Neck, Laryngeal, and Tracheal Trauma and Stenosis

54 Neck, Laryngeal, and Tracheal Trauma and Stenosis


54.1 Classification of Laryngeal Trauma


• Type:


figure Penetrating


figure Blunt


figure High velocity


figure Low velocity


• Site:


figure Supraglottis


figure Glottis


figure Subglottis


figure Hyoid


figure Cricoarytenoid


figure Cricothyroid


54.2 Soft Tissue Injury


• Oedema


• Haematoma (Fig. 54.1)


figure Supraglottic


figure Paraglottic


figure Reinke space


• Web: abrasions at anterior commissure


• Glottic incompetence


figure Arytenoid fixation


figure Resorption of the thyroarytenoid muscle


figure Atrophy of the cord


figure Recurrent laryngeal nerve palsies


54.3 Injuries to Skeletal Framework (High-Velocity Blunt)


• Loss of U-shaped rings—exertional dyspnea


• Granuloma formation


• Hyoid # (± bursa formation)


• Thyroid cartilage and arytenoids—depends on calcification:


figure # Line down thyroid prominence


figure Elastic cartilage—pre-epiglottic space bleeding with posterior displacement of epiglottis


figure Calcified cartilage—detachment of tendon of ant. commissure and petiole of epiglottis


figure Compressed calcified thyroid cartilage has to be reconstituted and stented


• Cricotracheal separation—usually results in fatality


54.4 Clinical Features of Upper Airway Injury


• Symptoms of upper airway injury


figure Dysphonia


figure Dyspnea


figure Odynophagia


figure Neck pain


• Signs of upper airway injury


figure Stridor


figure Cervical ecchymosis


figure Surgical emphysema in the neck


figure Loss of thyroid prominence


figure VC fixation


figure Gastric dilatation


figure Associated damage:


– Great vessels


– Cervical spine


– Chest—hemothorax/pneumothorax/emphysema/distant oesophageal tears


54.5 CXR Signs


• Incomplete bronchial transaction—apex of collapsed lung sits at level of hilum


• Deep cervical emphysema—radiolucent line along prevertebral fascia


• Peribronchial air


• Sudden obstruction along course of air-filled bronchus


• Fracture of 1st rib/scapula/sternum suggests severe injury with airway trauma


54.6 Management


Remember airway, breathing and circulation and also C-spine!


• Oedema only—bed rest


• No major mucosal laceration with visualization of tracheal lumen—ETT


• Immediate threat of loss of airway—tracheostomy


• Associated bronchial injury—intubate uninjured bronchus before thoracotomy


• Emergency thoracotomy for great vessel damage



figure

Fig. 54.1 Laryngeal trauma, with a haematoma on the inner larynx.


54.6.1 Laryngeal Framework Damage


• General supportive measures:


figure Bed rest and voice rest

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Jul 4, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Neck, Laryngeal, and Tracheal Trauma and Stenosis

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