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Larynx & trachea

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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

 

©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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