Carinal resection and reconstruction for tracheal bifurcation trauma with a widespread destruction of carinal cartilage; a case report

Abstract

We report a case of tracheal bifurcation injury with destruction of carinal cartilage in association with blunt chest trauma. A 29-year-old male truck driver arrived at the emergency room of a local hospital with subcutaneous emphysema of the neck. His truck crashed into a larger truck from behind after he fell asleep at the wheel. He was unrestrained and hit his mid-chest hard on the wheel. He was diagnosed with a tracheal bifurcation injury and was brought to our university hospital. Chest roentogenogram and CT showed pneumomediastinum. Preoperative flexible bronchoscopy showed a laceration of ∅8 mm at the carinal cartilage of the tracheal bifurcation, through which air bubbles came in and out. This was repaired by complete carinal resection followed by montage-type carinoplasty, since we were afraid that simple repair of the laceration with debridement may have resulted in dehiscence of the suture line or airway stenosis by hypertrophic granulation. The patient was discharged on the 29th postoperative day without any anastomotic problems. There has been no report to our knowledge of carinal resection and reconstruction for a tracheal bifurcation injury. We propose that for a tracheal bifurcation trauma with a widespread destruction of carinal cartilage carinal resection and reconstruction should be selected over simple repair with debridement.