BACKGROUND: We aimed to diagnose possible acute kidney injury (AKI) with new early biochemical markers in patients who were admitted to the emergency department frequently with mild and moderate brain trauma, and to prevent possible complications, shorten the duration of treatment and hospital stay. With this purpose, we decided to reach our scientific target using the experimental rat model.
METHODS: Wistar albino rats were included our experiment. Fifteen rats were randomly separated into three groups: Sham control (n=1: Underwent craniotomy alone), control (n=7: Without craniotomy), and trauma group (n=7: Underwent craniotomy followed by brain injury).
RESULTS: There were no significant differences groups creatinine levels within 0 and 24 h (0.35±0.02 and 0.33±0.03, respectively, p>0.05). Plasma NGAL and KIM1 concentrations were statistically significant different in both control and trauma groups (Friedman p<0.05) and significant differences at both NGAL and KIM-1 concentrations at dual comparisons by means of all sampling time (0–2 h, 0–24 h, and 2–24 h) (Wilcoxon p<0.001, after Bonferroni correction).
CONCLUSION: The presence of AKI in patients with mild-to-moderate brain trauma increases the risk of mortality. Early diagnosis of AKI reduces the hospitalization period and requiring of dialysis. Diagnosis of AKI within 24 h with early biomarkers and starting therapy is crucial issues.

BACKGROUND: Acute respiratory distress syndrome is a devastating complication of severe sepsis. Preclinical models suggest that direct lung injury begins with attack to the lung epithelium, but indirect lung injury results from systemic endothelial damage due to inflammatory mediators. The aim of the present study was to explore the effect of octreotide on lungs in a surgically induced sepsis model in rats.
METHODS: We used 32 male Sprague Dawley rats and divided into four groups. Group 1: Normal (non-operative and orally fed control, n=8); Group 2: Sham operated (n=8); Group 3: Cecal ligation and puncture (CLP) (untreated group, n=8); and Group 4: CLP and 100 µg/kg octreotide i.p. (n=8). For sepsis, CLP procedure was performed on 16 rats to induce a sepsis model. All groups were analyzed, their blood was taken for arterial blood gas analysis. For histological examination, lung tissues were removed and sections were prepared.
RESULTS: In histological examination, if we compare CLP + Octreotide with only CLP group in CLP + Octreotide group decreased inflammatory cell infiltration in alveolar and interstitial area as well as edema, bleeding, when CLP group was compared with octreotide group, all histopathological parameters improved significantly and the severity index decreased from 3 to 1. For arterial blood gas, when CLP and octreotide groups were compared with CLP group, it was observed that there was a significant change in favor of healing and that they almost came up to controls and sham group.
CONCLUSION: It could be hypothesized that it would be beneficial to administer octreotide for ameliorate lung injury state in sepsis patients.

BACKGROUND: It was aimed to determine whether Alpinia officinarum (AO) (galangal), which has been regarded to be effective on wound healing, is healing on experimental contact type burns and compare its effects with silver sulfadiazine (SSD).
METHODS: Thirty-five rats were divided into five groups of seven rats each group. Superficial second degree burns were formed by contacting a 1×1 cm copper tip which was kept at 100°C constant temperature to the three shaved areas on the back of rats without applying any pressure for 10 s. All groups were irrigated with a 100 cc saline solution for 2 min. Any procedure or treatment was not applied to Group I (Control). Group II (Burn Control) was only irrigated, Group III (SSD) was applied topical SSD 4 times, with 6-h intervals (at h 0, 6, 12 and 18), Group IV (Galangal) was applied topical AO 4 times, and Group V (Gel) was applied placebo topical material, used for the preparation of topical AO, 4 times. Wound healing findings were evaluated histopathologically.
RESULTS: In the galangal group, it was found that collagen discoloration didn’t penetrate into deep dermis compared to other groups; epidermis, hair follicles, and sebaceous glands remained protected compared to the burn control group, and there was a thicker layer of epidermis. It was found that the galangal group was the closest group to the control group histologically. In the galangal group, it was determined that the number of vessels and total hair follicles were significantly higher in the 8th h and 4th h respectively (p<0.05), while epidermal thickness and number of degenerated hair follicles were significantly higher in all hours compared to other three groups (p<0.05). It was determined that galangal group had the lowest scores in the evaluation of edema, polymorphonuclear leukocytes infiltration, collagen discoloration, injury of vessels, hair follicles and sebaceous glands in comparisons between groups and within groups’ own processes.
CONCLUSION: Administrating AO containing gel 4 times a day within the first 24 h is effective in the experimental contact type second degree burn model. It is significantly superior to SSD treatment, especially in the first 8 h of administration.

