Traumatic lesions of the cervical trachea: conservative or surgical treatment? A systematic review

Traumatic lesions of the cervical trachea are rare but critical conditions potentially resulting either from blunt, penetrating, or iatrogenic injuries. These traumatic events pose challenges in airway management due to their life-threatening nature and need for rapid decision-making. Choice of treatment – conservative versus surgical – depends on injury dynamics, features of the traumatic lesion, and patient-related factors. This systematic review, conducted following PRISMA guidelines on 211 studies involving 509 patients, evaluates management strategies, focusing on indications for conservative versus surgical approaches and differences between adults and children. Surgical treatment was preferred for penetrating and severe blunt traumas, while conservative management, such as distal intubation, was used for small, superficial lesions. Surgical indications included tears > 20 mm, significant subcutaneous emphysema, and ventilation failure. Treatment should be individualised based on lesion characteristics and patient factors. Surgery remains essential for severe cases, while conservative approaches are viable in selected scenarios, especially in children.