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Laryngotracheal and pharyngoesophageal traumatic injuries from US military operations in Iraq and Afghanistan, 2003–2017
  1. Michael Coulter1,
  2. R C Mickelson2,
  3. J L Dye3,
  4. E E Myers4 and
  5. A A Ambrosio1
  1. 1 Otolaryngology—Head & Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
  2. 2 Otolaryngology—Head and Neck Surgery, US Naval Hospital Yokosuka, Yokosuka, Yokohama, Japan
  3. 3 Axiom Resource Management, San Diego, California, USA
  4. 4 Naval Health Research Center, San Diego, California, USA
  1. Correspondence to Dr Michael Coulter, Otolaryngology- Head & Neck Surgery, Naval Medical Center San Diego, San Diego CA 92134, USA;{at}


Introduction Laryngotracheal and pharyngo-oesophageal trauma present military providers with especially difficult, life-threatening challenges. Although effective treatment strategies are crucial, there is no clear consensus. This study of combat injuries from Iraq and Afghanistan describes initial treatment outcomes.

Methods US service members who sustained ‘laryngotracheal’ and ‘pharyngoesophageal’ injuries while deployed in military operations from 2003 to 2017 were identified from the Expeditionary Medical Encounter Database. Those with inhalation or ingestion injuries and an Injury Severity Score (ISS) <16 were excluded. Data on demographics, survival, mechanism and type of injury and diagnostic and therapeutic intervention were recorded.

Results A total of 111 service members met inclusion criteria. Nearly one-third (32.4%) were killed in action (KIA) or died of wounds (DoW). Fatality was not significantly associated with age, theatre of operation, type of injury or mechanism of injury, but was associated with a higher ISS and those in the Marines. Although survival rates were not significantly different, the frequency of these injuries decreased after the introduction of cervical collar protection in 2007. Of those who DoW or survived, 41.1% required a surgical airway. Tracheobronchoscopy was performed in 25.6%, oesophagoscopy in 20.0% and oesophagram in 6.7%. Of the 85 with penetrating neck injuries, 43 (50.6%) underwent neck exploration, in which 31 (72.1%) required intervention.

Conclusions Severe laryngotracheal and pharyngo-oesophageal injuries have a high fatality rate and demand prompt treatment from skilled providers. Further work will elucidate preventive measures and clear management algorithms to optimise outcomes.

  • adult otolaryngology
  • head & neck surgery
  • laryngology
  • otolaryngology
  • trauma management
  • oral & maxillofacial surgery

Data availability statement

Data may be obtained from a third party and are not publicly available.

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Data availability statement

Data may be obtained from a third party and are not publicly available.

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  • Contributors MC: data collection, manuscript chief editor. RCM: data collection, assistant editor. JLD: database mining, background research. EEM: statistical analysis. AAA: study design, senior author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer I am a military service member (or employee of the US Government). This work was prepared as part of my official duties. Title 17, U.S.C. §105 provides the 'Copyright protection under this title is not available for any work of the United States Government'. Title 17, U.S.C. §101 defines a US Government work as work prepared by a military service member or employee of the US Government as part of that person’s official duties. This work was supported with resources provided by the US Navy Bureau of Medicine and Surgery’s Wounded, Ill, and Injured Program, Work Unit No. 60808. The views expressed in this research are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of the Army, Department of the Air Force, Department of Veterans Affairs, Department of Defense or the US Government. Approved for public release; distribution unlimited. This research has been conducted in compliance with all applicable federal regulations governing the protection of human subjects in research (protocol NHRC.2017.003).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.