Prolonged intubation and delayed tracheostomy in traumatic laryngotracheal separation

摘要

BackgroundThe survival from traumatic laryngotracheal separation (LTS) is rare. For those who survive, the management of LTS has traditionally been primary repair and the insertion of a tracheostomy tube?±?laryngeal stent. Long-term goals of treatment include patency of the airway, adequate voice production and deglutition without aspiration.CaseWe report a case of complete laryngotracheal separation with bilateral vocal cord paralysis (BVCP) after a clothesline injury. Intraoperative decision was made to leave the patient intubated and delay the insertion of a tracheostomy tube. The patient was successfully decannulated two months post injury with adequate voice and swallow in the context of bilateral vocal cord immobility.ConclusionThis case highlights the potential value of prolonged intubation and delayed tracheostomy in patients with laryngotracheal trauma. Prolonged intubation may allow for healing at the primary repair site, act as a laryngeal, and additionally allow for paramedian fixation of the vocal cords. All of which may increase the chance of decannulation and improve long-term functional outcomes.