Trends in blunt laryngotracheal trauma in children

ObjectiveTo examine the presentation, mechanisms, and management of blunt laryngotracheal trauma in a pediatric population, emphasizing the rise in severity.DesignRetrospective analysis of laryngotracheal trauma evaluated from 1995 to 2008. The presentation, mechanism, management and outcomes data are detailed.SettingTertiary medical center.PatientsThirty-five patients were identified with major laryngotracheal trauma.Main outcome measuresSurgical results, airway patency, voicing, swallowing and other residual disabilities are tabulated.ResultsAverage age was 10.8 years, with boys outnumbering girls 22–13. In cases of major trauma, mechanisms were related to motor vehicle accidents (MVAs) in seven patients. Five of 11 major trauma victims were unconscious at presentation. Definitive airway reconstruction involved laryngotracheoplasty and tracheal resection/reanastomosis. Ten of 11 remain decannulated.ConclusionsIn an increasingly mobile society, major laryngotracheal trauma is occurring in a younger population. Victims of major laryngotracheal trauma may be unconscious or have other injuries that obscure airway injury, highlighting the need for vigilance. Once the airway is secured and the patient stabilized, airway reconstruction is undertaken, achieving decannulation in most patients. Hoarseness is often a lasting morbidity.