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Aaron S. Estrera
Michael A. Wait
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J Thorac Cardiovasc Surg 2005;130:426-432
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Contemporary assessment of laryngotracheal trauma

Rehal A. Bhojani, BS a , David H. Rosenbaum, MD a , Erkan Dikmen, MD b , Michelle Paul, BS a , B. Zane Atkins, MD c , David Zonies, MD d , Aaron S. Estrera, MD a , Michael A. Wait, MD a , Dan M. Meyer, MD a , Michael E. Jessen, MD a , J. Michael DiMaio, MD a , *

a Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
b Department of Thoracic Surgery, Kirikkale University, Kirikkale, Turkey
c Department of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC
d Department of Surgery, Wilford Hall Medical Center, San Antonio, Tex.

Received for publication October 15, 2004; revisions received December 3, 2004; accepted for publication December 17, 2004.

* Address for reprints: J. Michael DiMaio, MD, 5323 Harry Hines Blvd, Dallas, TX 75390-8879. (Email: michael.dimaio{at}utsouthwestern.edu).

OBJECTIVES: Laryngotracheal trauma is a rare and potentially deadly spectrum of injuries. We sought to characterize the contemporary mechanisms, diagnostic modalities, and outcomes common in laryngotracheal trauma today.

METHODS: We performed a retrospective analysis of all laryngotracheal trauma cases at 2 major metropolitan hospitals between 1996 and 2004, detailing mechanisms, associated injuries, diagnostic modalities, and outcomes of laryngotracheal trauma.

RESULTS: We identified 71 patients with a mean age of 32.8 ± 13.3 years (range, 15–71 years). In our series penetrating trauma was the cause in 73.2% of patients; however, blunt trauma had a significantly higher mortality (63.2% vs 13.5%, respectively; P < .0001). Blunt mechanisms involved older patients (38.5 ± 15.2 years vs 30.1 ± 11.9 years, P = .017), and these patients were more likely to require emergency airways than those with penetrating trauma (78.9% vs 46.2%, P = .017). The requirement of an emergency airway was an independent predictor of mortality (P = .0066).

CONCLUSION: Laryngotracheal trauma is a deadly spectrum of injuries with a mortality of 26.8%. Blunt mechanisms are decreasing in frequency. This might reflect improvements in automobile safety. Additionally, violent crime is on the increase, producing penetrating injuries with increasing frequency. The most fundamental intervention for patients with laryngotracheal injury is airway control. Either routine intubation or a tracheostomy can secure the airway. Blunt trauma and the requirement of an emergency airway are independent predictors of mortality. Laryngotracheal trauma requires prompt recognition, airway protection, and skillful management to lessen the mortality of this deadly spectrum of injuries.






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