Laryngeal & cervical tracheal injuries
- uncommon, but can be fatal if not recognised
Likely mechanisms of injury
- Motor vehicle accident
- Clothesline injury
- Associated facial, neck or upper chest trauma
- Strangulation
Symptoms
- Respiratory distress
- Hoarseness
- Dysphonia
- Cough
- Noisy breathing and stridor
- Dysphagia
Physical signs
- Abnormal laryngeal contour
- Subcutaneous emphysema
- Cervical ecchymosis
- Haemoptysis
Findings on investigation
Radiography
- Air in soft tissues
- pneumomediastinum
- Pneumothorax
- Cervical spine fracture
CT scan
- Cartilage and soft tissue injury
- Altered airway patency
Laryngoscopy
- Vocal cord paralysis
- Mucosal or cartilage disruption
- Haematoma
- Laceration
- definitive investigation and management depend on the airway status and
presence of associated injuries.
- blind intubation can precipitate complete obstruction and is therefore
contraindicated
- also cricoid pressure is contraindicated because of the possibility of
cricoid fracture and dislocation
- tracheostomy is generally safe also allows retrieval of the distal trachea
in case of complete transection
- common associated injuries include
- c-spine fracture
- head injury
- oesophageal injury
- pneumothorax, pneumomediastinum
- multisystem trauma
- panendoscopy or contrast radiography and CXR are routinely indicated
- once airway is established definitive investigation is required and then
early surgery to prevent long-term morbidity.
- steroids no proven but recommended by some
- prophylactic antibiotics are recommended
Tracheal/laryngeal disruption
Junction of larynx and trachea most common site
Clinical features
- hoarseness
- subcutaneous emphysema
- oedema/bruising of neck
- may be minimal signs of injury
Treatment
- allow the patient to assume the most comfortable position
- airway management by an experienced doctor
- tracheostomy under local anaesthesia is one option
- cricothyrotomy should be avoided
© Ross Calcroft September 1999 and Charles Gomersall December 2002
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