Chapter 11 - Airway damage: iatrogenic and traumatic

Summary

Iatrogenic airway injury is mostly caused by laryngoscopy, visualisation of the laryngeal inlet, the placement of a tracheal tube and long-term intubation. Damage to teeth during laryngoscopy is the commonest cause of civil action against anaesthetists. Iatrogenic laryngeal trauma occurs mostly in patients undergoing routine, non-difficult, short-term tracheal intubation. Tracheal intubation-related neuropraxia of the lingual, hypoglossal, and laryngeal nerves have been described. Airway stenosis occurs at any level within the airway following tracheal intubation. Pharyngeal or oesophageal perforation is a serious complication of aerodigestive tract instrumentation, and is associated with a greater severity of injury and risk of mortality than other iatrogenic airway injuries. Trauma to the airway can be broadly classified into two types: external laryngeal trauma which includes blunt and penetrating injuries, and internal airway trauma which includes thermal, caustic and iatrogenic injuries. Non-iatrogenic airway trauma is rare but often life-threatening.