Laryngotracheal disruption from blunt pediatric neck injuries: Impact of early recognition and intervention on outcome

• Blunt and penetrating neck injuries are an infrequent cause of morbidity and mortality in the pediatric population. Although less common than penetrating injuries, blunt pediatric neck injuries are more often life-threatening because of associated laryngotracheal disruption. The authors reviewed t...

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Bibliographic Details
Published in:Journal of pediatric surgery 1995-02, Vol.30 (2), p.331-335
Main Authors: Ford, Henri R, Gardner, Mary J, Lynch, James M
Format: Article
Language:English
Subjects:
Adolescent
Airway Obstruction - diagnosis
Airway Obstruction - etiology
Airway Obstruction - surgery
Bicycling - injuries
Child
Child, Preschool
Female
Follow-Up Studies
Hoarseness - etiology
Humans
Infant
Intubation, Intratracheal
Larynx - injuries
Male
Neck - surgery
Neck Injuries
Subcutaneous Emphysema - etiology
Time Factors
Trachea - injuries
Tracheostomy
Wounds, Nonpenetrating - complications
Wounds, Nonpenetrating - diagnosis
Wounds, Nonpenetrating - therapy
Wounds, Penetrating
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Summary:• Blunt and penetrating neck injuries are an infrequent cause of morbidity and mortality in the pediatric population. Although less common than penetrating injuries, blunt pediatric neck injuries are more often life-threatening because of associated laryngotracheal disruption. The authors reviewed their experience with pediatric neck injuries over the past 5 years. There were nine blunt and 14 penetrating injuries, representing 0.5% of the trauma admissions. There was no significant difference in age or gender distribution between the two groups. Blunt pediatric neck injuries were more often associated with frank respiratory distress at the time of presentation. Massive subcutaneous emphysema and hoarseness were the most common symptoms encountered. All patients with blunt injury underwent direct laryngoscopy and bronchoscopy (DL & B) and esophagoscopy. DL & B results were positive for eight patients; seven patients underwent neck exploration and successful repair of the laryngotracheal injuries. There were two deaths; one of these patients had laryngeal transection, which was not recognized at the time of DL & B. The other death resulted from associated tracheobronchial disruption secondary to massive blunt chest trauma. The patients with penetrating neck injuries were more likely to be treated nonoperatively, to have a shorter stay in the hospital and intensive care unit, and to have a lower injury severity score. There were no deaths in this group. The authors conclude that all patients with blunt neck trauma should undergo emergent and meticulous DL & B. Visualization of laryngotracheal disruption mandates immediate neck exploration and primary repair.
ISSN:0022-3468
1531-5037
DOI:10.1016/0022-3468(95)90584-7