H. Kara et al. / Case Reports in Clinical Medicine 2 (2013) 502-504
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504
may give 20% - 40% false negative results and this ratio
increases if the bronchial injury is associated with other
organ injuries. Fiberoscopy is preferred in patients with
head-neck and cervical injuries. This also increases the
ratio of false negativity. So bronchoscopy should be re-
peated if the suspicion of rupture continues [5,8]. Our
patient had a nasal fracture in addition to the tracheal
rupture. On bronchoscopy, granulation tissue and covered
rupture site were observed at a 9 - 11 o’clock level, 1 - 2
cm distal to the vocal cords.
Treatment of tracheobronchial injuries is divided into
two methods: surgical and conservative. Care should be
taken to preserve lung parenchyma during operative pro-
cedures and bronchoscopic techniques should be per-
formed. Conservative treatment is sufficient if the bron-
choscopic trauma is at a perimeter less than 1/3 of the
trachea or bronchus, if air leakage is prevented with tube
drainage and if total lung expansion is obtained. Conser-
vative treatment methods include intubation, tracheo-
stomy and patient monitorization [8]. Our patient did not
have primary repair. The wound was left to recover sec-
ondary. Secondary repairs are required due to delays in
diagnosis in 17% - 27% of patients. Patients on average
apply to hospitals within 1 - 3 months. The lungs can be
expanded by a successful primary anastomosis even if
there is a delay in diagnosis and on average can become
functional at the end of 2 - 6 months [10,11]. In some
patients, stenosis may develop at the anastomosis site
following primary repair of the ruptured area. Endoscopic
dilation [bronchoscopic dilation, laser, cryotherapy, elec-
trocautery and stent implantation] may be performed in
patients who develop anastomotic stenosis [12].
In conclusion, the early diagnosis of tracheobronchial
ruptures, which may vary from simple tears to total rup-
tures and present with different clinical signs, is important.
Clinical evaluation and diagnostic tests should be per-
formed carefully and rapidly. Tracheobronchial rupture
should be suspected in all patients who have massive air
leakage after blunt thoracic trauma, mediastinal or subcu-
taneous emphysema with penumothorax and non-ex-
pansed lungs. Bronchoscopic evaluation should only be
performed under conditions where emergency surgery can
be performed. This life-threatening condition may be
controlled with intubation or tracheostomy. In addition,
care should be taken on the follow-ups after discharge in
patients with thoracic trauma and intervals should be fre-
quent within the first 3 months after trauma. Thus, the
injuries overlooked on the initial assessment may be rec-
ognized at a later period.
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