Traumatic airway injury, sinking Trachea: An unusual presentation

Abstract

Airway injuries are one of the less commonly encountered types of cases in the emergency department Neck lacerations can involve the superficial layers of skin, superficial fascia, deep structures including the airway and less commonly the structures encased in carotid sheath. Airway injuries are potentially life threatening. In this case report we present a cut throat case presented to the emergency services at our institute in an unusual way. And it was challenging case to treat as the trachea has got transacted and sinked into thorax. A 35-year-old male, laborer by profession, had sustained multiple injuries while lowering granite slab from a truck. He presented with a cut over his throat, and injury to his leg. He complained of pain in chest while breathing, difficulty in phonation, difficulty and pain while walking. He had a contused lacerated wound over the lower half of his neck .Deeper examination of the wound revealed that the trachea had been transected in half of its circumference. The lower tracheal segment was sinking in thorax due to complete transaction of trachea. Tracheostomy tube was placed in the lower segment. Patient was taken up for emergency airway assessment under general anesthesia and immediately resection and anastomosis surgery of trachea was performed in the same emergency operation theatre on the same day. Patient was taken up for emergency airway assessment under general anesthesia and immediately resection and anastomosis surgery of trachea was performed in the same emergency operation theatre on the same day. The challenge was to search the lower intrathoraccic segment of trachea & to pull it in the neck to perform resection anastomosis surgery.: Although airway injuries may not always be present in a case of lacerations of the neck, careful assessment is necessary to evaluate airway integrity even when the patient has no respiratory issues A carefully done & accurately placed tracheostomy helps not only to secure the airway but also makes any possible future airway surgery have a better outcome and thus reduce postoperative morbidity. Timely decision making, careful patient selection and aseptic & meticulous surgical technique reduces intraoperative complications, postoperative morbidity and also makes earlier functional recovery possible.