Surgical Treatment of a Life-Threatening Large Retropharyngeal Hematoma after Minor Trauma : Two Case Reports and a Literature Review

Abstract

Only a few cases of anterior longitudinal ligament (ALL) injury related with retropharyngeal hematoma without fracture have previously been reported. The treatment of choice for retropharyngeal hematoma is generally considered to be conservative care, but we believe that early surgery of this pathology would be better in certain situations. Here, we describe two cases with life-threatening large retropharyngeal hematomas related with ALL injuries and operated on at an early stage. Two previously healthy patients visited the emergency room with neck pain and dyspnea after falling. Serious neck swelling was observed and lateral neck X-ray showed severe widening of the prevertebral space. Due to dyspnea progression, emergency endotracheal intubation was performed. Although there was no primary cause of the retropharyngeal hematoma on preoperative examination, ALL tearing was intraoperatively confirmed during early surgery. The in-hospital evolutions of the patients were favorable after surgery. We should bear in mind the possibility of ALL injury and perform early surgery where possible given the earlier convalescence and good prognosis.

Analysis of the Risk Factors Associated with Prolonged Intubation or Reintubation after Anterior Cervical Spine Surgery

“… 6 7 8 9 10 These life-threatening airway distresses should be managed initially with endotracheal intubation or tracheostomy. 11 However, unplanned reintubation or tracheostomy after cervical surgery may result in plate or graft displacement, hypoxia or even death. 8 To avoid these issues, overnight intubation is often recommended to protect airway patency.…”

Traumatic Retropharyngeal Hematoma following Cervical Vascular Injury: A Case Report

“…They are associated with major cervical trauma, such as cervical fracture, anticoagulant therapy, iatrogenic injury, infections, foreign body ingestion, and vascular lesions. 6) However, a few cases of retropharyngeal hematoma after minor blunt force trauma without associated cervical fracture have been reported. 4 5 6) …”

“… 6) However, a few cases of retropharyngeal hematoma after minor blunt force trauma without associated cervical fracture have been reported. 4 5 6) …”

“…Surgical evacuation of large, rapidly expanding hematoma is indicated although in most cases conservative treatment is recommended. 4 6 7 8) Despite advancement in endovascular embolization of intracranial aneurysmal lesion, thoracic and abdominal traumatic lesion, very few cases have been reported embolization as the treatment option of retropharyngeal hematoma. 1 2) The choice between traditional surgical approach or endovascular approach depends on the clinical status of the patient, complexity and approachability of the lesion, availability of interventionist, and associated injury including esophagus, trachea, spinal structures.…”

Retropharyngeal hematoma secondary to cervical hyperextension in a minor collision trauma presenting with dyspnoea

“…In addition to spontaneous development, various other reasons that can cause retropharyngeal hematoma include anticoagulant therapy, infection, foreign body ingestion, vascular lesion, and trauma. [ 1 – 3 ] Interestingly, major trauma is usually associated with retropharyngeal hematoma, although minor trauma may also cause huge hematoma and is usually associated with delayed retropharyngeal hematoma. [ 1 , 4 ] The insidious progression of the hematoma over several hours delays symptoms and causes the hematoma to become huge.…”