Our 12 year experience with Montgomery T-tube in the management of acute blunt laryngotracheal trauma patients / Nossa experiência de 12 anos com o tubo T de Montgomery no tratamento de pacientes com trauma laringotraqueal contuso agudo

Abstract Introduction The Montgomery T-tube is a device used as a combined tracheal stent and tracheostomy tube to prevent post-operative tracheal stenosis. Objectives The purpose of this retrospective study is to evaluate the outcome following Montgomery T-tube stenting performed in for neck and airway injury in patients with acute blunt laryngotracheal trauma over a period of 12 years. Methods Between 2005 and 2017, 19 patients with acute blunt laryngotracheal trauma underwent Montgomery T-tube stenting. All 19 laryngotracheal trauma patients had undergone a preoperative tracheostomy in the emergency department by an ENT surgeon. Montgomery T-tube stenting was done later through an external approach. The follow up period ranged from 2 to 10 years. The Montgomery T-tube was removed after a period ranging from 6 months to 1½ year. Results The majority of patients in the study were in the age group of 21-30 years. A preoperative tracheostomy was done in all 19 patients. All patients except 3 underwent successful decannulation, and experienced long-term satisfactory result. Conclusion Management of acute blunt laryngotracheal trauma is a challenging problem that demands a multidisciplinary approach. The ideal treatment option should be individualized according to the patient's condition and characteristics of injury. According to our study we suggest that cases of acute blunt laryngotracheal trauma patients should be managed following the protocol as mentioned in our study, and we strongly emphasize that Montgomery T-tube should be left for at least 1 complete year in the airway as it results in negligible chances of post-traumatic stenosis of airway later.

Resumo Introdução O tubo T de Montgomery é um dispositivo usado como stent traqueal combinado com tubo de traqueostomia para evitar estenose traqueal pós-operatória. Objetivo Avaliar o resultado do procedimento cirúrgico feito para lesões no pescoço e nas vias aéreas em pacientes com trauma laringotraqueal contuso agudo e o resultado da colocação do tubo T de Montgomery nesses pacientes por 12 anos. Método Entre 2005 e 2017, 19 pacientes com trauma laringotraqueal contuso agudo foram submetidos ao implante do tubo T de Montgomery. Todos os 19 pacientes com trauma laringotraqueal foram submetidos a uma traqueostomia pré-operatória no pronto-socorro por um cirurgião otorrinolaringologista. O implante do tubo T de Montgomery foi feito posteriormente através de uma abordagem externa. O período de seguimento variou de dois a 10 anos. O tubo T de Montgomery foi removido após um período que variou de seis meses a um ano e meio. Resultados A maioria dos pacientes do estudo estava na faixa de 21 a 30 anos. A traqueostomia pré-operatória foi feita em todos os 19 pacientes. Todos, exceto três, tiveram decanulação bem-sucedida e resultado satisfatório em longo prazo. Conclusão O tratamento do trauma laringotraqueal contuso agudo é um desafio que exige uma abordagem multidisciplinar. A opção de tratamento ideal deve ser individualizada de acordo com a condição do paciente e as características da lesão. De acordo com nosso estudo, sugerimos que os casos de pacientes com trauma laringotraqueal contuso agudo sejam tratados de acordo com o protocolo mencionado em nosso estudo e enfatizamos fortemente que o implante do tubo T de Montgomery deve ser mantido por pelo menos um ano completo nas vias aéreas, pois resulta em chances insignificantes de posterior estenose pós-traumática das vias aéreas.

Damage control of laryngotracheal trauma: the golden day / Control de daños del trauma laringotraqueal: todo en 24 horas

Abstract Laryngotracheal trauma is rare but potentially life-threatening as it implies a high risk of compromising airway patency. A consensus on damage control management for laryngotracheal trauma is presented in this article. Tracheal injuries require a primary repair. In the setting of massive destruction, the airway patency must be assured, local hemostasis and control measures should be performed, and definitive management must be deferred. On the other hand, management of laryngeal trauma should be conservative, primary repair should be chosen only if minimal disruption, otherwise, management should be delayed. Definitive management must be carried out, if possible, in the first 24 hours by a multidisciplinary team conformed by trauma and emergency surgery, head and neck surgery, otorhinolaryngology, and chest surgery. Conservative management is proposed as the damage control strategy in laryngotracheal trauma.

