Complete Laryngotracheal Separation from Blunt Trauma: A Case Series and Discussion of Surgical Techniques

Abstract

Objectives:

(1) Recognize the often subtle clinical presentation of complete laryngotracheal separation. (2) Address immediate course of action in the event of a total separation. (3) Describe components of a successful surgical repair.

Methods:

Over 3 years at a tertiary care center in Las Vegas, Nevada, 3 cases of complete laryngotracheal separation secondary to blunt trauma were successfully treated with prompt surgical intervention. Various surgical techniques were employed, given the complexity and different characteristics of each patient’s presentation, with cartilaginous reduction and fixation favored over soft tissue apposition, along with fenestration tracheostomy procedures to prevent infection of the repair sites. Successful long-term outcome was defined by tracheostomy tube decannulation and lack of multiple tracheal dilations or other tracheoplasty procedures to maintain a patent airway.

Results:

All 3 patients initially required a tracheostomy due to airway edema, but each made an uneventful recovery with early capping and tracheostomy tube decannulation. None of the patients necessitated further tracheal procedures, and all had serviceable voice and good swallowing function.

Conclusions:

Because of the relative rarity of complete laryngotracheal separations due to blunt trauma, surgical methods for repair are not widely published. We present our experience with the hope that it will assist other surgeons when faced with the challenge of diagnosing and repairing this life-threatening injury.