Traumatic Tracheal Injury in Children

Introduction:Injuries to the tracheobronchial region are rare, but have the potential for rapid progression and maybe life-threatening. Etiologies of non-penetrating tracheobronchial injuries include blunt cervical trauma, endotracheal intubation, and other iatrogenic causes. Several options for treatment ranging from conservative to surgical exist, but no single treatment has been implemented with consensus. While early surgical repair was once considered the cornerstone of the therapy, evidence supporting conservative treatment continues to gain strength.Methods: In this retrospective, Single-institution case series over a 5-year period, all pediatric patients who suffered from non-penetrating injuries to the trachea who were treated by the Pediatric Surgery Service at Namazi hospital from May 2013 through March 2018 were studied. A total of 7 patients were identified. Data included type of injuries, endoscopic assessment of injury, method of treatment, complications and follow-up.Results: We present seven children, aged 3 to 14 years, with tracheal injury after blunt cervical trauma. All patients showed cervical and chest wall subcutaneous emphysema with pneumomediastinum. All patients underwent Laryngo-tracheo-bronchoscopy. All patients were successfully treated with medical management and/or thoracostomy tube insertion and supportive ventilation.Discussion:Blunt tracheal trauma seldom develops in children because of their anatomy and the mobility of the cartilage. It has the potential to be overlooked, either because of the severity of concomitant injuries or because of the unfamiliarity of paediatricians with this type of injury. However, tracheal injury might be lethal due to airway compromise. Early bronchoscopy may be necessary to anticipate complications andprevent permanent dysfunction. Minimal lesions due to blunt tracheal trauma could be treated conservatively in children. Since the external signs of tracheal injury are not indicative of the extent of the trauma, a high index of suspicion is warranted in these patients.