BACKGROUND: With the rapid and effective change created by the COVID-19 pandemic in all medical practice, we aimed to evaluate the impact of the first 100 days of the COVID-19 pandemic on the operations performed in a reference university hospital in the field of orthopedics and traumatology. Compare the results with the same period of the previous year and aim to evaluate importance of restrictions.
METHODS: The operations performed in orthopedics and traumatology clinic between March 18, 2020 (the day we stopped the elective surgeries), and July 1, 2020 (when the normalization process began), were collected from the electronic archive to compare with the same period of 2019.
RESULTS: Comparing the same periods of the year, it was seen that 102 surgeries were performed in the 2020 COVID-19 period compared to 380 operations performed in 2019. Although most of the operations performed during the COVID-19 period were traumas, the comparison revealed that trauma cases decreased by 25% from 73 to 58 (p<0.001). Among trauma patients operated in the restraint period, decrease in the pediatric group and the increase in patients over 65 years of age had seen statistically significant. Compared to the same period of the previous year, 50% increase seen in amputation cases related to diabetic foot (p<0.001).
CONCLUSION: The postponement of elective cases due to the COVID-19 pandemic enabled us to manage trauma cases despite decreasing capacity utilization. In addition, it was observed that the transition of schools to online education and the implementation of curfews significantly reduced the number of trauma in the pediatric group. Separation of operating rooms and wards had a huge effect on protection of non-COVID patients. We hope that, in light of this study, we can guide health policies and help other colleagues to manage the possible new waves of the pandemic process or similar processes that may occur in the future.

BACKGROUND: Recognition and management of abdominal emergencies in geriatric patients are more complicated compared to the younger population. We aimed to investigate the demographic characteristics of geriatric patients diagnosed with acute appendicitis and to investigate the factors associated with perforation in the early stages in this study.
METHODS: After obtaining local ethical committee approval, patients 65 years and older who had appendectomy between January 2015 and December 2019 were included the study. Demographic data of the patients, physical examination findings, and laboratory results were analyzed. Patients were divided into two groups based on surgical reports: Perforated and simple appendicitis.
RESULTS: During the study period, 72 patients were evaluated. In our study, 48.6% of the patients were male, and the median age was 71.5 years (IQR 25–75, 68–80). Perforated appendicitis was detected in 28% of the patients. We were determined that the vast majority of patients with perforated appendicitis were male; had more frequent chronic kidney disease and post-operative local complications; had increased leukocytes, neutrophils, blood urea nitrogen, creatinine, and total bilirubin; and had reduced albumin; and these differences were statistically significant (all values p<0.05). Multivariate analysis shows increased neutrophil count and male sex was significantly associated with perforated appendicitis (p=0.035 and p=0.01, respectively).
CONCLUSION: Geriatric patients with chronic kidney disease can be at higher risk of perforated appendicitis due to inadequate abdominal physical examination results. In addition, male gender and an elevated neutrophil count are independent predictors of perforation.

BACKGROUND: The emergency department (ED) admission rate for elderly patients with non-variceal upper gastrointestinal bleeding (UGIB) is increasing. The AIMS65 and Glasgow-Blatchford score (GBS) are two distinct scoring systems proposed to predict in-hospital and post-discharge mortality, length of stay (LOS), and health-related costs in these patients. The objective of the present study is to evaluate the accuracy of these scoring systems, in conjunction with the Charlson comorbidity index (CCI), to predict 30-day mortality and LOS in UGIB patients who are 80 years of age or older
METHODS: A retrospective analysis was undertaken of 182 patients with non-variceal UGIB who were admitted to the ED of Canakkale Onsekiz Mart University Hospital. The AIMS65, GBS, and CCI scores were calculated and adverse patient outcomes were assessed.
RESULTS: The mean age of patients was 85.59±4.33 years, and 90 (49.5%) of the patients were males. The AIMS65 was superior to the GBS (area under the receiver operating characteristic curve [AUROC] 0.877 vs. 0.695, respectively) and CCI (AUROC 0.877 vs. 0.526, respectively) in predicting the 30-day mortality. All three scores performed poorly in predicting the LOS in hospital. The cutoff threshold that maximized sensitivity and specificity for mortality was three for the AIMS65 score (sensitivity, 0.87; specificity, 0.80; negative predictive values [NPV], 0.977; positive predictive values [PPV], 0.392), 14 for GBS (sensitivity, 0.83; specificity, 0.51; NPV, 0.923; PPV, 0.367), and 5 for CCI (sensitivity, 0.91; specificity, 0.22; NPV, 0.946; PPV, 0.145).
CONCLUSION: The AIMS65 is a simple, accurate, and non-endoscopic scoring system that can be performed easily in ED settings. It is superior to GBS and CCI in predicting 30-day mortality in elderly patients with UGIB.

