Acute tracheobronchial injury.

We reviewed our experience with tracheal and bronchial trauma from 1977 to 1988. There were 22 patients with tracheobronchial injuries treated in this period. Seventeen (77%) of the injuries were due to penetrating trauma and five (23%) were due to blunt trauma. Thirteen patients had major associated injuries, including six esophageal injuries. The most common physical findings were tachypnea (13 patients) and subcutaneous emphysema (nine patients). Eight patients presented with airway obstruction. All patients with penetrating cervical tracheal injuries underwent neck exploration and primary repair. All blunt injuries were diagnosed by bronchoscopy. Three patients with blunt injuries were treated with primary repair. Two patients with blunt chest trauma and small bronchial tears were treated nonoperatively with good results. All three deaths (14% mortality rate) were due to associated injuries. We conclude that patients with penetrating tracheobronchial injuries should be managed by surgical exploration and primary repair, although selected patients with blunt injury may be treated nonoperatively.