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Gray S, Khan K, Dieudonne B, Iqbal F, Saeed S. Blunt Laryngeal Fracture Status Post Fall on a Paintball Gun. Cureus 2018; 10:e2637. [PMID: 30034959 PMCID: PMC6047837 DOI: 10.7759/cureus.2637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Laryngeal fracture is a rare but potentially lethal injury. A high degree of suspicion along with an expeditious investigation is warranted to prevent airway complications. The initial assessment of the airway is vital as the patient can suffer a severe anoxic brain injury. If the patient is stable, a computed tomography (CT) scan of the neck should be obtained; this was done urgently for our patient and was managed without any extraneous intervention. We report a case of a 38-year-old man that presented to the emergency room with anterior neck pain after falling onto the back of a paintball gun. The patient was managed conservatively and favorable outcomes were obtained.
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Affiliation(s)
- Sanjiv Gray
- Surgery, University of Central Florida, Orlando, USA
| | - Khuram Khan
- Surgery, Harlem Hospital Center, New York, USA
| | | | - Farhana Iqbal
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Saqib Saeed
- Surgery, Harlem Hospital Center, New York, USA
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52
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Laryngeal injury in closed cervical traumatism. Med Intensiva 2018. [PMID: 29530327 DOI: 10.1016/j.medin.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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53
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Ostby ET, Crawley BK. Helmet Clasp Cracks Larynx? A Case Series and Literature Review. Ann Otol Rhinol Laryngol 2018; 127:282-284. [PMID: 29383952 DOI: 10.1177/0003489418755405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Helmet use is well known to greatly reduce the risk of head injury in both bicycle and motorcycle riding. However, helmet buckle position may increase the risk of injury to the neck cartilages. We present a series of cases in which thyroid cartilage fracture is presumed to arise from the position of the helmet buckle during a crash. Our objective with this case series is to outline an unusual series of cases and review the literature regarding laryngeal injuries secondary to helmet impact. DESIGN Single institution case series. MATERIALS AND METHODS We present 3 adult patients with laryngeal fractures following bicycle and motorcycle accidents. Medical records were reviewed for history. RESULTS All patients in this series presented with voice or swallowing complaints and were found to have thyroid cartilage fractures. It was determined that the buckle of the helmet was positioned overlying the larynx during these accidents, so the impact and flexion of the head and neck may have produced sufficient force against it to fracture the cartilage. A literature search yielded works supporting helmet use for head and brain protection but only a single report of laryngeal injuries secondary to helmet use. CONCLUSIONS Though wearing a helmet is protective against head injuries, it may create serious risk to the neck cartilages when the buckle is positioned adjacent to the larynx. Rare but serious, neck cartilage fracture should be considered in helmeted cycling accidents. It may be reasonable to advance a helmet design that positions the buckle and other nonpliable components laterally, away from neck cartilages.
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Affiliation(s)
- Erin T Ostby
- 1 Department of Otolaryngology, Loma Linda University Health, Loma Linda, California, USA
| | - Brianna K Crawley
- 2 Department of Otolaryngology, Voice and Swallowing Center, Loma Linda University Health, Redlands, California, USA
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Kuckelman J, Cuadrado D, Martin M. Thoracic Trauma: a Combat and Military Perspective. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0112-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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55
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Al-Khalifa M, Buali F, Alshehabi M. Common Findings in Blunt Thyroid Fracture. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2017; 5:267-270. [PMID: 30787800 PMCID: PMC6298297 DOI: 10.4103/1658-631x.213306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although blunt neck trauma is known to be rare, occurring in approximately 5% of all neck traumas, undiagnosed cases may have a devastating outcome. Physicians need to fully understand the mechanism of the injury and the external laryngeal trauma signs. A physician's precise diagnosis and proper management are necessary to avoid long-term complications or death. Although blunt laryngeal injuries are uncommon, prompt recognition of the subtle signs is crucial to avoid the catastrophic complications associated with such injuries. This case report aims to demonstrate the symptoms and signs of laryngeal injury in a young healthy male following a road traffic accident.
