Rapid awake airway stabilization by direct tracheal intubation through an open cervical wound in severe laryngotracheal injury: a case report.

BACKGROUND: Penetrating neck injuries with open laryngotracheal disruption are rare but represent an extreme airway emergency in which standard airway management algorithms may be unsafe due to profound anatomical distortion. In such situations, airway control must be tailored to the extent of structural disruption. CASE PRESENTATION: We report a 38-year-old woman who sustained a severe anterior cervical stab wound resulting in complete laryngotracheal disruption, including transection of the thyroid cartilage and rupture of the cricoid cartilage. Conventional oral intubation and rapid sequence intubation were contraindicated due to distorted anatomy, and immediate tracheotomy was not feasible under awake conditions. Therefore, awake tracheal intubation through the open cervical wound was deliberately selected as a nonconventional airway management strategy to achieve rapid airway stabilization. Following successful airway control, the patient underwent definitive tracheostomy and surgical reconstruction, with successful decannulation four weeks later. Follow-up examinations at three and six months demonstrated normal vocal cord mobility and showed no evidence of tracheal stenosis on flexible laryngoscopy. CONCLUSIONS: This case highlights the importance of anatomy-driven and innovative airway decision-making and suggests that direct wound intubation may expand the available airway management options in carefully selected patients with severe penetrating laryngotracheal trauma.