title: Management of traumatic tracheobronchial separation in a teenager using a fabricated extra-long endotracheal tube.
abstract: Tracheobronchial separation (TBS) due to blunt chest trauma in children is extremely rare. We report the case of a 14-year-old boy who fell 20 feet and developed respiratory distress, bilateral pneumothoraces, pneumomediastinum, and subcutaneous emphysema. Computed tomography imaging at the initial institution failed to detect tracheobronchial disruption, and the patient was managed conservatively. The patient's worsening condition prompted bronchoscopic examination which revealed complete separation of the right main bronchus from the trachea. Single-lung ventilation was instituted using a fabricated extra-long nasotracheal tube due to the patient's large size and mandibular fracture, and the airway was primarily anastamosed with an open thoracotomy approach. The clinical features of tracheobronchial separation as well as anesthetic, clinical and surgical management of this rare but life-threatening injury are described.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. evan.propst@cchmc.org
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Propst
authors.forename: Erica P
authors.initials: EP
authors.lastname: Lin
authors.forename: George K
authors.initials: GK
authors.lastname: Istaphanous
authors.forename: R Paul
authors.initials: RP
authors.lastname: Boesch
authors.forename: Frederick C
authors.initials: FC
authors.lastname: Ryckman
authors.forename: Robin T
authors.initials: RT
authors.lastname: Cotton
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rutter
mesh_terms: D000058:Accidental Falls; D000293:Adolescent; D001980:Bronchi / Q000293:injuries*; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D013908:Thoracotomy; D014132:Trachea / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000150:complications