laryngeal trauma - lectures/larynx...4/14/2009 1 laryngeal trauma prof. m.hesham department of...

4/14/2009

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Laryngeal Trauma

Prof. M.HeshamDepartment of ORL-HNS

Alexandria Faculty of Medicine

What Makes the larynx vulnerable to trauma ?

•Cross road

•Rigid structures

•Subcutaneous

•Vertebral column•Vertebral column

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What protects the larynx against trauma ?

•Cartilage VS Ossified

•Mandible

•Sternum

•Vertebral column

Protective mechanisms

•Reflex closure of the laryngeal inlet

•C h r fl•Muscles

•Cough reflex

Types of laryngeal trauma

A. External trauma

1. Closed

2. Open

B. Internal trauma

1. Through upper air passages

2. Through upper food passages

C. Psychological trauma

D. Voice trauma

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Voice trauma•Voice users

•Singer’s nodes Screamer’s nodes•Singer s nodes Screamer s nodes

Closed external trauma

Trauma applied to the larynx through the frontTrauma applied to the larynx through the front of the neck while the skin of the neck is not cut.

•Blunt trauma

•Physical trauma y

•Burns

•Radiotherapy

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External blunt traumaMechanism

External blunt traumaCauses

•Motor car accidents

•Sport injuries

•Recreation vehicles

•Hanging and throttling

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External blunt traumaInjuries

More internal than external damage

•Soft tissue injuries•Hematoma•Dislocation

More internal than external damage

•Fractures•Esophageal tear

Cricotracheal separation Immediate death

External blunt trauma

Clinical picture

History of trauma to the necky

Asymptomatic in early cases

Symptoms:

•Dysphonia

•Dyspnoea

•Dysphagia•Dysphagia

•Cough

•Aspiration

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Neck SwellingEmphysemaEchymosisPain

Signs:•External

Do not move the neck until cervical fracturesDo not move the neck until cervical fractures ruled out

•Cervical emphysema Tear

•Edema Hemorrhage

•Loss of laryngeal prominence Fracture

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Signs:• Internal

Indirect Laryngoscopy

Hemorrhage

Laceration

Arytenoid dislocation

Immobility

Investigations

External blunt trauma

•Radiology

•Plain Xray•CT scan •Barium swallow

Air

Fractures

OOther injuries

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External blunt trauma

Management

Hospitalization

Observation

Secure airway

Even if the external signs are minimal

The patient may deteriorate rapidly

ManagementExternal blunt trauma

•Recognition of the extent of injury

•Stabilization of the airway

•Restoration of an intact cartilagenous framework

•Reestablishment of internal mucosal integrity

•Prevention of infection

•Prevention of stenosis

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External blunt traumaManagement

•Conservative

•Endoscopic

•Open surgery

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Open external trauma

Trauma to the larynx through the neck by a sharp y g y pobject that leads to cutting of the skin

•Gunshot

•Stab wound

•Cut throat

•Less dangerous than the closed trauma

•Suffocation

•Death from carotid bleeding

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Internal trauma•Foreign bodies

•Caustic soda or potashp

•Inhalational of caustic fumes and irritant gases

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Surgical trauma

ExternalExternal

Thyroidectomy

Open heart surgery

Tracheotomy

Internal

Endotracheal intubation

Endoscopy

Intubation injuries

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Intubation injuries

Immediate injuries

Lacerations, edema, hematoma

Dislocation

Delayed injuries

Intubation granuloma

Gl tti bGlottic webs

Joint fixation

Subglottic stenosis

Intubation granuloma

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Subglottic stenosis

Webs

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