BACKGROUND: This study aims to examine the factors affecting the selection of anaesthesia method in Fournier’s gangrene.
METHODS: A retrospective evaluation was made of 113 patients operated on because of Fournier’s gangrene between January-May 2019. The operations were performed under spinal anaesthesia in 78 cases (Group S) and under general anaesthesia in 35 cases (Group G). The patients were evaluated regarding age, gender, the anaesthesia method used (spinal, general) anaesthetic agent applied, presence of sepsis, and biochemical, hematological and inflammatory parameters.
RESULTS: When the patients were evaluated regarding the Fournier Gangrene Severity Index (FGSI), patients in Group S had lower scores (p=0.001). Examination of the tomography images revealed that in 13 (37.1%) patients, air values were seen in the right or left gluteal area, or both, extending to the subcutaneous tissue. In the evaluation of the factors affecting the selection of general anaesthesia, a positive correlation was determined between an increase in FGSI (r=0.482, p=0.001) and the presence of sepsis (r=0.485, p=0.001) and gluteal region involvement (r=0.628, p<0.001).
CONCLUSION: The selection of anaesthesia method in Fournier gangrene patients is a complex process affected by factors, such as the patients’ general condition, sepsis, and whether or not there is bleeding diathesis. The risk -benefit balance in the selection of anaesthesia method should be evaluated individually for patients.

BACKGROUND: Burns are common injuries among children resulting with significant mortality and morbidity, especially in developing countries. Epidemiological data may guide for the preventive measures and contribute reducing the incidence of burns in children. The aim of this study is to report the epidemiological features of pediatric burn patients treated in a tertiary burn center and to suggest preventive measures.
METHODS: Between January 1, 2015, and June 30, 2019, a total of 1442 children hospitalized in our burn center were evaluated retrospectively. Demographic, epidemiological, and clinical data including burn etiology, percentage of burned total body surface area (TBSA), hospital stay, infection, and mortality rate were reported.
RESULTS: The percentage of burned TBSA was 11.23±10.70 and the length of hospital stay was 14.38±18.1 days. In total, 89.18% of the patients (n=1286) experienced burn injury indoors. With regard to the etiology, scalding with hot water and tea was the most common in all age groups. Flame burn incidence increases after infancy, and electrical burns occur more in school age. A total of 10 patients (0.69%) were died and seven of them were delayed referrals from other hospitals.
CONCLUSION: Infants and males consist of the majority of our pediatric burn patients. The percentage of burned TBSA and length of hospital stay increased as the patient age increased. Childhood burn injuries are mainly scald burns that occur indoors, while their parents were nearby. Therefore, education programs focusing on primary prevention addressing family members are required to avoid pediatric burns.

BACKGROUND: This study aims to determine whether refugee patients are more likely to present with complicated appendicitis.
METHODS: Patients who were hospitalized and treated with the diagnosis of acute appendicitis in a single center between 2018 and 2020 were evaluated within the scope of this study, and the included patients were divided into two groups as refugees (n=140) and local patients (n=386). The primary outcome was complicated appendicitis rate, and the duration of symptoms, time to appendectomy, operation time, diagnostic modality, and length of hospital stay were also analyzed. According to operational diagnosis and pathology reports, cases were categorized as either non-complicated or complicated.
RESULTS: The complicated appendicitis rate, and the number of patients with symptoms lasting longer than 72 h were statistically more significant in refugee patients (p=0.009 and n: 186, p=0.000, respectively). The refugee patients had a younger mean age and a higher male patient rate which was statistically significant (p=0.000 for both). There was no significant difference between the groups concerning time to appendectomy, operation time, type of surgery, hospital length of stay, and diagnostic modality (p>0.05).
CONCLUSION: The findings of this study demonstrated that refugee patients have a higher complicated appendicitis rate and late admission rate, even though refugee patients have equal access to healthcare in our country. Future research is needed to identify factors affecting outcomes of refugee patients.