Resumen El trauma laringotraqueal es poco frecuente, pero con alto riesgo de comprometer la permeabilidad la vía aérea. El presente artículo presenta el consenso de manejo de control de daños del trauma laringotraqueal. En el manejo de las lesiones de tráquea se debe realizar un reparo primario; y en los casos con una destrucción masiva se debe asegurar la vía aérea, realizar hemostasia local, medidas de control y diferir el manejo definitivo. El manejo del trauma laríngeo debe ser conservador y diferir su manejo, a menos que la lesión sea mínima y se puede optar por un reparo primario. El manejo definitivo se debe realizar durante las primeras 24 hora por un equipo multidisciplinario de los servicios de cirugía de trauma y emergencias, cirugía de cabeza y cuello, otorrinolaringología, y cirugía de tórax. Se propone optar por la estrategia de control de daños en el trauma laringotraqueal.

Technical Considerations in the Surgical Management of External Laryngotracheal Trauma: Surgical Outcomes

External laryngotracheal (ELT) trauma is rarely encountered in clinical practice. In most circumstances, this injury is overlooked by the primary attending team. Surgical management of ELT trauma is complicated, because there is no established management approach for this potentially life-altering, high morbidity injury. It is important for this injury to be identified early, as any delay in surgical intervention may result in poor airway and phonatory outcomes. The aim of surgical reconstruction is to minimise the above debilitating morbidities by restoring the main laryngeal functions as much as possible. Methods: We reviewed the outcomes of six surgical interventions for ELT trauma at Tengku Ampuan Afzan Hospital from June 2007 to June 2014. Clinical presentations, computed tomography (CT) scans features, intraoperative findings, and postoperative outcomes were evaluated. Results: All patients made a good recovery in terms of phonation except for one patient who had reduced speech function. After one year, one patient was still dependent on a fenestrated tracheostomy. This article describes the surgical reconstruction techniques used to achieve these positive outcomes. Stenting is helpful to aid healing and re-epithelialisation. Conclusion: Prompt recognition and non-traumatised airway control are essential for addressing laryngotracheal trauma. Subcutaneous emphysema is an important hallmark that should alert the attending physician to the possibility of ELT trauma. Immediate surgical intervention using appropriate techniques can produce favorable patient outcomes.

The clinical analysis and treatment of 38 cases with open laryngotracheal trauma / 中华急诊医学杂志

Objective To discuss the cause and treatment strategy for open laryngotracheal trauma.Methods The clinical data of 38 cases with open laryngotracheal trauma admitted from 1998 to 2012 were collected and analyzed.Of them,one patient died in emergency department despite energetic resuscitation,37 were hospitalized and given advanced treatment after life support measures in emergency department.They were treated with tracheotomy before or during operation.Of them,32 patients were regularly followed up for imaging studies.Result Except 1 patient died of exsanguination from carotid artery rupture,the other 37 survived after successful treatment.Twenty patients were treated with debridement and suture of the wounds and laryngoplasty (20/37,54.1％),8 patients were operated with laryngoplasty plus intraluminal stents implanted (8/37,21.6％) ; the rest 9 patients (9/37,24.3％) were separately given placement of nickel-titanium shape memory alloy stent (n =2),laryngofissure with rubber gloves throat models implanted and laryngoplasty (n =3),linear silicone tube implanted and laryngoplasty with trans-cervical approach (n =1) and tracheoesophageal fistula neoplasty with laryngoplasty and laryngofissure (n =3).The operated patients were followed-up for 0.5 to 3 years after discharge.Of them,35 patients (35/37,94.6％) had successful decannulation,breathing smoothly and swallowing normally,23 patients (23/37,62.2％) had almost normal pronunciation,12 patients (12/37,32.4％) had different degrees in hoarseness of voice,and 2 patients (2/37,5.4％) were referred to other hospital because of failure in extubation with severe stenosis of laryngotrachea.Conclusions When the patients with open laryngotracheal trauma were treated,the essential strategy was to prevent shock,hemorrhage,and asphyxia.In the case of patent respiratory tract and stable vital signs,laryngotracheal reconstruction should be carried out as soon as possible to prevent complications,thereby obtaining good therapeutic effect.