Aerodigestive injuries of the neck.
Cervical aerodigestive trauma is rare and most centers have a limited experience with its management. The purpose of this review was to study the epidemiology, diagnosis, and problems related to the early evaluation and management of these injuries. This was a retrospective study based on trauma registry and on chart, operative, radiological, and endoscopic reports. There were 1560 admissions with blunt or penetrating trauma to the neck. The overall incidence of aerodigestive trauma was 4.9 per cent (10.2% for gunshot wounds, 4.6% for stab wounds, and 1.2% for blunt trauma). All patients with aerodigestive trauma had suspicious signs or symptoms on admission. The most common life-threatening problem in the emergency room and directly related to the aerodigestive trauma was airway compromise. Twenty-nine per cent of patients with laryngotracheal trauma required an emergency room airway establishment because of threatened airway loss. Although rapid sequence induction was successful in the majority of cases, in 11.9 per cent there was loss of airway and a cricothyroidotomy was necessary. Overall, 9 per cent of cases with aerodigestive injuries were successfully treated nonoperatively. Thirty-six per cent of patients with laryngotracheal trauma and surgical repair were successfully treated without a protective tracheostomy. There was no mortality due to the aerodigestive injuries. Cervical aerodigestive trauma is rare. In conclusion, all patients with significant aerodigestive injuries requiring treatment had suspicious signs and symptoms. Airway compromise was a common problem in the emergency room. Loss of airway after rapid sequence induction is a potentially lethal complication and the trauma team should be ready for a surgical airway. Repair of laryngotracheal injuries without a protective tracheostomy is safe in selected cases.
Vassiliu
P
P
Department of Surgery, University of Southern California, Los Angeles, USA.
Baker
J
J
Henderson
S
S
Alo
K
K
Velmahos
G
G
Demetriades
D
D
D000402:Airway Obstruction / Q000150:complications / Q000209:etiology* / Q000628:therapy; D019468:Disease Management; D004947:Esophagus / Q000293:injuries*; D006801:Humans; D007830:Larynx / Q000293:injuries*; D010614:Pharynx / Q000293:injuries*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D014950:Wounds, Penetrating / Q000150:complications / Q000175:diagnosis / Q000628:therapy