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Posttraumatische Trachealstenose nach komplexer HWS-Fraktur

Eine seltene Komplikation

Posttraumatic tracheal stenosis after complex fracture of the upper cervical spine

A rare complication

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Zusammenfassung

Verletzungen der Trachea bei einem Kombinationstrauma der oberen HWS sind selten und können zu bedrohlichen Atemwegsverlegungen führen. Daher ist es wichtig, diese Weichteilverletzungen neben den knöchernen Verletzungen zu erkennen und adäquat zu therapieren. Wir berichten über einen Fall, bei dem es verzögert zu einer hochgradigen Trachealstenose gekommen ist, die letztlich nur durch eine Notfalltracheotomie und Tracheaquerresektion zu beherrschen war.

Die 25-jährige Patientin erlitt nach einem Verkehrsunfall eine komplexe Fraktur der oberen HWS mit einer Jefferson-Fraktur, einer Densfraktur sowie einer HWK6/7-Luxationsfraktur. Bereits unmittelbar posttraumatisch war ein Stridor aufgetreten. Im Verlauf der Behandlung kam es zu einer Zunahme der Trachealstenose. Die Biopsie zeigte in der histologischen Aufarbeitung reines Granulationsgewebe. Auch wenn die knöcherne Pathologie schnell und effizient operativ behoben wird, kann bei schwerem Trauma der HWS nicht ausgeschlossen werden, dass auch Weichteilverletzungen gerade an der Trachea auftreten können.

Daher ist es von enormer Wichtigkeit, solche Patienten engmaschig nachzuuntersuchen, damit der Zeitpunkt für ein sicheres operatives Verfahren zur Behebung von Tracheaverletzungen festgelegt werden kann.

Abstract

Combined injuries of the upper cervical spine are rare and can lead to life-threatening positional changes of the respiratory tract. Hence, it is very important to recognize tracheal and soft tissue injuries and to treat these adequately. We report on the clinical course and outcome of a case with a delayed high-grade tracheal stenosis after cervical spine injury, which could only be treated by emergency tracheotomy and partial transverse trachea resection.

The 25-year-old female suffered a complex dislocated upper cervical spine fracture with a Jefferson fracture, an odontoid fracture and a dislocated C6/7 luxation fracture after a motor vehicle accident. Immediately after trauma inspiratory stridor was reported. Postoperatively, the tracheal stenosis increased and the histological examination of tissue collected during emergency bronchoscopy showed granulation tissue.

Even if fractures of cervical spine injuries are treated successfully, soft tissue and tracheal injuries cannot be precluded. Therefore, it is most important that such patients are followed-up closely to classify the problem and to determine the ideal time for surgical treatment of tracheal injuries and stenoses.

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Literatur

  1. Andrews BT, Graham SM, Ross AF et al (2007) Technique, utility, and safety of awake tracheoplasty using combined laser and balloon dilation. Laryngoscope 117:2159–2162

    Article  PubMed  Google Scholar 

  2. Bolliger CT, Sutedja TG, Strausz J, Freitag L (2006) Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents. Eur Respir J 27:1258–1271

    Article  PubMed  CAS  Google Scholar 

  3. Cavaliere S, Venuta F, Foccoli P et al (1996) Endoscopic treatment of malignant airway obstructions in 2,008 patients. Chest 110:1536–1542

    Article  PubMed  CAS  Google Scholar 

  4. Chen FH, Fetzer JD (1993) Complete cricotracheal separation and third cervical spinal cord transection following blunt neck trauma: a case report of one survivor. J Trauma 35:140–142

    Article  PubMed  CAS  Google Scholar 

  5. Donahue DM, Grillo HC, Wain JC et al (1997) Reoperative tracheal resection and reconstruction for unsuccessful repair of postintubation stenosis. J Thorac Cardiovasc Surg 114:934–938; discussion 938–939

    Article  PubMed  CAS  Google Scholar 

  6. Epstein BS, Epstein JA, Jones MD (1978) Lap-sash three point seat belt fractures of the cervical spine. Spine 3:189–193

    Article  PubMed  CAS  Google Scholar 

  7. Feat S, Le Clech G, Riffaud L, Godey B (2002) Complete cervical tracheal rupture in children after closed trauma. J Pediatr Surg 37:E39

    Article  PubMed  Google Scholar 

  8. Ford HR, Gardner MJ, Lynch JM (1995) Laryngotracheal disruption from blunt pediatric neck injuries: impact of early recognition and intervention on outcome. J Pediatr Surg 30:331–334; discussion 334–335

    Article  PubMed  CAS  Google Scholar 

  9. Gale SC, Gracias VH, Reilly PM, Schwab CW (2005) The inefficiency of plain radiography to evaluate the cervical spine after blunt trauma. J Trauma 59:1121–1125

    Article  PubMed  Google Scholar 

  10. Grillo HC (2000) Stents and sense. Ann Thorac Surg 70:1142

    Article  PubMed  CAS  Google Scholar 

  11. Grillo HC, Donahue DM, Mathisen DJ et al (1995) Postintubation tracheal stenosis. Treatment and results. J Thorac Cardiovasc Surg 109:486–492; discussion 492–483

    Article  PubMed  CAS  Google Scholar 

  12. Grillo HC, Mathisen DJ, Wain JC (1992) Laryngotracheal resection and reconstruction for subglottic stenosis. Ann Thorac Surg 53:54–63