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Affiliation(s)
- Muneera Al-Khalifa
- Department of ENT and Head and Neck Surgery, Bahrain Defense Force Hospital, Riffa, Kingdom of Bahrain
| | - Fatima Buali
- Department of ENT and Head and Neck Surgery, Bahrain Defense Force Hospital, Riffa, Kingdom of Bahrain
| | - Mohamed Alshehabi
- Department of ENT and Head and Neck Surgery, Bahrain Defense Force Hospital, Riffa, Kingdom of Bahrain
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56
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Jain S, Singh P, Gupta M, Kamble B, Phatak SS. Comminuted Laryngeal Fracture Following Blunt Trauma: A Need for Strict Legislation on Roads! Ann Maxillofac Surg 2017; 7:124-128. [PMID: 28713750 PMCID: PMC5502499 DOI: 10.4103/ams.ams_60_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Laryngeal fracture is a rare condition with potential life-long implications related to airway patency, voice quality, and swallowing. Rarity of the condition leads to lack of consensus on the most suitable way to manage this injury. The mode of injury can be prevented by strict legislation on the roads. We report a case of a 28-year-old Indian male who sustained a comminuted displaced fracture of the thyroid cartilage with disruption of anterior commissure due to blunt trauma caused by the metallic side rod of a ladder projecting from the rear of a vehicle in front of the bike on which he was riding. He presented with breathing difficulty, change in voice, surgical emphysema, and pneumomediastinum, but without any skin changes over the neck. His airway could be restored due to early tracheostomy and open reduction with internal fixation with sutures along with laryngeal stenting. He has no significant swallowing or breathing problem and reasonably good voice 6 months after surgery. This case highlights the need for strict legislation on roads in India and the importance of high level of suspicion for laryngeal fracture in acute trauma patient. Early identification and timely internal fixation not only restore the airway but also improve long-term voice and airway outcomes.
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Affiliation(s)
- Shraddha Jain
- Department of Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, DMIMSU, Wardha, Maharashtra, India
| | - Pragya Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, DMIMSU, Wardha, Maharashtra, India
| | - Minal Gupta
- Department of Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, DMIMSU, Wardha, Maharashtra, India
| | - Bhavna Kamble
- Department of Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, DMIMSU, Wardha, Maharashtra, India
| | - Suresh S Phatak
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, DMIMSU, Wardha, Maharashtra, India
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57
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Blunt laryngeal trauma secondary to sporting injuries. The Journal of Laryngology & Otology 2017; 131:728-735. [PMID: 28595674 DOI: 10.1017/s0022215117001220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Laryngeal injury after blunt trauma is uncommon, but can cause catastrophic airway obstruction and significant morbidity in voice and airway function. This paper aims to discuss a case series of sports-related blunt laryngeal trauma patients and describe the results of a thorough literature review. METHOD Retrospective case-based analysis of laryngeal trauma referrals over six years to a tertiary laryngology centre. RESULTS Twenty-eight patients were identified; 13 (46 per cent) sustained sports-related trauma. Most were young males, presenting with dysphonia, some with airway compromise (62 per cent). Nine patients were diagnosed with a laryngeal fracture. Four patients were managed conservatively and nine underwent surgery. Post-treatment, the majority of patients achieved good voice outcomes (83 per cent) and all had normal airway function. CONCLUSION Sports-related neck trauma can cause significant injury to the laryngeal framework and endolaryngeal soft tissues, and most cases require surgical intervention. Clinical presentation may be subtle; a systematic approach along with a high index of suspicion is essential, as early diagnosis and treatment have been reported to improve airway and voice outcome.
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58
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Manchi G, Brunnberg MM, Shahid M, Al Aiyan A, Brunnberg L, Stein S. Larynx Trauma and Hyoid Bone Fracture after Bite Injury in Dog: Case Report. Front Vet Sci 2016; 3:64. [PMID: 27579303 PMCID: PMC4985691 DOI: 10.3389/fvets.2016.00064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/03/2016] [Indexed: 01/29/2023] Open
Abstract
An 8-year-old male Jack Russell crossbreed dog was admitted to our hospital with dyspnea and shock following a dog-bite injury on the ventral neck. Radiographs revealed subcutaneous emphysema and bilateral thyrohyoid bone fractures. Intraoperatively, rupture of both sternohyoid muscles, both hyoepiglotticus muscles, both thyrohyoid muscles, and a partial cranial rupture of the superficial sphincter colli muscle were detected. Part of the epiglottis was detached from the thyroid cartilage. The patient's severed muscles and torn epiglottis were reattached using a simple interrupted suture pattern. Hyoepiglotticus muscles could not be identified. The bilateral thyrohyoid bone fractures were repaired with intraosseous wire suture. A temporary tracheostomy tube and an esophageal feeding tube were placed postoperatively. The dog was discharged after 8 days, re-examined at 2 and 6 months and laryngeal and pharyngeal function were evaluated as normal. To the authors' knowledge, this is the first report of a dog that presented with laryngeal trauma with hyoid bone fracture and acute dyspnea that underwent surgical treatment resulting in an acceptable outcome.
