Complete laryngotracheal disruption caused by blunt injury.

BACKGROUND

We reviewed the clinical courses and evaluated the surgical results of 7 patients with complete laryngotracheal disruption caused by blunt injury.

METHODS

Seven patients with complete laryngotracheal disruption caused by blunt injury were successfully treated in a 13-year period. Six of the seven incidents involved men younger than 30 years on motorcycles. All but one had intact cutaneous tissue of the neck. Six of seven laryngotracheal disruptions were at the cricotracheal junction and the other was at the junction of second and third tracheal ring. In the emergency departments, 4 of these 7 patients underwent endotracheal intubation and three others underwent tracheostomy after failed intubation. Two of 7 patients underwent delayed surgery (posttrauma day 3 and day 5) because of delayed diagnosis. All patients underwent laryngotracheoplasty with (n = 3) or without (n = 4) concomitant tracheostomy.

RESULTS

Total hospital stays ranged from 9 to 28 days (average 15 days). Intensive care unit stay ranged from 2 to 10 days (average 5.8 days). All 7 patients had paralysis of bilateral vocal cords that were revealed by postoperative bronchoscopy. In 3 patients who underwent concomitant tracheostomy, the tracheostomy tubes were removed within 3 to 5 months after surgery. In the other 4 patients who underwent laryngotracheoplasty only, the endotracheal tube was used as an airway support for 2 to 6 days (average 3.5 days). All patients had patent airways. Vocal cord function partially recovered in one side (n = 6) or both sides (n = 1). Their voices were audible but still husky 5 months or 1 year later.

CONCLUSIONS

Complete laryngotracheal disruption can be treated by laryngotracheoplasty with or without concomitant tracheostomy, and phonation can be partially recovered.