Anesthetic Management of Traumatic Laryngotracheal Laceration in a Postpartum Patient: A Case Report

Traumatic laryngotracheal lacerations are rare but immediately life-threatening injuries that require rapid, individualized airway management. The anesthesiologist faces the dual challenge of securing a compromised airway while avoiding progression of a partial tear to a complete transection. We report the case of a 35-year-old woman, 28 days postpartum, who presented to the emergency department after a self-inflicted penetrating anterior neck injury. On arrival, she had hoarseness, moderate respiratory distress, and extensive subcutaneous emphysema. Computed tomography of the neck demonstrated a 5-cm full-thickness defect in the anterior laryngeal wall at the level of the thyroid cartilage, with bilateral paratracheal air pockets and no clear evidence of distal airway disruption. Given the risk of rapid airway deterioration, urgent surgical repair was planned. Airway management was performed while preserving spontaneous ventilation using intravenous fentanyl and incremental inhalational sevoflurane. Videolaryngoscopy (VL) enabled visualization of the glottis, and tracheal intubation was successfully achieved on the first attempt using a gum-elastic bougie and a 7.0-mm cuffed endotracheal tube (ETT). Flexible fiberoptic bronchoscopy (FOB) was then used to advance the tube tip distal to the laceration and confirm tracheobronchial continuity up to the carina. Neuromuscular blockade with intravenous rocuronium was administered only after definitive airway control had been secured, followed by transition to controlled ventilation. Definitive surgical repair proceeded uneventfully. The patient was transferred intubated to the intensive care unit, successfully extubated on postoperative day (POD) 2 following airway assessment, and discharged on POD 6 with minimal residual dysphonia. This case demonstrates that controlled orotracheal intubation under spontaneous ventilation, with bronchoscopic confirmation, can be safely performed in selected cases of partial laryngeal disruption, in contrast to wound intubation, which is typically reserved for complete transections.