[Traumatic subcutaneous ruptures of the cervical trachea (author's transl)]

Abstract

Traumatic subcutaneous rupture of the cervical trachea is a rare but serious lesion that may cause death of the patient. Few cases come to treatment. This lesion results from a contusion to the anterior neck during hyperextension. It consists in a straight transection between larynx and trachea or between one of the 4 first tracheal rings, and is usually associated to multiple trauma involving the chest and head. Specific symptoms are often blurred by those of the associated lesions making diagnosis complex. This should ideally be confirmed by endoscopy or, if not feasable by cervicotomy. Emergency treatment is directed to restablishment of an adequate ventilation. Direct anastomosis by separate resorbable sutures yields excellent long-term results without stenosis. Creation of a transitory tracheotomy, when commanded by regional atresion, sometimes induces late stenosis; secondary repair is then less favorable. The rate of definitive recurrent nerve paralysis is high. There are also frequent distortions of the vocal cords with modifications of the voice and transitory palsy of the phrenic nerve. The authors draw these conclusions from one personal case and from the literature.