• R de Bree, E B Van Nieuwkerk, A Vos, S Ekkelkamp, R D Sibarani-Ponsen, K Haasnoot, and H F Mahieu.
• Academisch Ziekenhuis Vrije Universiteit, Amsterdam.
• Ned Tijdschr Geneeskd. 1999 Jul 24;143(30):1564-8.

AbstractFour newborn boys developed respiratory insufficiency and pneumothorax, pneumomediastinum or subcutaneous emphysema as the result of a laryngeal or tracheal rupture. These ruptures were due to birth injuries after difficult labour resulting from shoulder dystocia or a large lymphangioma and to a birth weight of at least 4500 g. The three children with shoulder dystocia also had a clavicular fracture, a Horner's syndrome, Erb paralysis or phrenic nerve paresis. Treatment consisted of surgical repair followed by a few days' intubation. The children with a shoulder dystocia recovered well, although in one of them a tracheal stenosis had to be resected a few months later. The child with the lymphangioma died from a bifurcation embolus. In newborns with respiratory insufficiency and pneumomediastinum or subcutaneous emphysema after a difficult delivery an emergency laryngotracheoscopy has to be performed to exclude rupture of larynx or trachea.

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