Combined cervicothoracic surgical repair of an extensive tracheal laceration following endotracheal intubation: a case report

BACKGROUND: Tracheal membranous laceration is a rare but life-threatening complication of endotracheal intubation. Most reported tears are short (< 4 cm) and confined to either the cervical or the thoracic trachea. We present a case of an exceptionally extensive posterior tracheal laceration (estimated length spanning nearly the entire intrathoracic trachea) that required a combined cervicothoracic surgical approach, highlighting a reproducible repair strategy. CASE PRESENTATION: A 66-year-old man underwent endoscopic submucosal dissection under general anesthesia. Twenty minutes after uneventful intubation, a sudden air leak and cuff rupture occurred. Bronchoscopy revealed a full-thickness longitudinal tear from approximately 3 cm below the vocal cords to 2 cm above the carina. Emergent repair used a combined right thoracoscopic (VATS) and cervical approach: the thoracic portion was closed with interrupted 3 - 0 non-absorbable sutures after division of the azygos vein, and the cervical portion was repaired through a longitudinal anterior tracheotomy. No intraoperative complications occurred. The patient was extubated on postoperative day 1 and discharged on day 12. At 3-month follow-up, complete healing without stenosis was observed. CONCLUSIONS: This case demonstrates that a combined cervicothoracic approach is safe and effective for extensive tracheal lacerations that cannot be adequately exposed by a single incision. The technique provides complete visualization, allows tension-free watertight closure, and minimizes recurrent laryngeal nerve injury.