Tracheal Injury

Tracheal InjuryTracheal injury is treated either by the ENT or Cardiothoracic Surgeons. Cervical injury is the domain of the ENT surgeon and intra-thoracic injury is treated by the Cardiothoracic surgeon. Any cervical or upper thoracic stab or gun shot wound has potential for causing tracheal injury. Any suspicion should be investigated by rigid bronchoscopy with consent for early repair. Minor injuries can be treated conservatively with bed rest and antibiotics. Injuries complicated by ongoing air leak either through the incision or into the thorax should be explored.

Most injuries, even intra-thoracic upper tracheal can be approached via a cervical incision, very low injuries may require thoracotomy. We favour primary repair with very early post-operative extubation and avoid tracheostomy when possible, it seems odd to treat a stab injury by performing a second stab injury albeit in controlled circumstances.

Blunt injury of the bronchus is usually fatal, however injury presenting early with pneumothorax unresponsive to pleural intubation should alert the physician to the possibility of a bronchial rupture, the x-ray showing the lung ‘hanging’ from the hilum. Endotracheal intubation for a patient with this condition is usually rapidly fatal unless a double lumen tube is inserted, the patient relying entirely on movement of the unaffected lung’s diaphragm and intercostal muscles for survival. Incomplete rupture may present late with bronchial stenosis, the lung eventually becoming atellectatic and collapsing beyond the complete obliteration which may occur. Late surgery for this condition can be very rewarding with complete re-expansion of the distal lung providing it has not been damaged by infection.