ABSTRACT

Tracheal trauma affecting the cervical portion is uncommon (10% of all neck injuries), with penetrating mechanism as the most frequent and mortality of 30-80% during transfer. The proper management of the initial trauma with the assurance of the airway is only part of the problem that the patient may present: one of the major complications is tracheal stenosis. The probability of detecting this type of complications implies an adequate follow-up of these patients, to avoid their complications. We present the case of a 28-year-old man with assault by third parties with gunshot wound on the anterior face of the neck, through which a tracheal lesion was detected, which warranted the initial placement of a tracheostomy cannula. For the same site of injury, studying with satisfactory evolution and exit. The patient was referred to a third-level center with a diagnosis of traumatic tracheal injury; was evaluated by bronchoscopy and a candidate for tracheoplasty was determined by stenosis, which was carried out without complications at the second month after the initial surgery. It evolved satisfactorily and graduated seven days later, with follow-up in outpatient consultation one month later with favorable evolution. Regarding this case, we propose a follow-up protocol for patients with traumatic tracheal injury, to detect and correct one of its most serious.

KEYWORDS

Tracheal trauma, posttraumatic stenosis.

REFERENCES

1. Palacios-Zertuche JT, Montero-Cantú CA, Guerrero-Hernández AJ, Salinas-Domínguez R, Pérez-Rodríguez E, Muñoz-Maldonado GE. Herida por proyectil de arma de fuego en cuello con lesión traqueoesofágica y colocación de parche muscular de esternotiroideo. Neumol Cir Torax 2016;75(3):222-226.

2. Magaña SI, Cabello PR, Mendoza MD, Galván RJ, Chávez RJJ. Patrón de lesiones de cuello en el Hospital Central Militar. Cir Gen 2001;23:240-244.

3. Johnson SB. Tracheobronchial injury. Semin Thorac Cardiovasc Surg 2008;20(1):52-57. doi: 10.1053/j.semtcvs.2007.09.00.

4. Prokakis C, Koletsis EN, Dedeilias P, Fligou F, Filos K, Dougenis D. Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment. J Cardiothorac Surg 2014;9:117. doi: 10.1186/1749-8090-9-117.

5. Soda MA, Delgado FA, Morales GJ. Manejo quirúrgico de la estenosis traqueal. Gac Med Mex 1994;130:386-389.

6. Koletsis E, Prokakis C, Baltayiannis N, Apostolakis E, Chatzimichalis A, Dougenis D. Surgical desición making on the basis of clinical evidences and the injury’s anatomical setting. Injury 2012;43(9):1437-1441. doi: 10.1016/j.injury.2010.08.038.

7. Hashemzadeh S, Hashemzadeh K, Kakei F, Aligholipour R, Ghabili K. Surgical treatment of postintubation tracheal stenosis: Iranian experience of effect of previous tracheostomy. Int J Gen Med 2012;5:93-98. doi: 10.2147/IJGM.S27559.

8. Estrella-Sánchez JA, Carlos-Guillén JA. Traumatismo traqueal. Presentación de un caso y revisión de la literatura. Rev Med MD 2015;6(3):218-222.

9. Grillo HC, Donahue DM, Mathisen DJ, Wain JC, Wright CD. Postintubation tracheal stenosis. Treatment and results. J Thorac Cardiovasc Surg 1995;109(3):486-493.

10. Bibas BJ, Terra RM, Oliveira AL, et al. Predictors for postoperative compliations after tracheal resection. Ann Thorac Surg 2014;98(1):277-282. doi: 10.1016/j.athoracsur.2014.03.019.

11. Mutrie CJ, Eldaif SM, Rutledge CW, et al. Cervical tracheal resection: new lessons learned. Ann Thorac Surg 2011;91(4):1101-1106. doi: 10.1016/j.athoracsur.2010.11.066.

12. Couraud L, Jougon JB, Velly JF. Surgical treatmen of nontumoral stenoses of the upper airway. Ann Thorac Surg 1995;60(2):250-260.

13. López EF, Zabalo M, Encinas M, Díaz RG, González FC, Pagola MA. Rotura bronquial en traumatismo torácico cerrado. Arch Bronconeumol 2000;36(11):651-654. doi: 10.1016/S0300-2896(15)30088-0.

14. Montes de Oca NJ, Ortega J, Escobedo D, Loyola U. Fractura bronquial izquierda, secundaria a trauma cerrado de tórax. Reporte de caso y revisión de la literatura. Neumol Cir Torax 2007;66(2):93-96.

15. Makhani M, Midani D, Goldberg A, Friedenberg FK. Pathogenesis and outcome of traumatic injuries of the esophagus. Dis Esophagus 2014;27(7):630-636. doi: 10.1111/dote.12132.

16. Valadez-Caballero D, Pérez-Romo A, González V, et al. Tratamiento quirúrgico de la estenosis traqueal. Cir Gen 2009;31(4):239-243.

17. Riley RD, Miller PR, Meridith JW. Injury to the esophagus, trachea and bronchus. In: Moore EE, Feliciano DV, Mattox KL, editors. Trauma. 5th ed. New York: Mac Graw-Hill; 2004. p. 539-552.

18. Karmy-Jones R, Wood DE. Traumatic injury to the trachea and bronchus. Thorac Surg Clin 2007;17(1):35-46.

19. Cassada DC, Munyikwa MP, Moniz MP, Dieter RA Jr, Schuchmann GF, Enderson BL. Acute injuries of the trachea and major bronchi: importance of early diagnosis. Ann Thorac Surg 2000;69(5):1563-1567.

20. Carretta A, Melloni G, Ciriaco P, et al. Preoperative assessment in patients with postintubation tracheal stenosis: Rigid and flexible bronchoscopy versus spiral CT scan with multiplanar recostructions. Surg Endosc 2006;20(6):905-908.

21. Saito N, Hito R, Burke PA, Sakai O. Imaging of penetrating injuries of the head and neck: current practice at a level I trauma center in the United States. Keio J Med 2014;63(2):23-33.

22. Santiago-Rosado LM, Lewinson CS. Trauma trachea. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018. Access date: 2018 Apr 24. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29763191

23. Samolski D, Ortiz NA, Sansostera A, Audagna C, Alicio L, Duré R. Estenosis traqueal sintomática post intubación: análisis espirométrico pre y post dilatación terapéutica. Rev Amer Med Resp 2011;11(4):183-187.