Improving outcomes in the management of acute external laryngotracheal trauma

To highlight the presentation, management, and functional outcomes of subjects with acute laryngotracheal trauma, managed by a dedicated laryngology unit in a tertiary care hospital in South India.

A retrospective review of the medical records of acute laryngotracheal trauma cases from 1st January 2014 to 31st August 2023 was carried out. Data collected included demographics, mechanism of trauma, age, and sex, presentation, time of injury to intervention, investigations, Schaefer-Fuhrman (SF) grade, management (airway access, surgical techniques & conservative methods) and outcomes. Complications (via a graded complication classification grouped into mild, moderate , severe), functional airway, voice and swallowing outcomes were analysed separately as well as at the end of one year follow up.

Sixty-eight subjects (57 males and 11 females) with laryngotracheal trauma were managed during this study period. All but 2 subjects received definitive management within 48 hours of the trauma. 91.2% (n=62) of them were managed within 24 hours of the injury. We encountered 2 deaths and one subject developed Hypoxic Ischaemic encephalopathy (HIE) during emergent management. Main mode of injury was motor vehicular accident (41%, n=28). SF group III and IV was observed in 33.8% (n=23) and 29.4% (n=20) subjects. The endolaryngeal mucosal repair as well as reduction and stabilisation of fractured cartilage segments were done using absorbable polyglactin (vicryl). Of the 54 who required surgery only 16 % (n=11) required stenting. Successful decannulation was achieved in 96% of the tracheostomised subjects (n=48/50) and successful rehabilitation from assisted to oral feeding was possible in 90.7 % (n=39/43). Poor voice, airway and swallowing outcomes were seen in 11%, 3% and 3% of our subjects during 1 year follow up. Long -term major complications were seen in 6% (n=4) and minor ones in 15.4 % (n=10).

Early intervention remains pivotal for successful management of laryngotracheal trauma. This single institutional study, characterized primarily by early definitive management by an experienced team; was able to achieve favourable outcomes even with the use of simple, readily available, inexpensive materials like - absorbable sutures for mucosal and cartilage approximation, and modified endotracheal tube as stents.