From Crisis to Control: Successful Management of Cricotracheal Separation

Abstract

Introduction:
Cutthroat injuries constitute 5–10% of all traumatic injuries and may involve vital neck structures, including the laryngeal framework. Cricotracheal separation, the most severe form of laryngeal trauma per the Schaefer-Fuhrman classification, is a life-threatening emergency requiring immediate airway management and surgical intervention.

Case Presentation:
We report the case of a 34-year-old male with a self-inflicted cutthroat injury resulting in a partial cricotracheal separation. On arrival, the patient was conscious, with stable vital signs but aphonic, and had a deep neck wound exposing the trachea. Emergency tracheostomy was performed through the distal end of the transected trachea, followed by neck exploration and primary repair of the cricotracheal junction using interrupted 3-0 polygalactin sutures. Comminuted thyroid and cricoid cartilage fractures were reconstructed, and postoperative care included antibiotics, corticosteroids, and enteral feeding via Ryle’s tube. The patient was successfully decannulated on postoperative day 9.

Outcomes:
At 10 months of follow-up, the patient demonstrated normal voice quality, fully mobile vocal cords, no evidence of airway stenosis, and no requirement for further airway support. Psychiatric evaluation led to initiation of treatment for depression, and the patient remains stable both physically and mentally.

Discussion:
Cricotracheal separation is a rare but critical component of cutthroat injuries. Immediate airway control, appropriate surgical repair, and multidisciplinary care are crucial for favourable outcomes. Our case highlights the potential for full functional recovery with timely intervention, even in resource-constrained settings.