    PubMed  CAS  Google Scholar 

  13. Grillo HC, Mathisen DJ, Wain JC (1992) Management of tumors of the trachea. Oncology (Williston Park) 6:61–67; discussion 68:70–72

  14. Guillamondegui OD, Nance ML, Gaynor JW et al (2004) Successful management of concommitant blunt injury to the trachea, esophagus and cervical spine in a 6-year-old girl. J Pediatr Surg 39:1130–1132

    Article  PubMed  Google Scholar 

  15. Hoy GA, Cole WG (1993) The paediatric cervical seat belt syndrome. Injury 24:297–299

    Article  PubMed  CAS  Google Scholar 

  16. Huelke DF, O’Day J, Mendelsohn RA (1981) Cervical injuries suffered in automobile crashes. J Neurosurg 54:316–322

    Article  PubMed  CAS  Google Scholar 

  17. Jackson RS, Banit DM, Rhyne AL 3rd et al (2002) Upper cervical spine injuries. J Am Acad Orthop Surg 10:271–280

    PubMed  Google Scholar 

  18. Mace A, Sandhu G, Howard D (2005) Securing tracheal stents: a new and simple method. J Laryngol Otol 119:207–208

    Article  PubMed  Google Scholar 

  19. Mathisen DJ (1996) Tracheal tumors. Chest Surg Clin N Am 6:875–898

    PubMed  CAS  Google Scholar 

  20. Messineo A, Narne S, Mognato G et al (1997) Endoscopic dilation of acquired tracheobronchial stenosis in infants. Pediatr Pulmonol 23:101–104

    Article  PubMed  CAS  Google Scholar 

  21. Müller E, Muhr G (1997) Wirbelsäulenverletzungen. Thieme, Stuttgart New York, S 38–68

  22. Neef H (1997) Tracheobronchial injuries in blunt thoracic trauma. Zentralbl Chir 122:674–680

    PubMed  CAS  Google Scholar 

  23. Nouraei SA, Kapoor KV, Nouraei SM et al (2007) Results of endoscopic tracheoplasty for treating tracheostomy-related airway stenosis. Clin Otolaryngol 32:471–475

    Article  PubMed  CAS  Google Scholar 

  24. Rau BK, Harikrishnan KM, Krishna S (1994) Nd-YAG laser therapy for palliation of obstructed colorectal carcinomas. Indian J Cancer 31:240–243

    PubMed  CAS  Google Scholar 

  25. Rau BK, Harikrishnan KM, Krishna S (1994) Neodymium:YAG laser in the management of tracheal stenosis. Ann Acad Med Singapore 23:333–334

    PubMed  CAS  Google Scholar 

  26. Reddin A, Mirvis SE, Diaconis JN (1987) Rupture of the cervical esophagus and trachea associated with cervical spine fracture. J Trauma 27:564–566

    Article  PubMed  CAS  Google Scholar 

  27. Senthuran S, Lim S, Gunning KE (1999) Life-threatening airway obstruction caused by a retropharyngeal haematoma. Anaesthesia 54:674–678

    Article  PubMed  CAS  Google Scholar 

  28. Shapshay SM (1987) Laser applications in the trachea and bronchi: a comparative study of the soft tissue effects using contact and noncontact delivery systems. Laryngoscope 97:1–26

    PubMed  CAS  Google Scholar 

  29. Shapshay SM, Beamis JF Jr, Hybels RL, Bohigian RK (1987) Endoscopic treatment of subglottic and tracheal stenosis by radial laser incision and dilation. Ann Otol Rhinol Laryngol 96:661–664

    PubMed  CAS  Google Scholar 

  30. Shapshay SM, David LM, Zeitels S (1987) Neodymium-YAG laser photocoagulation of hemangiomas of the head and neck. Laryngoscope 97:323–330

    PubMed  CAS  Google Scholar 

  31. Sheely CH 2nd, Mattox KL, Beall AC Jr (1974) Management of acute cervical tracheal trauma. Am J Surg 128:805–808

    Article  PubMed  Google Scholar 

  32. Sheski FD, Mathur PN (1998) Long-term results of fiberoptic bronchoscopic balloon dilation in the management of benign tracheobronchial stenosis. Chest 114:796–800

    Article  PubMed  CAS  Google Scholar 

  33. Slimane MA, Becmeur F, Aubert D et al (1999) Tracheobronchial ruptures from blunt thoracic trauma in children. J Pediatr Surg 34:1847–1850

    Article  PubMed  CAS  Google Scholar 

  34. Stephens KE Jr, Wood DE (2000) Bronchoscopic management of central airway obstruction. J Thorac Cardiovasc Surg 119:289–296

    Article  PubMed  Google Scholar 

  35. Taylor TK, Nade S, Bannister JH (1976) Seat belt fractures of the cervical spine. J Bone Joint Surg [Br] 58:328–331

    Google Scholar 

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, BG Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    M. Dudda, T.M. Frangen, G. Muhr & C. Schinkel

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  1. M. Dudda
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  2. T.M. Frangen
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  3. G. Muhr
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Correspondence to M. Dudda.

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Dudda, M., Frangen, T., Muhr, G. et al. Posttraumatische Trachealstenose nach komplexer HWS-Fraktur. Unfallchirurg 112, 734–737 (2009). https://doi.org/10.1007/s00113-009-1625-y

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