MANAGEMENT OF TRACHEOBRONCHIAL INJURY: CASE PRESENTATION AND REVIEW OF THE LITERATURE

Abstract

Tracheobronchial injuries are uncommon and their successful diagnosis and treatment often requires high level of suspicious. Surgical repair should be individualized for each type of injury. This article reviews diagnosis and management of traumatic injuries to the trachea and major bronchi. From March 1991 to March 2003, twenty-seven patients with major airway trauma were managed in Nemazee Hospital, Shiraz, Iran. Afterwards these patients were prospectively studied, for a period of 10 years. The mechanism of injury was blunt trauma in 13 patients, stab wound in 6, gunshot in 2 and iatrogenic in 6. Two patients had associated esophageal injury. Twenty-one patients were male and 6 were female. Eight patients had major bronchial injury, 13 had cervical tracheal injury and 6 had mediastinal tracheal injury. Six patients had re-implantation of main bronchus (5 right and 1 left), and two patients had repair of bronchus with concomitant bi-lobectomy in one of them. In cases of tracheal injury, 12 patients had primary repair of trachea with distal tracheostomy in two. However, 7 patients were managed conservatively with later sleeve resection of trachea and laryngotracheal anastomosis in three patients. Three patients died. Tracheobronchial injury is extremely challenging due to its early threat to life. A high level of suspicious and the liberal use of bronchoscope are critical in the diagnosis of tracheobronchial injuries. Avoidance of iatrogenic complications, primary repair and liberal use of autogenous tissue for wrapping or buttressing increases success rate.