Laryngotracheal trauma

Brig Anwar ul haq

Laryngotracheal Trauma

Brig Anwar ul Haq00923018513303

PAKISTAN

Laryngotracheal trauma

Brig anwar ul haq

E:\presentations\animations\larynx\normal larynx during phonation.Flv

Types Chemical Thrermal Physical

Aetiology Automobile accidents

Blow or kick on the neck. Striking against a stretched wire or

cable. Strangulation. Penetrating injuries with

Sharp instruments gunshot wounds

Pathology Haematoma and oedema of

Suprag lottic or subglottic region. Tears in laryngeal or pharyngeal mucosa

leading subcutaneous emphysema.

Dislocation of cricoarytenoid joints Arytenoid

Cartilage may be displaced anteriorly Dislocated Avulsed

Dislocation of cricothyroid joint Recurrent laryngeal nerve paralysis traverses just behind this joint.

Fractures of the hyoid bone

Pathology Fractures of thyroid cartilage.

Vertical Transverse. Fracture of upper part of thyroid cartilage

May result in avulsion of epiglottis One or both false cords.

Fractures of lower part of thyroid Displace or disrupt the true vocal cords. Fractures of cricoid cartilage.

Fractures of upper tracheal rings. Trachea may separate from the cricoid

cartilage Retract into upper mediastinum Injury to recurrent laryngeal

Clinical features Respiratory distress. Hoarseness of voice or aphonia. Painful swallowing. Aspiration of food. Local pain in the larynx

Marked on speakingSwallowing.

HaemoptysisTears in laryngeal or tracheal

mucosa.

External signs Bruises or abrasions over the skin. Tenderness Subcutaneous emphysema due to mucosal

tears Flattening of thyroid prominence Loss of contour of anterior cervical region. Thyroid notch may not be palpable Fracture displacements of thyroid or cricoid Fracture of hyoid bone. Gap may be felt between the fractured

fragments. Bony crepitus Separation of cricoid cartilage from larynx

or trachea.

Diagnostic evaluation Indirect laryngoscopy Direct laryngoscopy X-rays. Soft tissue CT scan

Associated injuries Examine for other injuries like

Injury to head Cervical spine Chest Abdomen and extremities.

X-ray chest for pneumothorax Gastrograffin swallow for

oesophageal tears

Treatment - conservative Patient should be hospitalised and

observed for Respiratory distress. Voice rest is essential. Humidification of inspired air is e en

ria\. Steroid therapy

Immediatelly Full dose Reduce edeme Prevent scarring and stenosis.

Antibiotics - Perichondritis and Cartilage necrosis.

Treatment - surgical Tracheostomy Endotracheal intnbation

Difficult Hazardous. Tracheostomy is preferred

Open reduction 3-5 days after injury Should not be delayed beyond 10 days.

Fixation Wired Miniplates

Open reductio and fixation Mucosal lacerations repaired - catgut Loose fragments of cartilage removed. Epiglottis

Anchored Excised.

Arytenoid cartilages – repositioned Laryngotracheal separation,

End to end anastomosis Lntemal splintage Laryngeal stent Silicone tube which - 2 to 6 weeks on an average .. Webbing Prevented by a silastic keel.

Complications Laryngeal stenosis,

Supraglottic Glottic Subglottic.

Perichondritis Laryngeal abscess. Vocal cord paralysis.

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