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DiGrazia GN, Aktan SL, Sechrist EM, Rehn J, Joyce C, Siddiqui MH. CT Findings in Laryngeal Trauma and the Clinical Implications. Clin Neuroradiol 2023; 33:1123-1131. [PMID: 37410170 DOI: 10.1007/s00062-023-01323-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/30/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Acute traumatic osseous and cartilaginous injuries to the larynx are rare injuries presenting to the emergency department. Despite the low reported incidence, laryngeal trauma carries a high morbidity and mortality. The purpose of this study is to identify fracture and soft tissue injury patterns in laryngeal trauma and explore associations with patient demographics, mechanisms of injury, urgent airway and surgical intervention. METHODS A retrospective review of patients with laryngeal injury who underwent multidetector computed tomography (MDCT) imaging was performed. The CT findings of laryngeal and hyoid fracture location, fracture displacement, and soft tissue injuries were recorded. Clinical data including patient demographics, mechanisms of injury, frequency of airway and surgical intervention were also recorded. Correlation of imaging characteristics with patient demographics, mechanism of injury and interventions were assessed for statistical significance using χ2 and Fisher's exact tests. RESULTS The median patient age was 40 years old with a strong male predominance. The most common mechanisms of injury included motor vehicle collisions and penetrating gunshot wounds. Thyroid cartilage fractures were the most common fracture type. Findings of fracture displacement and airway hematoma had a higher correlation with requiring urgent airway management. CONCLUSION Radiologists' early recognition and prompt communication of laryngeal trauma to the clinical service is important to reduce associated morbidity and mortality. Displaced fractures and laryngeal hematomas should be promptly conveyed to the clinical service as they are associated with more complex injuries and higher rates of urgent airway management and surgical intervention.
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Affiliation(s)
- Gianna N DiGrazia
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Avenue, 60153, Maywood, IL, USA.
| | - Serra L Aktan
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Avenue, 60153, Maywood, IL, USA
| | - Emma M Sechrist
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Avenue, 60153, Maywood, IL, USA
| | - Justina Rehn
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Avenue, 60153, Maywood, IL, USA
| | - Cara Joyce
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Avenue, 60153, Maywood, IL, USA
| | - Mariah H Siddiqui
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Avenue, 60153, Maywood, IL, USA
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Moroco AE, Patel VA, Saadi RA, Gniady JP, Lighthall JG. Systematic Review of Laryngeal Fractures and Trends in Operative Management. Craniomaxillofac Trauma Reconstr 2023; 16:62-69. [PMID: 36824183 PMCID: PMC9941301 DOI: 10.1177/19433875221074847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design Systematic review of the literature. Objective The goal of this study is to review the current literature on the trends in management of laryngeal fractures following trauma. Methods Independent searches of the PubMed and MEDLINE databases were performed. Articles from the period of 1963 to 2020 were collected. All studies which described laryngeal fractures using the Boolean method and relevant search term combinations, including "Laryngeal", "Fracture", "Operative", and "Management" were collected. Results A total of 588 relevant unique articles were identified for analysis. Of these, 24 articles were deemed appropriate for inclusion in the literature review. Due to variability in study design and outcome measures, formal synthesis of data in the form of a meta-analysis was not possible. Conclusions Laryngeal fractures are rare traumatic injuries that require early identification and evaluation with complex management options. This comprehensive review aims to highlight the breadth of the topic with regard to presentation and clinical management. Though there remains no clear best practice for laryngeal fracture management, we review trends in clinical practice throughout the literature.
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Affiliation(s)
- Annie E. Moroco
- Department of Otolaryngology – Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vijay A. Patel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, UPMC Centers for Cranial Base Surgery & Sinonasal Disorders and Allergy, Pittsburgh, PA, USA
| | - Robert A. Saadi
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - John P. Gniady
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Jessyka G. Lighthall
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Gao JM, Li H, Du DY, Yang J, Kong LW, Wang JB, He P, Wei GB. Management and outcome of bronchial trauma due to blunt versus penetrating injuries. World J Clin Cases 2022; 10:5185-5195. [PMID: 35812647 PMCID: PMC9210895 DOI: 10.12998/wjcc.v10.i16.5185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/21/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The number of patients with bronchial trauma (BT) who survived to hospital admission has increased with the improvement of prehospital care; early diagnosis and treatment should be considered, especially among blunt trauma patients, whose diagnosis is frequently delayed.
AIM To describe the early recognition and surgical management considerations of blunt and penetrating BTs, and to elaborate the differences between them.
METHODS All patients with BTs during the past 15 years were reviewed, and data were retrospectively analyzed regarding the mechanism of injury, diagnostic and therapeutic procedures, and outcomes. According to the injury mechanisms, the patients were divided into two groups: Blunt BT (BBT) group and penetrating BT (PBT) group. The injury severity, treatment procedures, and prognoses of the two groups were compared.
