Surgical bleeding is an unlikely, but potentially devastating, event during the surgical management of pediatric and adult laryngotracheal disorders. Therefore, an intimate knowledge of the anatomy of the large vessels coursing in the vicinity of the airway is imperative. Anatomic variants in the position of the inominate artery or the superior thyroid artery can place individuals with these variations at particular risk in these cases. Delayed bleeding from an inominate artery fistula is a particularly devastating complication from open airway surgery. A high index of suspicion is necessary to allow for early identification and aggressive treatment of this potential complication.
Key learning points
At the end of this article, the reader will:
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Know if bleeding is expected in the majority of laryngotracheal procedures.
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Be able to identify which injuries can result in potentially fatal bleeding during tracheal surgery.
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Know the factors that contribute to delayed hemorrhage risk after airway surgery.
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Be able to identify the surgical anatomy of the great vessels around the trachea, and the vascular supply to the larynx.
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Know which endoscopic instruments can be associated with bleeding risk during endoscopic airway surgery.
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Know which techniques can be used to mitigate bleeding in the airway.
Introduction
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Unlikely, but possibly devastating, early or late complication of tracheal surgery.
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Potential trauma during thermal control to important adjacent structures (ie, recurrent laryngeal nerve).
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Medical morbidities include:
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Potential for added morbidity owing to airway obstruction when bleeding into the airway;
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Hypoxia; and
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Transfusion of blood products.
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