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Affiliation(s)
- George Manchi
- Faculty of Veterinary Medicine, Small Animal Clinic, Freie University Berlin , Berlin , Germany
| | - Mathias M Brunnberg
- Faculty of Veterinary Medicine, Small Animal Clinic, Freie University Berlin , Berlin , Germany
| | - Muhammad Shahid
- Faculty of Veterinary Medicine, Small Animal Clinic, Freie University Berlin , Berlin , Germany
| | - Ahmad Al Aiyan
- Veterinary Medicine Department, College of Food and Agriculture, United Arab Emirates University , Al Ain , United Arab Emirates
| | - Leo Brunnberg
- Faculty of Veterinary Medicine, Small Animal Clinic, Freie University Berlin , Berlin , Germany
| | - Silke Stein
- Faculty of Veterinary Medicine, Small Animal Clinic, Freie University Berlin , Berlin , Germany
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59
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Ferreira E, Nabuco Araújo C, Agostinho S, Santos AR. Cricohyoidoepiglottopexy in Laryngeal Trauma. Otolaryngol Head Neck Surg 2016; 155:886-887. [DOI: 10.1177/0194599816659059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 06/21/2016] [Indexed: 01/29/2023]
Affiliation(s)
- Eduardo Ferreira
- Otorhinolaryngology Department, Hospital de Santa Maria, Lisbon, Portugal
| | | | - Sandra Agostinho
- Otorhinolaryngology Department, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
| | - Ana Rita Santos
- Otorhinolaryngology Department, Hospital de Santa Maria, Lisbon, Portugal
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60
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Madani A, Pecorelli N, Razek T, Spicer J, Ferri LE, Mulder DS. Civilian Airway Trauma: A Single-Institution Experience. World J Surg 2016; 40:2658-2666. [DOI: 10.1007/s00268-016-3588-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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61
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Wang TC, Kuo CL. Rapid airway compromise caused by neck trauma: A case report. J Acute Med 2016. [DOI: 10.1016/j.jacme.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
There is a lack of evidence-based approach regarding the best practice for airway management in patients with a traumatized airway. General recommendations for the management of the traumatized airway are summarized in table 5. Airway trauma may not be readily apparent, and its evaluation requires a high level of suspicion for airway disruption and compression. For patients with facial trauma, control of the airway may be significantly impacted by edema, bleeding, inability to clear secretions, loss of bony support, and difficulty with face mask ventilation. With the airway compression from neck swelling or hematoma, intubation attempts can further compromise the airway due to expanding hematoma. For patients with airway disruption, the goal is to pass the tube across the injured area without disrupting it or to insert the airway distal to the injury using a surgical approach. If airway injury is extensive, a surgical airway distal to the site of injury may be the best initial approach. Alternatively, if orotracheal intubation is chosen, spontaneous ventilation may be maintained or RSI may be performed. RSI is a common approach. Thus, some of the patients intubated may subsequently require tracheostomy. A stable patient with limited injuries may not require intubation but should be watched carefully for at least several hours. Because of a paucity of evidence-based data, the choice between these approaches and the techniques utilized is a clinical decision depending on the patient's condition, clinical setting, injuries to airway and other organs, and available personnel, expertise, and equipment. Inability to obtain a definitive airway is always an absolute indication for an emergency cricothyroidotomy or surgical tracheostomy.
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63
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Chatterjee D, Agarwal R, Bajaj L, Teng SN, Prager JD. Airway management in laryngotracheal injuries from blunt neck trauma in children. Paediatr Anaesth 2016; 26:132-8. [PMID: 26530711 DOI: 10.1111/pan.12791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2015] [Indexed: 12/27/2022]
Abstract
Pediatric laryngotracheal injuries from blunt neck trauma are extremely rare, but can be potentially catastrophic. Early diagnosis and skillful airway management is critical in avoiding significant morbidity and mortality associated with these cases. We present a case of a patient who suffered a complete tracheal transection and cervical spine fracture following a clothesline injury to the anterior neck. A review of the mechanisms of injury, clinical presentation, initial airway management, and anesthetic considerations in laryngotracheal injuries from blunt neck trauma in children are presented.
