Successful conservative management of a laryngotracheal injury in a 6-year-old child: a case report

Abstract

Introduction: Diagnosis of laryngotrachel injuries is confirmed by bronchoscopy, and treatment depends on the patient’s condition and the anatomy of the injury. Evidence shows that selected cases can be managed without surgery. This study aimed to report the successful conservative management of laryngotracheal injury. Case presentation: A 6-year-old boy was transferred to our unit from the ENT unit for laryngotracheal injury following neck trauma 20 hours before. His breath rate was also stable. He presented with subcutaneous emphysema on the upper anterior chest, neck swelling, and right pneumothorax. The computed tomography scan revealed tracheal injury, and bronchoscopy revealed a 3-cm transversal tracheal injury and laryngeal edema. Considering the patient’s stable condition and the delay in consultation, we opted for conservative management. On day 4, he presented with worsening breath rate due to right pneumothorax. A chest tube was inserted, and the patient recovered. Clinical discussion: Laryngotracheal injury is rare in children and requires a multidisciplinary approach. The gold standard for diagnosis is bronchoscopy; there is a debate about the timing or opportunity to perform this invasive procedure. Some authors recommend surgical treatment for lesions larger than 2 cm. The post-surgical mortality rate is 45%, making it important to select patients who can be managed without surgery. Conclusion: Conservative management can be safely performed in selected patients with laryngotracheal injury, including children. Further studies are needed to guide physicians in choosing which patients can be treated without surgery and to define the criteria for follow-up.