Two cases of upper airway obstruction due to retropharyngeal hematoma after head and neck injuries

• Published in: Nihon Kyukyu Igakukai Zasshi Vol. 25; no. 3; pp. 119 - 124
• Main Authors: Tanaka, Masaou, Yonemitsu, Takahumi, Kawazoe, Yuu, Miyamoto, Kyohei, Kida, Maki, Iwasaki, Yasuhiro, Kato, Seiya
• Format: Journal Article
• Language: English
• Published: Japanese Association for Acute Medicine 15.03.2014
• Subjects: airway management; blunt injury; cervical spine CT
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.25.119

We encountered two cases of upper airway obstruction due to retropharyngeal hematoma. Case 1 involved a 55-year-old man admitted to our hospital following a traffic accident. He had a past history of hypertension. Although he sustained a left femoral neck fracture and contusion on the head and neck, his general condition was stable. About two hours after the accident, his breath sounds became similar to snoring. We performed airway management by cricothyroidotomy. A CT scan demonstrated retropharyngeal hematoma. He was extubated on the 13th day after the hematoma disappeared, and discharged on the 23th day. Case 2 involved a 56-year-old man admitted to our hospital following a traffic accident. He had a past history of coronary artery bypass graft surgery and had been taking anticoagulants. When the ambulance service met him, he was totally alert and his general condition was stable. In forty minutes after the accident, he lost consciousness and his breath sounds became similar to snoring. We performed airway management by oral intubation. As soon as the intubation was done, he recovered consciousness. A CT scan demonstrated no intracranial hemorrhage or hematoma, but retropharyngeal hematoma. He was extubated on the 6th day after the hematoma disappeared, and discharged on the 26th day. Retropharyngeal hematomas can cause fatal upper respiratory tract obstruction. Therefore, careful follow-up is necessary for patients with head and cervical injuries.