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Our Experience with Laryngotracheal Trauma (LTT) in a Tertiary Care Centre of Western Rajasthan

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Abstract

LTT is a life-threatening incident that is fortunately rare. The presenting symptoms might not correlate with the intensity of trauma and range from mild endolaryngeal edema to complete laryngotracheal transection. An early diagnosis and timely intervention is required for successful outcomes and minimizing complications. This retrospective audit was performed on 18 patients of LTT who presented to the emergency from January 2017 to December 2019. The history, clinical presentation, examination findings, degree and nature of trauma, diagnostic modalities, medical and surgical management, and outcomes were analyzed. A total of 13 males and 5 females were included in this audit, with a mean age of 38.7 years. The most common cause was accidental in 77.7% patients. 61.5% of patients presented with Schaefer grade 3 and higher. Out of which 46% underwent emergent neck exploration and repair. 27.7% (5/18) presented with sequelae which were managed either by T- tube stenting, endoscopic dilatation by coblation, or laryngotracheal resection (LTR) and end-to-end anastomosis (EEA). Out of 14 surgically reconstructed airways, successful decannulation was achieved in 57.1% (8) patients. High clinical suspicion, early referral with emergent intervention is paramount for successful outcomes, fewer recurrences, and reduction of hospital’s and patient’s financial burden as timely planning and intervention can ensure successful decannulation of around two thirds of the higher grades (grade 3–5) of laryngotracheal traumatic injuries. Early airway establishment is the most critical goal. Definitive treatment protocols are needed in this field which warrants further formulation of multicentric studies and audits.

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Acknowledgements

This manuscript is original and it, or any part of it, has not been previously published; nor is it under consideration for publication elsewhere. This audit was presented during the clinical grand rounds dated 31st July 2019 at AIIMS, Jodhpur and we sincerely acknowledge the support from AIIMS, Jodhpur for the same.

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Authors and Affiliations

  1. Dept of Oto-Rhino-Laryngology, AIIMS, Jodhpur, India

    Neha Shakrawal, Sourabha K. Patro, Kapil Soni, Darwin Kaushal, Bikram Choudhury & Amit Goyal

  2. Dept of Otolaryngology & Head and Neck Surgery, PGIMER, Sector-12, Chandigarh, 160012, India

    Sourabha K. Patro

  3. Dept of Oto-Rhino-Laryngology, SNMC, Jodhpur, India

    Neha Shakrawal

  4. Dept of Oto-Rhino-Laryngology, AIIMS, Bilaspur, India

    Darwin Kaushal

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  1. Neha Shakrawal
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  2. Sourabha K. Patro
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  3. Kapil Soni
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  4. Darwin Kaushal
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  5. Bikram Choudhury
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  6. Amit Goyal
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Contributions

NS- Conception of article, data collection, drafting the manuscript. SKP- Conception and design of article, contributed data, analysis of the content, final approval of the version. KS- Drafting and revising article critically for important intellectual content, contributed data, final approval of the version. DK- Contributed data, revising the manuscript for important intellectual content, final approval of the version. Contributed data or analysis tools, designed the anal;ysiss. BC- Contributed data, designed analysis, revising the manuscript for important intellectual content, final approval of the version. AG- Contributed data, designed analysis, revising the manuscript for important intellectual content, final approval of the version.

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Correspondence to Sourabha K. Patro.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Shakrawal, N., Patro, S.K., Soni, K. et al. Our Experience with Laryngotracheal Trauma (LTT) in a Tertiary Care Centre of Western Rajasthan. Indian J Otolaryngol Head Neck Surg 74, 375–382 (2022). https://doi.org/10.1007/s12070-021-02820-5

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