The Pathology of Laryngotracheal Complications: Lesions of the Larynx and Trachea After Intubation Anesthesia

Since Elsberg¹reported the advantages of endotracheal anesthesia for certain surgical procedures, much improvement has been made in technique and instrumentation. However, a considerable number of reports²⁻²⁶indicate that lesions of the larynx and trachea are not uncommon after intubation used in such anesthesia. The more common lesions are focal abrasion, hemorrhage, ulceration, and, later, granuloma. Laceration and perforation of the larynx or injuries of the lips, teeth, and esophagus are rare accidents. Scott and Brechner²⁷recently reported a case of retrobulbar hemorrhage resulting from nasotracheal intubation, while Smith, et al.²⁴reported subcutaneous emphysema. The most tragic complication is pseudomembranous laryngotracheitis, which if not immediately and appropriately treated, may lead to sudden death of the patient. This report describes the gross and microscopic findings in the larynges of 23 patients who had been intubated. Most of them died soon after surgery. Two of these deaths were