BACKGROUND: Violence against women deprives women of their rights to enjoy equality, security, dignity, self-worth and fundamental freedoms and devalues them; is one of the most significant social facts that force women to exist at a lower social level than men and constitute a significant obstacle to the formation of healthy societies. This study was conducted to determine the status of exposure to spousal violence of 15 years and older married women living in the city center.
METHODS: Family health centers in Elazig Province were visited and 792 married women were selected from the related records by systematic sampling. As a data collection tool, a questionnaire form was used. The questionnaire consists of two parts. In the first part, participants were asked about demographic characteristics such as age, gender, education level, and profession, while in the second part, questions were asked to determine the extent of exposure to violence. Questionnaires were filled out using interview technique by making home visits.
RESULTS: It has been found that the low level of education of the wife and her spouse, perception of the economic situation of the family as being bad, and the fact that the woman does not work in an income-generating business can be an important factor in exposing to both physical violence and economic violence by her husband.
CONCLUSION: Conclusion: Rate of exposure to spousal violence is high in married women living in the city center of Elazig Province. Education and services should be provided for solving the problem at individual, familial, and social levels.

BACKGROUND: Overtime, agricultural machines have been designed appropriate to more simple needs, instead of tractors which have a wide area of use. An example of these is the “patpat,” so named because of the sound of the motor, and for which the main purpose is ploughing.
METHODS: A patpat is a single-axle, two-wheeled tractor with a trailer attached. In this descriptive study, the descriptive characteristics and causes of death were analyzed of case related to patpat accidents for which autopsies were performed by the Forensic Medicine Institution Trabzon Group Directorate between 2006 and 2017.
RESULTS: Information was retrieved from the scene of accident examination documents, and the autopsy and laboratory records. The 21 cases comprised 17 (81%) males and 4 (19%) females, with a mean age of 47.6±20.3 years (median: 57, range: 10–75 years). Of the total accidents, in 85.7% (n=18), no other vehicle was involved. Following the accident, 52.4% (n=11) of the patpats were found at the side of the road, and 33.3% (n=7) at the edge of a stream or at the bottom of a steep valley. The cause of the accident was determined to be that the patpat had overturned on a bend in 33.3% (n=7) cases and in 85.7% (n=18) of cases, the patpat was found overturned or on its side. The most common injury was being thrown from the vehicle (38.1%, n=8), and in 66.7% (n=14) of cases, the deceased was the patpat driver.
CONCLUSION: Patpat accidents are a serious problem because of the frequency of use of these vehicles without proper supervision and especially because of the hazardous topographical conditions where they are used.

BACKGROUND: Majority of the pediatric burns happen when an adult is nearby the child. This suggests the role of adult carelessness or neglect as a cause of burns. The aim of this study is to provide clinical data on pediatric hand burns and to draw attention to the role of neglect in pediatric burn injuries.
METHODS: Children admitted to a tertiary burn center between September 2017 and October 2018 were included in the study. Epidemiological data including age, sex, etiology and place of injury, presence of caregiver nearby, physical signs of neglect or abuse, clinical outcomes including burned total body surface area, length of admittance, and complications were recorded.
RESULTS: A total of 335 pediatric burns were admitted to the burn center. Among them 89 patients with hand involvement were included in the study. Most of the patients were under the age of 6 (79.8%) and 88.8% of the burn accidents occurred indoors. Scalding was the main mechanism for hand burns. There was an adult nearby in 71.9% of the patients. Among patients with hand involvement, 19 (21.35%) were considered as neglect. All the neglect cases were under the age of 6.
CONCLUSION: Pediatric burn accidents occurred mainly at home, mostly with an adult around. Habits of drinking hot beverages, dangerous cooking practices and lack of awareness are some important issues leading to burn accident. Neglect is found in 21.35% of hand burns as the etiology. In addition to general preventive measures special attention should be paid to the signs of neglect in the evaluation of patients. These burns should also be reported to official services, as they may reflect inadequate supervision or neglect by the caregiver.

