Anesth Pain Med.  2018 Jan;13(1):102-106. 10.17085/apm.2018.13.1.102.

Delayed diagnosis of postintubation tracheal laceration in a patient who underwent septorhinoplasty including osteotomy: A case report

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea.
  • 2Department of Otorhinolaryngology, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 3Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea. yoonji07@gmail.com
  • 4Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea.

Abstract

Iatrogenic postintubation tracheal injury is a rare but potentially fatal complication associated with anesthesia. However, as signs of tracheal injury including subcutaneous emphysema, pneumomediastinum, pneumothorax, and respiratory distress may also be related to surgical technique, diagnosis may be confused and treatment of tracheal injury can be delayed. We report a case of postintubation tracheal laceration, whose diagnosis was delayed because of symptoms were confused with subcutaneous emphysema after septorhinoplasty including osteotomy. As symptoms deteriorated in spite of conventional management, patient underwent evaluation to determine other causes and eventually postintubation tracheal injury was detected. Therefore, even if there is no problem during tracheal intubation, it is necessary to consider postintubation tracheal injury in patients with subcutaneous emphysema that worsens despite appropriate treatment after septorhinoplasty including osteotomy.

Keyword

Endotracheal intubation; Subcutaneous emphysema; Tracheal laceration

MeSH Terms

Anesthesia
Delayed Diagnosis*
Diagnosis
Humans
Intubation
Intubation, Intratracheal
Lacerations*
Mediastinal Emphysema
Osteotomy*
Pneumothorax
Subcutaneous Emphysema

Figure

  • Fig. 1 Axial computed tomography images showing posterior tracheal wall injury with subcutaneous and mediastinal emphysema, and right side pneumothorax (arrow, posterior tracheal wall defect).

  • Fig. 2 Bronchoscopic view. (A) 4 cm linear laceration at the posterior tracheal wall on the postoperative day 3. (B) Healed state of laceration on postoperative day 13.


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