Results of Treatment of Ten Cases of Trachea and Larynx Disruption due to Trauma at Masih Daneshvari Hospital, Tehran

Introduction & Tracheal disruption due to penetrating and blunt trauma is rare. Delayed diagnosis and treatment can lead to major morbidity and even death. The aim of this study was to assess the treatment and its outcome in 10 patients with trachea and larynx disruption. We studied 8 cases of tracheal disruption and 2 cases of larynx disruption which، were treated in our department during 8 years (April 2003- March 2011). Eight patients were immediately transferred and treated in our department and 2 were referred from other departments after initial treatments. The first priority for patients with tracheal disruption was to establish and maintain a patent airway to provide sufficient tissue oxygen delivery and then there was assessment of patient condition and acute problems. Surgical procedures were: tracheal resection and anastomosis for tracheal disruption (8 patients) and laryngeal repair for laryngeal injuries (2 patients). Five patients were treated immediately (few hours to 4 days post injury) and others were treated with a delay of 57 to 730 days. Patients were followed up post-operatively for the development of immediate and delayed complications. The average time between the accident and the surgery was 154. 6 days (between a few hours to 370 days). The follow up was carried out for a minimum period of 12 months to a maximum period of 84 months. Eight patients had bilateral vocal cord paralysis before operation. After the surgery 2 cases resumed improved vocal cord function، 2 patients sustained unilateral vocal cord paralysis and in 4 patients vocal cords sustained bilateral paralysis but were in paramedian position. All patients were decannulated finally. In spite of vocal cord paralysis in most of patients، tracheal resection and anastomosis، without tracheotomy، was possible in all cases. With proper treatment، it is possible for all patients to be decannulated with patent airway and acceptable voice.