upon admission, the patient exhibited stable respiratory function, and there were no overt signs of laryngeal injury aside from subcutaneous emphysema around the neck. Imaging via a computed tomography scan revealed a distorted cricotracheal framework, raising suspicion of a high-grade airway injury and prompting surgical exploration. Upon surgical exploration of the neck, a complete cricotracheal transection was discovered with a wide separation of the tracheal ends and an inflated endotracheal tube cuff, which surprisingly prevented any air leak. Intraoperative management included performing a tracheostomy distal to the injury site, followed by a primary end-to-end anastomosis of the cricotracheal injury. This case underscores the crucial importance of prompt and efficient airway management in patients with complete cricotracheal separation. This case underscores the critical need for high clinical suspicion in subtle presentations, the importance of early surgical intervention, and the role of airway devices in stabilizing severe laryngeal trauma.