الفهرس 
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Abstract
Tracheobronchial injury is a potentially lethal that can be caused by blunt trauma like crushing or twisting injuries, falling from a height, in addition following penetrating injuries and iatrogenic causes. Several mechanisms been suggested. Compression of the trachea by the sternum against the vertebral column, or the explosive force due to forced expiration against closed glottis is the commonest. Most of tracheobronchial injuries involve a main stem bronchus close to the carina; the right side is commonly affected than the left. Serious concomitant injuries as multiple ribs fractures, head or abdominal injuries may occur. Since the tracheobronchial injury often communicate with the mediastinal and the pleural spaces resulting in pneumomediastinum and pneumothorax with progressive symptoms of airway obstruction, the diagnosis is usually suspected, and best confirmed by bronchoscope. TBI is suspected if thoracic trauma of a sever nature implicating upper ribs fractures, progressive mediastinal emphysema and cervical surgical emphysema, and haemoptysis associated with pneumothorax and surgical emphysema is too inconstant. Pneumothorax not responding to drainage by intercostals tube and the lung remains atelectatic and deterioration of the patient?s clinical condition out of proportion to the apparent closed chest injury raises the possibility of such injury. Bronchoscope examination remains the definitive way of diagnosis not only to detect but also to define the site and the extent of any tear or laceration. Immediate thoracotomy is indicated when the tear is confirmed by bronchoscope in presence of sever air leak, mediastinal emphysema, surgical emphysema or fistulate with the esophagus. Right posterolateral thoracotomy provides access to the intrathoracic trachea, associated right main bronchus and proximal left main bronchus. Cervical tracheal tear can be approached by collar cervical incision. Using of absorbable suture is best with less chance for formation of granulation tissue than nonabsorbable suture. Interrupted suture with knots outside is performed than the continuous technique. The suture line can be supported by Teflon or a pleural flap. Postoperative use of bronchoscope examination, nasotracheal suction or forced coughing is important and the patients should be reassessed by bronchoscope and tracheobronchography three months after repair.