BACKGROUND: In this article, we aimed to evaluate results of patients who acquired various injuries during Libya civil war who then were transferred to our facility with genitourinary trauma for further assessment and treatment.
METHODS: A total of 121 wounded patients, including 21 (17.3%) with 1 or more combined urogenital injuries, were treated at Yeni Yüzyýl University Private Gaziosmanpaþa Hospital from October 2014 to September 2016.
RESULTS: Of the 21 patients, 13 (61.9%) were injured by explosive weapons, while the rest 8 (38.1%) had bullet wounds. The 21 urogenital injuries were to the kidney in 7 cases (33.4%), ureter in 5 (23.8%), bladder in 5 (23.8%), scrotum in 2 (9.5%), and penis in 2 (9.5%). There was associated damage to organs other than the urogenital system in 21 patients (100%). Two patients had nephrectomies performed on-site medical facility. The rest of patients had no urogenital organ resections. Urogenital trauma had higher rates of liver damage, generalized infection, blood transfusions, and longer hospital stay.
CONCLUSION: Knowing that war related surgery patients should be approached as a distinct and non-standard category, every case must be evaluated individually. Patients should be evaluated in a multidisciplinary approach and physicians should be aware of infections affecting morbidity and mortality.

BACKGROUND: The purpose of this study is to investigate the effects of implemented social isolation measures on the characteristics of orthopedic pediatric traumas during this COVID-19 pandemic lockdown period.
METHODS: Patients who were admitted at our center between two time periods: April 3, 2019–May 31, 2019 (no lockdown period) and April 3, 2020–May 31, 2020 (lockdown period) were included to the study. Group 1 comprised 743 patients who were treated during no lockdown period, whereas Group 2 comprised 615 patients who were treated during lockdown period. Patients’ medical records and radiographs were reviewed through our hospital’s computer database. In addition, we recorded each patients’ age and gender, their definite diagnosis, the anatomic location of the trauma, the type of trauma (fracture, dislocation, tendon injury, ligament injury, fracture dislocation, open fracture, etc.), the type of pediatric fracture (displaced fracture, torus fracture, epiphyseal fracture, pathological fracture, etc.), and the treatment method (non-operative/operative).
RESULTS: The mean age of the patients was significantly lower in Group 2 (p<0.001). There were significant differences between the groups in terms of anatomic locations of the traumas (p<0.001). The types of the traumas, pediatric traumas, and treatment were significantly different between the groups (p<0.001, p<0.001, and p<0.001, respectively). The frequency of operative treatment was significantly higher in Group 2 (p<0.001).
CONCLUSION: Our results demonstrated significant differences in patients’ demographics as well as trauma characteristics during COVID-19 pandemic.

BACKGROUND: Mandibular condyle fractures can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation. Although many studies have discussed for the optimal treatment method, the issue remains controversial. In this study, we aimed to compare conservative techniques in the mandibular condyle fractures.
METHODS: Twenty four unilateral condyle fracture patients aged between 18 and 48 years were treated according to one of three different modalities. Bracketing, arch bar or mini screw was applied to all non-surgery patients to obtain IMF. Eight patients were treated with only IMF meanwhile eleven patients were treated with one or double-sided amplifier occlusal splint according to the status of fractured segments, in addition to IMF. Remaining five patients have undergone open reduction and fractured segments immobilized with mini plates. Pre- and post-operative images were recorded with a computerized tomography device. Clinical and radiological examinations were performed by orthodontists and surgeons at baseline and at 6 months of treatment.
RESULTS: The condyle lengths of the patients with unilateral fracture after recovery were compared with the unaffected side. The length between the most protruding point of the condyle and the mandible was measured and the length difference was only 5.94 mm in patients who were treated by IMF. The length difference of patients who used brackets and splints was 3.36 mm (p<0.05). The length difference of patients who were repaired by plate screws was 1.80 mm (p>0.05). However, there was no statistically significant difference (p>0.05) between the groups in the IMF, occlusal splint and IMF and mini plate groups, between the trauma side and the opposite side. None of the patients developed ankylosis, open mouth, limitation of mouth opening, facial asymmetry, laterognathia, and retrognathia. The occlusion of the patients who were not known to have pre-trauma occlusions were directed, repositioned and provided an appropriate occlusion.
CONCLUSION: The use of IMF with an occlusal splint is a more conservative and acceptable treatment modality than open reduction in selected cases.

