REVIEW ARTICLE


Tracheostomy-related Tracheal Tears in Pediatrics



Mazyad Alenezi1, *, Ali Alsudays2, Sultan Alanazy3, Eman Almashharawi4, Samir Bawazir4
1 Department of Otolaryngology Head and Neck Surgery, College of Medicine, Qassim University, Buriyadh, Qassim, Kingdom of Saudi Arabia
2 Department of Otolaryngology Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
3 Department of Surgery, Ears Nose and Throat Unit, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
4 Division of Pediatric Otolaryngology, Department of Otolaryngology Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia


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Creative Commons License
© 2022 Alenezi et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Otolaryngology Head and Neck Surgery, College of Medicine, Qassim University, Buriyadh, Qassim, Kingdom of Saudi Arabia; Tel: 00966 506119621; E-mail: m.alenezi@qu.edu.sa


Abstract

Introduction:

Tracheostomy-related tracheal tear is a serious complication that may follow surgical or percutaneous tracheostomy. Pediatric populations carry a higher risk because of anatomical differences. The aim of this article is to review this condition and to help in its diagnosis and management with the assistance of clinical and radiological findings.

Materials and Methods:

An English literature review was done using the terms pediatric, tracheostomy, tracheal tear and tracheostomy tube.

Result:

Two cases reported in the literature met the criteria to be included in the review.

Discussion:

Tracheostomy-related tracheal tear needs immediate diagnosis as it may lead to life-threatening outcomes, such as pneumothorax, respiratory distress, extensive subcutaneous emphysema and pneumomediastinum. Symptoms and complications of the tear may occur intraoperatively or postoperatively. Gold standard methods for diagnosis include flexible or rigid tracheobronchoscopy, which helps in determining the management plan. The treatment choices for iatrogenic tracheal tears depend on the tear site, size, and extension of the tear and patient’s hemodynamic status. Conservative management is sufficient for stable patients with small tears, whereas surgical management is essential for unstable patients and those with large or complicated tears.

Conclusion:

Tracheostomy-related tracheal tear is a serious rare complication. The pediatric age group carries a higher risk of the condition and its management, either conservative or surgical, depends on airway endoscopy findings and patient’s hemodynamic status.

Keywords: Tracheal tear, Tracheostomy, Pediatric, Tracheostomy tube, Tracheobronchial tears, Tracheobronchoscopy.