Laryngotracheal lesions by near-hanging

Abstract

Introduction: The hanging injury is considered a closed trauma of the cervical trachea.

Objective: To present the cases of six patients treated for sequelae after failed hanging attempt, and to review the literature about diagnostic and therapeutic methods.

Methods: A descriptive study was carried out of six consecutive patients treated between 1989 and 2011 at Hermanos Ameijeiras Hospital. All were referred from different hospitals, with a tracheostomy for controlling the airway. The variables studied were sex, age, definitive diagnosis, surgical techniques used, postoperative evolution, complications and mortality.

Results: All patients were male, aged between 16 and 66 years (median: 28.5). Four were less than 30 years old; one, 38; and the last, 66. The diagnosis was made by flexible tracheoscopy and computerized axial tomography. The injury was located in the subglottis (2) and the trachea (4). Two patients were operated on before referral, through tracheal (1) and laryngotracheal (1) resection. Definitive treatment in our center consisted of tracheal (4) and subglottic (2) resection. There were no complications or deaths. During the postoperative follow-up (7-26 months), five injured patients had excellent outcomes and one had satisfactory outcomes, associated with a weak voice.

Conclusions: Tracheal trauma after failed hanging is very rare. Timely and appropriate managment can reduce complications and mortality. An experienced surgical team can achieve satisfactory outcomes in a large group of injured people. Tracheostomy, under local anesthesia, is the method of choice for controlling the airways in patients with cervical trauma.

Keywords: hanging; trachea; subglottis; diagnosis; tracheal resection; laryngotracheal resection.