Management of Tracheobronchial Injury: Case Presentation and Review of the Literature

Tracheobronchial injuries are uncommon and their successful diagnosis and treatment oftenrequires high level of suspicious. surgical repairs should be individualized for each type of injury. thisarticle reviews diagnosis and management of traumatic injuries to the trachea and major bronchi. frommarch 26, 1991 to march 20, 2003, twenty-seven patients with major airway trauma were managed innemazee hospital, shiraz, iran. afterwards these patients were prospectively studied, for a period of 10years. the mechanism of injury was blunt trauma in 13 patients, stab wound in 6, gunshot in 2 patients,and iatrogenic in 6. two patients had associated esophageal injury. twenty-one patients were male and6 were female. eight patients had major bronchial injury, 13 had cervical tracheal injury and 6 hadmediastinal tracheal injury. six patients had re-implantation of main bronchus (5 right and 1 left), andtwo patients had repair of bronchus with concomitant bi-lobectomy in one of them. in cases of trachealinjury, 12 patients had primary repair of trachea with distal tracheostomy in two. however, 7 patientswere managed conservatively with later sleeve resection of trachea and laryngotracheal anastomosis inthree patients. there was no morbidity but three patients died. tracheobronchial injury is extremelychallenging due to its early threat to life. a high level of suspicious and the liberal use of bronchoscopeare critical in the diagnosis of tracheobronchial injuries. avoidance of iatrogenic complications, primaryrepair and liberal use of autogenous tissue for wrapping or buttressing increases successful rate.