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Affiliation(s)
- Debnath Chatterjee
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rita Agarwal
- Department of Anesthesiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Lalit Bajaj
- Department of Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarena N Teng
- Department of Anesthesiology, Ochsner Hospital for Children, New Orleans, LA, USA
| | - Jeremy D Prager
- Department of Otolaryngology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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64
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Kilgué A, Teudt IU, Grundmann T, Püschel K. [Complex fracture of the larynx caused by a horse kick]. HNO 2014; 62:886-9. [PMID: 25270837 DOI: 10.1007/s00106-014-2913-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Every blunt laryngeal trauma requires examination by an ENT physician and may necessitate observation for a number of hours. The literature shows a heterogeneous picture regarding airway management (tracheotomy vs. intubation). Extremely violence forces such as horse kicks require a tracheotomy, as demonstrated by case studies. In such cases, a high level of responsibility lies with the emergency physician providing the initial treatment. We present the case of a 37-year-old horse trainer, who suffered a horse kick to the larynx with a complex laryngeal fracture. Intubation of the patient by the emergency physician would most probably have led to incorrect placement of the tube or complete displacement of larynx and trachea. In addition to securing a vital airway by tracheotomy, a timely reconstruction of the airways, where necessary by employing the temporary insertion of a tracheal stent, is the treatment of choice. The latter therapy should be applied within the first 6 hours following the accident.
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Affiliation(s)
- A Kilgué
- Abteilung für Hals-, Nasen-, Ohrenheilkunde, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Deutschland,
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65
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Hiller KN, Hagberg CA. Erroneous Creation of a Surgical Airway Through the Thyrohyoid Membrane. ACTA ACUST UNITED AC 2014; 3:88-90. [DOI: 10.1213/xaa.0000000000000091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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66
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Hernandez DJ, Jatana KR, Hoff SR, Rastatter JC. Emergency Airway Management for Pediatric Blunt Neck Trauma. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2014. [DOI: 10.1016/j.cpem.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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67
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Liao CH, Huang JF, Chen SW, Fu CY, Lee LA, Ouyang CH, Wang SY, Kuo IM, Yuan KC, Hsu YP. Impact of deferred surgical intervention on the outcome of external laryngeal trauma. Ann Thorac Surg 2014; 98:477-83. [PMID: 24961838 DOI: 10.1016/j.athoracsur.2014.04.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/08/2014] [Accepted: 04/15/2014] [Indexed: 01/29/2023]
Abstract
BACKGROUND External laryngeal trauma (ELT) can be a fatal injury. Proper management of ELT significantly affects patient survival and quality of life. The optimal timing of surgical intervention is controversial. In this study, we review the incidence, management, and outcome of ELT and attempt to analyze the risk factors and prognosis of this injury. METHODS We conducted retrospective review using prospective data collection from patients with ELT in a level I trauma center from May 2008 to May 2013. We retrieved data regarding the severity of ELT, Injury Severity Score (ISS), New Injury Severity Score (NISS), Reverse Trauma Score (RTS), surgical timing, intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), long-term outcome, and mortality. We analyzed the risk of prolonged hospitalization, adverse outcome, and mortality. RESULTS The 48 patients in this cohort had a mean age of 40.8±19.6 years. Twenty-four patients underwent operation within 48 hours, 10 patients underwent operation after 48 hours, and the other 14 patients did not require surgical intervention. A high NISS and the necessity for operation prolonged the ICU LOS and the HLOS. A high ISS and a low RTS predicted mortality. Initial phonatory impairment and the necessity of surgical intervention increased adverse outcomes. CONCLUSIONS In conclusion, ELT leads to high mortality and morbidity. The mortality in our series was related to severe associated injuries and to initial physical decompensation. Proper resuscitation and aggressively physiologic compensation were more important in the initial phase. Deferred treatment was acceptable until the patients were ready for operation.
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Affiliation(s)
- Chien-Hung Liao
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Fu Huang
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Wei Chen
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Li-Ang Lee
- Department of Otorhinolaryngology, Head, and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hsiang Ouyang
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - I-Ming Kuo
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chin Yuan
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Pao Hsu
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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