Key Points

• The initial priority is airway stabilization, which may require flexible or rigid bronchoscopy.
• Penetrating injury predominantly affects the cervical trachea, and blunt trauma affects the distal trachea carina, and mainstem bronchi.
• Diagnosis should be suspected in patients with significant air leak, subcutaneous emphysema, and/or pneumothorax despite tube thoracostomy.
• The diagnosis can be missed, resulting in airway stricture, parenchymal necrosis, and/or late-onset asthma.
• The upper half of the trachea is best exposed via a collar cervical incision, the distal half in most cases by a right fourth intercostal posterolateral thoracotomy.
• Operative repair involves precise débridement of devitalized tissue, but in most cases simple reconstruction with absorbable interrupted sutures suffices.

Tracheobronchial injury is uncommon but immediately life threatening. The immediate sequelae can include death from asphyxiation, whereas lack of recognition or incorrect management may result in life-threatening or disabling airway stricture. Penetrating injuries can occur with any laceration to the neck or from projectile injuries to the neck or chest. Blunt injuries can occur from a variety of direct and indirect trauma. Laryngotracheal injuries are sometimes classified together, but in this discussion they are separated from laryngeal trauma, including laryngotracheal separation, which is discussed elsewhere. In this chapter, we concentrate on injuries that occur between the cricoid cartilage and the right and left main stem bronchial bifurcations.