Prolonged intubation and delayed tracheostomy in traumatic laryngotracheal separation

Abstract

Background: The 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. Case: We 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. Conclusion: This 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. Keywords: Laryngology, Laryngeal trauma, Vocal cord paralysis, Tracheostomy, Prolonged intubation