External laryngotracheal trauma in children.
External laryngotracheal trauma in the paediatric population, although rare, presents a diagnostic and therapeutic dilemma for the attending surgeon. The purpose of this study was to evaluate the clinical profile, treatment and outcome and to establish a simple, effective management protocol in this emergency. A retrospective case series was studied. There were 12 patients aged 2-14 years in this series, eight of them (67%) having closed injuries. Their clinical presentation was correlated to conservative management, tracheostomy and surgical intervention. In the open injury group all the patients (100%) underwent tracheostomy, upper endoscopy and neck exploration. One patient (25%) in this group developed subglottic stenosis. In the closed injury group, seven patients (88%) had tracheostomy with upper endoscopy, and two of them (25%) had neck exploration in addition. One patient (13%), however, developed glottic stenosis. The patients with stenosis underwent multiple surgical interventions prior to final decannulation. There was no mortality. Breathing difficulty/stridor were the commonest clinical presentations in children with acute external laryngotracheal trauma. Tracheostomy and early surgical intervention appeared to be the treatment of choice. A protocol with major and minor criteria of clinical presentation is suggested for effective management.
Kurien
M
M
Department of ENT, Christian Medical College and Hospital, Vellore, Tamilnadu, India. kurien123@hotmail.com
Zachariah
N
N
D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007828:Laryngoscopy; D007829:Laryngostenosis / Q000209:etiology / Q000601:surgery; D007830:Larynx / Q000293:injuries* / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D014132:Trachea / Q000293:injuries* / Q000601:surgery; D014139:Tracheostomy / Q000379:methods; D015599:Trauma Severity Indices