Penetrating Injury of Cervical Trachea: Two Case Reports

Hong, Yoon Joo

Abstract

Penetrating neck trauma involving tracheobronchial tree is potentially fatal, especially in cases of gunshot injury, which are rare in Korea. A 28-year-old male presenting with an air-leaking gunshot wound in the left supraclavicular area and a 39-year-old female with a full depth penetrating laceration in her chest wall and a pin-point sized cervical wound on the midline below the cricoid cartilage presented with common symptoms of dyspnea and subcutaneous emphysema, and radiologic findings of pneumomediastinum, bilateral pneumothorax and hemothorax, which are key findings suggesting potential major airway injury. Urgent bronchosopic evalution was performed to confirm the suspected diagnosis of tracheobronchial injury, as well as the extent and the level of injury. To exclude associated injury of esophagus and major vascular structures prior to surgical exploration, esophagography and angiography had been carefully planned based on the principles, but were only performed for the second case. Through a low collar incision extending to an mid-thoracotomy incision, the damaged segment of tracheal rings of cervical trachea was resected out and an end-to-end anastomosis was performed for both cases. Extubation was done on the first postoperative day and the chin-to-chest sutures done to minimize the tension at the suture line were maintained until postoperative day 7. Both cases with penetrating injury of cervical trachea regardless of the mechanism of injury were successfully treated by early diagnosis and prompt surgical exploration.