Paratracheal abscess after traumatic tracheal intubation

Abstract

Major complications of laryngoscopy and tracheal intubation are rare. However, mucosal trauma during airway management can lead to the introduction of oropharyngeal bacterial flora into the deep neck spaces, with the potential for fatal complications. This report describes the development of a paratracheal abscess in a healthy 62-year-old man following an outpatient herniorrhaphy. The patient was treated with intravenous antibiotics and underwent ultrasound-guided needle aspiration of the abscess. He was later re-admitted to the hospital with re-accumulation of the abscess, which was successfully treated by open surgical drainage. Though deep neck space infection following laryngoscopy is more common in patients with significant comorbidities and when tracheal intubation has been difficult, this case highlights the need for careful airway management in all patients.

A dangerous cause of airway obstruction: deep neck infection

“…Patients with pretracheal space infections may develop hoarseness, dysphagia, and severe dyspnea. Prompt surgical drainage is critical, especially in patients presenting with symptoms and signs of airway compromise [22]. Notably, endotracheal intubation can rarely cause pretracheal space infections, leading to tracheal obstruction [23].…”

We Asked the Experts: Fiberoptic Laryngoscopy Needs to be Included as an Adjunct to Primary Survey (ATLS) After Neck Trauma

“…The second reason is to visualize mucosal barrier injury/ breakdown. For the patient with mucosal injury, intubation may worsen the local mucosal trauma, and the potential for the highly morbid and potentially fatal infections of the deep neck spaces [6]. In the patient who requires intubation, this added knowledge might lead to an endotracheal intubation under direct observation, the intubation done by a more senior/experienced physician performing, or a surgical cricothyroidotomy/tracheostomy (in more extreme cases), and appropriate prophylactic antibiotics.…”