title: [Laryngotracheal traumatic injuries (LTI) in children: when to operate?]
abstract: BACKGROUND
  Paediatric LTI is associated with significant morbid-mortality. Although historically first line treatment was surgical, conservative management is making headway. The purpose of this study was to analyze the management and surgical indications of LTI treated at our institution.
  
  
  METHODS
  Retrospective study of patients with LTI treated between 2007 and 2014.
  
  
  RESULTS
  Six out of seven patients, with a median age of 4 years (2-15), had blunt traumas and one had an open trauma. Respiratory distress, pain and subcutaneous emphysema were presented in 71.4% of the patients. Five children were intubated (3 pre-hospital care and 2 after reaching the hospital), all of them underwent fibrobronchoscopy, determining the location, the extention, and assessing the possibility of extubation. Esophagoscopy was made in 2 cases. The remaining 2 cases were bounded to observation as they did not have respiratory symptoms or progressive emphysema, precluding bronchoscopy. Conservative management was followed in 71.4% of the patients, with a 100% success rate. Conservative management criteria were no progression of emphysema or respiratory distress, regardless the degree and location of the lesions. Two patients needed surgery: one tracheoesophageal fistula caused by a button battery, and the other was a tracheal open section associated with vascular injury. Both of them recovered uneventfully.
  
  
  CONCLUSIONS
  If the respiratory symptoms or the emphysema do not progress, patients with LTI can be managed conservatively, regardless of size or location of the injury. Associated esophageal lesions and open injuries require surgical management. An early diagnosis is mandatory in order to minimize morbidity and mortality.
authors: Servicio de Cirugía Pediátrica. Hospital Vall d'Hebron. Barcelona.
authors: S
authors: S
authors: Santiago-Martínez
authors: Servicio de Cirugía Pediátrica. Programa de Trauma Pediátrico. Hospital Vall d'Hebron. Barcelona.
authors: A
authors: A
authors: Laín
authors: Servicio de Cirugía Pediátrica. Hospital Vall d'Hebron. Barcelona.
authors: G
authors: G
authors: Guillén
authors: Servicio de Cirugía Pediátrica. Programa de Trauma Pediátrico. Hospital Vall d'Hebron. Barcelona.
authors: R
authors: R
authors: Gander
authors: Servicio de Cirugía Pediátrica. Hospital Vall d'Hebron. Barcelona.
authors: S
authors: S
authors: López-Fernández
authors: Servicio de Otorrinolaringología Pediátrica. Hospital Vall d'Hebron. Barcelona.
authors: F
authors: F
authors: Pumarola
authors: Programa de Trauma Pediátrico. Servicio de Cuidados Intensivos Pediátricos. Hospital Vall d'Hebron. Barcelona.
authors: L
authors: L
authors: Seidler
authors: Servicio de Cirugía Pediátrica. Hospital Vall d'Hebron. Barcelona.
authors: J
authors: J
authors: Lloret
keywords: Bronchoscopy; Conservative treatment; Laryngotracheal trauma; Paediatrics; Subcutaneous emphysema; Tracheal surgery; Tracheobronchial injuries