ABSTRACT

Cervical trachea is at high risk of lesions from cervical trauma. Objective: To present three patients who underwent open cervical tracheal lesions with wires (2/3) or closed lesions with a string (1/3), hanged out over public way, while travelling in a motorcycle. Material and methods: Descriptive study on a prospective data base related to airway diseases. All were treated primarily in other hospital and later referred to us to sequela treatment. Sex, age, location and type of lesion, definitive treatment, complications and final results were studied. Results: All three patients (males) were referred to us after initial treatment. First patient (31 years) underwent an open trauma. He was treated with a tracheal resection and endoscopic methods. After tracheal stenosis recurrence he was referred to our hospital. Firstly, we inserted a T tube, because of a complex subglottic lesion and important inflammation. A postoperative granuloma was treated conservatively. A satisfactory result was obtained by subglottic resection. Second patient (20 years) had a contused tracheal trauma due to striking against a corde. We performed a subglottic resection with excellent results. The last patient (35 years) underwent an open trauma (with a wire). He had a bilateral recurrent nerve paralysis. In the first time posterior cordoaritenoidectomy was done, and posteriorly a subglottic resection. Final result was satisfactory. Conclusions: Cervical trachea is exposed to severe lesions in cases of cervical trauma. Described production mechanism is so rare that were not found cases in the reviewed literature. Treatment of sequela in survivors could have satisfactory results if treated in centers and surgeons with experience in tracheal surgery.

KEYWORDS

Cervical trauma, trachea, wires, cords, tracheal trauma.

REFERENCES

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

2. Vázquez-Minero JC, Morales-Gómez J, Guzmán-de Alba E, Álvarez-Álvarez S, Trueba-Lozano D, Cervantes-Silva Y, et al. Trauma traqueal penetrante. Recomendaciones para su manejo. A propósito de un caso. Neumol Cir Torax. 2018;77(4):286-292.

3. Dougenis D. Trauma of the tracheobronchial tree. Arch Hellen Med. 2002;19(3):258-269.

4. Zhao Z, Zhang T, Yin X, Zhao J, Li X, Zhou Y. Update of the diagnosis and treatment of tracheal and bronchial injury. J Thorac Dis. 2017;9(1):E50-E56. https://doi.org/10.21037/jtd.2017.01.19

5. 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.

6. Johnson SB. Tracheobronchial injury. Semin Thorac Cardiovasc Surg. 2008;20(1):52-57. https://doi.org/10.1053/j.semtcvs.2007.09.001

7. Abernathy JH III, Reeves ST. Airway catastrophes. Curr Opin Anaesthesiol. 2010;23(1):41-46. https://doi.org/10.1097/aco.0b013e328333b768

8. Carretta A, Melloni G, Bandiera A, Negri G, Voci C, Zannini P. Conservative and surgical treatment of acute posttraumatic tracheobronchial injuries. World J Surg. 2011;35(11):2568-2574. https://doi.org/10.1007/s00268-011-1227-z

9. Welter S, Cheufou D, Darwiche K, Stamatis G. Tracheal injuries, fistulae from bronchial stump and bronchial anastomoses and recurrent laryngeal nerve paralysis: management of complications in thoracic surgery. Chirurg. 2015;86(5):410-418. https://doi.org/10.1007/s00104-014-2862-3