[Management of traumatic tracheal injuries: presentation of a rare case and review of the literature].

BACKGROUND: Traumatic injuries of the tracheobronchial system are rare, but a big challenge for the clinician in early diagnosis and optimal management in the prevention of high fatality and morbidity. PRESENTATION OF THE CASE: We present the case of a patient with suicidal deep cervical stabbing wound and consecutive subtotal transsection of the trachea. The patient was treated by an interdisciplinary team and emergency operation was performed after admission to the hospital. Intubation was done through the stabbing wound and the knife was removed intraoperatively. After removal the knife an end-to-end reanastomosis of the trachea was performed. There were no further injuries of large vessels or the oesophagus. The long term result showed, with the exception of a unilateral palsy of the recurrent laryngeal nerve and consecutive minor dysphonia, no further morbidity.
CONCLUSIONS: The management of tracheobronchial injuries consists, depending on the severity, of emergency operation, in cases of tracheal rupture, haemorrhage or oesophageal injury, or of selective operation, in cases of minor injury and clinically stable patient. In the diagnostic pathways, the clinical examination is followed by radiologic imaging, angiography, computer tomography, and tracheo-bronchio-esophagoscopy. Particularly dangerous are total tear-offs of the trachea, tracheal contusions, tracheal or oesophageal fistula and postoperative stenosis of the trachea. The prognosis of the patient is largely dependent on an early diagnosis and good interdisciplinary management.