BACKGROUND: Fractures of proximal femur are rarely seen in childhood. These fractures can result in serious complications such as avascular necrosis (AVN), coxa vara, and early closure of the femoral epiphysis. The aim of this study is to investigate retrospectively the Delbet type 2 fractures that are commonly seen and has high rates of AVN.
METHODS: Forty-two patients whose Delbet type 2 fractures were treated in our hospital between January 2009 and June 2018 were analyzed. The patients’ mechanism of fracture formation, displacement of the fracture, presence of accompanying injuries, timing of surgery, open or closed reduction, whether the screws cross the epiphyseal growth plate epiphyseal line, and AVN data were analyzed retrospectively.
RESULTS: Of the 42 screened patients, 34 patients with complete follow-up graphs and files were included in the study. The mean age of the patients was 11.02 years (1–17 years old), and the mean follow-up time was 40.82 months (range 24 to 98 months). When the follow-up radiographs of the patients were examined, it was found that AVN in 9 patients (26.5%), coxa vara in 2 patients (5.9%), and non-union in 1 patient (2.9%). The AVN rate was significantly higher in patients with high-energy injuries and high fracture displacement at baseline (p=0.034 and p=0.047, respectively).
CONCLUSION: According to our findings in Delbet type 2 fractures, other than the severity of the trauma and the initial displacement of the fracture, factors related to the treatment process do not have a significant effect on the development of AVN. Age was not determined as a risk factor for the development of AVN in these patients.

We report an incidental finding on 99mTc-labelled RBC gastrointestinal bleeding scintigraphy of a 49-year-old female patient referred to our clinic in order to localize the bleeding site. The patient has also been suffering from chronic renal insufficiency and received several interventions of femoral catheterization. During the follow-up, an intense uptake was observed at the right inguinofemoral area which is evaluated as a large soft tissue hematoma and confirmed by SPECT/CT subsequently. On the 24th h delayed image an activity accumulation along the bowel trace on the right side of the abdomen was seen as evidence of lower gastrointestinal bleeding.

Extrahepatic bile duct injuries are very uncommon and easily be missed in multitrauma patients. Patients suffer from bile duct injuries need special approach to this situation. In this report, a case with total transection of common hepatic duct and treatment approach was presented. In unstable patients, damage control surgery can be applied. A 32-year-old male patient was brought to the emergency department after a beating that includes multiple blunt trauma. Radiological screening showed cranial, nasal, lumbar vertebral, and costal bone fractures, decreased blood flow to the right kidney and free perihepatic and perisplenic fluid. Neurosurgeons operated this patient at the day of admission and no plan for laparotomy was made for this patient at that time. Second day postoperatively patient was transferred to the department of surgery and exploratory laparotomy has been made. Common hepatic duct was fully transected and because of the patient’s hemodynamic instability, an external fistula has been made. The patient discharged 10th day postoperatively. The patient was operated after follow-up and a Roux-en-y hepaticojejunostomy has been made. Extrahepatic bile duct injuries are rare and high suspicion is important in complex multitrauma patients. Extent of the injury is unique for every patient and technical aspect of repair can be challenging.

Trans-sectional injuries of trachea are quite rare and can be extremely challenging for anesthesiologists to deal with. About 25% of post-traumatic deaths are due to thoracic traumas in which blunt injuries take a rather small place within and the resultant damage of respiratory tract is quite rare with an incidence of 0.5–2%. A recent review from a single trauma center revealed an incidence of 0.4% for tracheobronchial injury (TBI) due to blunt thoracic injuries. Most of the patients having tracheal transection lose their lives on the field due to loss of airway. Patients mostly present with a large spectrum of clinical features varying from hoarseness to respiratory collapse; though subcutaneous emphysema is the most common presenting sign which should remind possible TBI. Emergent surgery is preferred seldomly; such in cases of partial damage or because of late diagnosis, due to favorable outcome of conservative approach. Herein, we report the management of a case on TBI due to blunt thoracic trauma, experiencing difficult ventilation despite tracheal intubation. Fiber-optic bronchoscope (FOB) seems obligatory to visualize site and severity of injury and to ensure safe airway during procedures such as the neck exploration, primary end-to-end anastomosis of the trachea, tracheostomy, diversion pharyngostomy, and feeding jejunostomy.