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      Complete Laryngotracheal Separation Following Attempted Hanging

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          Abstract

          Laryngotracheal separation (LTS) is the most immediately life-threatening airway injury. LTS is so rare that very few otolaryngologists have experience with it. LTS is one of the diagnostic and therapeutic challenges in airway diseases and its management remains to be established. We experienced a patient with complete LTS after attempted hanging. A high index of suspicion, adequate imaging, prompt airway establishment and early surgical repair are the most vital factors in managing a patient with LTS.

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          Most cited references 10

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          Laryngeal trauma. A historical comparison of treatment methods.

           D Leopold (1983)
          In the last 20 years, several authors have reported their experience with the treatment of laryngeal trauma. Over 200 cases of laryngeal trauma in the literature were reviewed and compared with the experience at Upstate Medical Center, Syracuse, NY. Special attention was paid to surgical v medical treatment, type and duration of stenting techniques, and time interval between injury and surgery. Results were compared in terms of voice and airway status. If surgical treatment is not required, the results for airway and voice are generally excellent. In those cases requiring open surgical treatment, the adequacy of airway was independent of the use or method of stenting. Superior voice results were obtained when stenting was not used. In general, better results were obtained when treatment was carried out within the first 24 hours.
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            Danger of false intubation after traumatic tracheal transection.

            Blunt tracheobronchial injuries may be difficult to diagnosis at presentation but can pose major airway difficulties. We present a patient with a tracheal transection who underwent intubation with the tip of the endotracheal tube exiting the trachea and terminating in the mediastinum adjacent to the distal trachea. He underwent surgical repair of the injury with end-to-end anastomosis. Although intubation over a flexible fiberoptic bronchoscope is desirable in cases of suspected tracheobronchial injury, it may not be feasible. In cases of suspected tracheobronchial injuries with blind endotracheal intubation, the possibility of false intubation should always be entertained.
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              Complete tracheal rupture after a failed suicide attempt.

              Tracheal rupture is life-threatening and its management poses a considerable challenge to both anesthesiologists and surgeons. We report the case of a 44-year-old patient with a complete tracheal rupture after a failed suicide attempt by hanging. A rare bilateral injury of the laryngeal nerves was associated. An original tracheal intubation was performed using the video unit for thoracoscopy. The severity of the lesions required the placement of a tracheostomy cannula after the tracheal repair. The postoperative course was uneventful. The patient was discharged on the 12th day, with a remaining moderate dysphonia.
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                Author and article information

                Journal
                Clin Exp Otorhinolaryngol
                Clin Exp Otorhinolaryngol
                CEO
                Clinical and Experimental Otorhinolaryngology
                Korean Society of Otorhinolaryngology-Head and Neck Surgery
                1976-8710
                2005-0720
                September 2012
                29 November 2011
                : 5
                : 3
                : 177-180
                Affiliations
                Department of Otolaryngology-Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea.
                Author notes
                Corresponding author: Yeo-Hoon Yoon, MD. Department of Otolaryngology-Head and Neck Surgery, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel: +82-42-280-8375, Fax: +82-42-253-4059, yyh9635@ 123456cnuh.co.kr
                Article
                10.3342/ceo.2012.5.3.177
                3437421
                22977717
                Copyright © 2012 by Korean Society of Otorhinolaryngology-Head and Neck Surgery.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Case Report

                Otolaryngology

                hanging, laryngotracheal separation

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