2017-18 HSC Section 3 Green Book

Airway management in pediatric blunt neck trauma

D. Chatterjee et al.

with minimal weakness in his right upper extremity. The rest of the patient’s hospital course was uncomplicated and the patient was discharged home after 5 weeks with a tracheostomy tube and a halo vest.

Discussion

Laryngotracheal injuries secondary to blunt neck trauma are encountered in < 1% of all trauma patients (1 – 3). The incidence of laryngotracheal injuries in children is even lower (4,5). Compared to adults, children are less likely to be involved in motor vehicle accidents and violent alterca- tions. Anatomically the pediatric larynx is located higher in the neck, allowing the mandibular arch to protect the larynx (5 – 8). Additionally, the laryngeal cartilages in chil- dren are more pliable, decreasing the likelihood of laryn-

Figure 2 Sagittal T2-weighted MR image of the cervical spine show- ing anterior tilting of the dens secondary to C2 – C3 fracture (large white arrow) with subsequent effacement of the anterior thecal sac. Not subtle increased T2 signal within the cord (short white arrows) at C2 – C3 level.

Figure 4 Open neck exploration showing proximal tracheal segment (white arrow).

Figure 3 Flexible tracheoscopy showing complete tracheal transec- tion below the first tracheal ring (black arrow). The thyroid gland (white arrow) is visible through the defect.

ETT was removed. Awake flexible laryngoscopy con- firmed bilateral vocal cord paresis with both vocal cords in the paramedian position. Subsequent flexible bron- choscopy revealed normal patency of the tracheal repair site. Neurologically, he was moving all four extremities

Figure 5 Open neck exploration showing distal tracheal segment (white arrow) and tracheostomy (black arrow).

© 2015 John Wiley & Sons Ltd Pediatric Anesthesia 26 (2016) 132–138

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