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      Successful Stenting for Bronchial Stenosis Resulting from Blunt Airway Trauma

      case-report

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          Abstract

          Blunt airway trauma is rare but life threatening. Injuries to other vital organs accompany this type of injury in most cases; therefore, conservative treatment may be considered first. In cases of delayed fibrotic airway stenosis after conservative treatment, surgical treatment or bronchoscopic intervention are therapeutic options. We herein report a case of delayed airway stenosis after a blunt traumatic airway injury that was successfully managed by silicone stenting.

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          Use of silicone stents for the management of post-tuberculosis tracheobronchial stenosis.

          Dae-Hyun Kim, Jason Kwon, Young Kwon … (2006)
          The role of bronchoscopic management in post-tuberculosis tracheobronchial stenosis is not well defined. To investigate the role of bronchoscopic intervention, including silicone stenting, in the management of post-tuberculosis tracheobronchial stenosis, the current retrospective study was conducted at a tertiary referral hospital. Under rigid bronchoscopy, 80 patients underwent ballooning, neodymium-yttrium aluminium garnet laser resection and/or bougienation as first-line methods of airway dilatation between January 2000 and December 2003 inclusive, and were followed for a median of 41 months. Silicone stents were required in 75 out of 80 (94%) patients to maintain airway patency. Bronchoscopic intervention provided immediate symptomatic relief and improved lung function in 88% of the patients. After airway stabilisation, stents were removed successfully in 49 out of 75 (65%) patients at a median of 14 months post-insertion. Three patients out of 75 (4%) eventually underwent surgical management. Acute complications included: excessive bleeding (n = 1); pneumothorax (n = 5); and pneumomediastinum without mortality (n = 2). Stent-related late complications, such as migration (51%), granuloma formation (49%), mucostasis (19%) and re-stenosis (40%), were controllable during a median follow-up of 41 months. In conclusion, bronchoscopic intervention, including silicone stenting, could be a useful and safe method for treating post-tuberculosis tracheobronchial stenosis.
          Article 0 comments Cited 30 times – based on 0 reviews     Review now
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            Traumatic injury to the trachea and bronchus.

            Riyad Karmy-Jones, Douglas E Wood (2007)
            Tracheobronchial injuries are relatively uncommon, often require a degree of clinical suspicion to make the diagnosis, and usually require immediate management. The primary initial goals are twofold: stabilize the airway and define the extent and location of injury. These are often facilitated by flexible bronchoscopy, in the hands of a surgeon capable of managing these injuries. Most penetrating injuries occur in the cervical area. Most blunt injuries occur in the distal trachea or right mainstem, and are best approached by a right posterolateral thoracotomy. Choice and timing of approach are dictated by the presence and severity of associated injuries. The mainstay of intraoperative management remains a single-lumen endotracheal tube. Most injuries can be repaired by simple techniques, using interrupted sutures, but some require complex reconstructive techniques. Follow-up to detect stenosis or anastomotic technique is important, as is attention to pulmonary toilet.
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              A review of traumatic airway injuries: potential implications for airway assessment and management.

              Fernando Netto, C. Kummer, Sandro B. Rizoli … (2006)
              Obtaining a patent airway can be difficult in patients with traumatic airway injuries (TAI). There is a paucity of data available about the incidence of airway compromise and techniques used in these patients. Charts review of all patients with TAI treated in a Regional Trauma Center from July 1989 to June 2005. One hundred and four patients were identified as TAI in the study period (incidence of 0.4% for blunt and 4.5% for penetrating trauma). Sixty-eighty patients were victims of penetrating trauma (ISS: 24+/-10; mortality: 16%). Thirty-six patients were blunt trauma victims (ISS: 33+/-16; mortality: 36%). Overall, 65% of the patients received a definitive airway (DA) in the pre-hospital setting or at the initial hospital assessment. Alternative techniques for obtaining DA including wound tracheal tube, surgical airway and intubation under fiberoptic bronchoscopy were used in 30% of the patients. Among 24 deaths, 10 were considered primarily due to the airway injury. Twelve patients presented with thoracic TAI with nine deaths in this subgroup. Overall, the incidence of TAI is low. Blunt trauma TAI is less common, and these patients have a different clinical presentation, higher ISS and mortality than the penetrating TAI group. Early assessment of airways is crucial and DA was required in 2/3 of the patients with TAI. Lower airway injuries have higher mortality than upper airway injuries. Even though most patients died as a result of other injuries, causative factors of death included difficulty in obtaining DA and ventilation/oxygenation problems.
              Article 0 comments Cited 17 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Intern Med
                Journal ID (iso-abbrev): Intern. Med
                Title: Internal Medicine
                Publisher: The Japanese Society of Internal Medicine
                ISSN (Print): 0918-2918
                ISSN (Electronic): 1349-7235
                Publication date (Electronic): 6 July 2018
                Publication date (Print): 15 November 2018
                Volume: 57
                Issue: 22
                Pages: 3277-3280
                Affiliations
                [1 ]Department of Intermal Medicine, Pusan National University School of Medicine, Korea
                [2 ]Department of Radiology, Pusan National University School of Medicine, Korea
                [3 ]Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Korea
                Author notes

                Correspondence to Dr.　Jung Seop Eom, ejspulm@ 123456gmail.com

                Article
                DOI: 10.2169/internalmedicine.0569-17
                PMC ID: 6287989
                PubMed ID: 29984759
                SO-VID: 30640b9f-6799-4eae-b35f-801cf7bd9a01
                Copyright © Copyright © 2018 by The Japanese Society of Internal Medicine
                License:

                The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit ( https://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 23 November 2017
                Date accepted : 11 April 2018
                Categories
                Subject: Case Report

                Keywords: trauma,blunt injuries,airway obstructions,stenosis,stents
                Data availability:
                Keywords: trauma, blunt injuries, airway obstructions, stenosis, stents

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