RESULTS A total of 73 patients with BT were admitted during the study period. The proportion of BTs among the entire cohort with chest trauma was 2.4% (73/3018), and all 73 underwent thoracotomy. Polytrauma patients accounted for 81.6% in the BBT group and 22.9% in the PBT group, and the mean Injury Severity Score was 38.22 ± 8.13 and 21.33 ± 6.12, respectively. Preoperative three-dimensional spiral computed tomography (CT) and/or fiberoptic bronchoscopy (FB) were performed in 92.1% of cases in the BBT group (n = 38) and 34.3% in the PBT group (n = 35). In the BBT group, a delay in diagnosis for over 48 h occurred in 55.3% of patients. In the PBT group, 31 patients underwent emergency thoracotomy due to massive hemothorax, and BT was confirmed during the operation. Among them, 22 underwent pulmo-tractotomy for hemostasis, avoiding partial pneumonectomy. In this series, the overall mortality rate was 6.9% (5/73), and it was 7.9% (3/38) and 5.7% (2/35) in the BBT group and PBT group, respectively (P > 0.05). All 68 survivors were followed for 6 to 42 (23 ± 6.4) mo, and CT, FB, and pulmonary function examinations were performed as planned. All patients exhibited normal lung function and healthy conditions except three who required reoperations.
CONCLUSION The difference between blunt and penetrating BTs is obvious. In BBT, patients generally have no vessel injury, and the diagnosis is easily missed, leading to delayed treatment. The main cause of death is ventilation disturbance due to tension pneumothorax early and refractory atelectasis with pneumonia late. However, in PBT, most patients require emergency thoracotomy because of simultaneous vessel trauma and massive hemothorax, and delays in diagnosis are infrequent. The leading cause of death is hemorrhagic shock.
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Affiliation(s)
- Jin-Mou Gao
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Hui Li
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Ding-Yuan Du
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Jun Yang
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Ling-Wen Kong
- Department of Cardiothoracic Surgery, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Jian-Bai Wang
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Ping He
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Gong-Bin Wei
- Department of Traumatology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400014, China
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Forner D, Noel CW, Guttman MP, Haas B, Enepekides D, Rigby MH, Taylor SM, Nathens AB, Eskander A. Volume-outcome relationships in laryngeal trauma processes of care: a retrospective cohort study. Eur J Trauma Emerg Surg 2022; 48:4131-4141. [PMID: 35320370 DOI: 10.1007/s00068-022-01950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The extent to which patients with laryngeal trauma undergo investigation and intervention is largely unknown. The objective of this study was to therefore determine the association between hospital volume and processes of care in patients sustaining laryngeal trauma. METHODS This retrospective cohort study used the American College of Surgeons Trauma Quality Improvement Program database. Adult patients (≥ 18) who sustained traumatic laryngeal injuries between 2012 and 2016 were eligible. The exposure of interest was average annual laryngeal trauma volume categorized into quartiles. The primary and secondary outcomes of interest were the performances of diagnostic and therapeutic laryngeal procedures respectively. Multivariable logistic regression under a generalized estimating equations approach was utilized. RESULTS In total, 1164 patients were included. The average number of laryngeal trauma cases per hospital ranged from 0.2 to 7.2 per year. Diagnostic procedures were performed in 31% of patients and therapeutic in 19%. In patients with severe laryngeal injuries, diagnostic procedures were performed on a higher proportion of patients at high volume centers than low volume centers (46% vs 25%). In adjusted analysis, volume was not associated with the performance of diagnostic procedures. Patients treated at centers in the second (OR 1.94 [95% CI 1.29-2.90]) and third (OR 1.67 [95% CI 1.08-2.57]) volume quartiles had higher odds of undergoing a therapeutic procedure compared to the lowest volume quartile. CONCLUSION Hospital volume may be associated with processes of care in laryngeal trauma. Additional research is required to investigate how these findings relate to patient and health system outcomes.
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Affiliation(s)
- David Forner
- Division of Otolaryngology, Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Christopher W Noel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Matthew P Guttman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Barbara Haas
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Danny Enepekides
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology, Head & Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 047, Toronto, ON, M4N 3M5, Canada
| | - Matthew H Rigby
- Division of Otolaryngology, Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - S Mark Taylor
- Division of Otolaryngology, Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Avery B Nathens
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Antoine Eskander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada. .,Department of Otolaryngology, Head & Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 047, Toronto, ON, M4N 3M5, Canada.
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CT-based assessment of laryngeal fracture patterns and associated soft tissue abnormality. Eur Radiol 2021; 31:5212-5221. [PMID: 33409785 DOI: 10.1007/s00330-020-07548-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/02/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Acute traumatic injuries to the larynx, including fractures of the hyoid bone, cricoid, and thyroid cartilage, are uncommon injuries. The purpose of this study was to assess fracture and soft tissue patterns associated with laryngeal trauma. METHODS This was a retrospective review of patients with laryngeal fractures who presented to two level I trauma centers and underwent CT imaging. Imaging findings, including fractures of the cartilaginous structures of the larynx and hyoid bone, and soft tissue abnormalities including focal hematoma, edema with non-focal hemorrhage, and additional penetrating injuries were recorded. Frequencies of fracture patterns were recorded. RESULTS Thyroid cartilage fractures were most frequently observed occurring in 45/55 patients, followed by cricoid fractures in 13/55 patients. Hyoid fractures were encountered in 8/55 patients. Multi-site fractures were observed in 12/55 patients with thyroid-cricoid fractures occurring in 8/12 patients, followed by thyroid-hyoid fractures in 2/12 patients. Most multi-site fractures occurred in association with focal supraglottic hematomas (10/12), supraglottic edema and non-focal hemorrhage (11/12), and focal subglottic hematoma (5/12). All 13 cricoid fractures occurred with either focal supraglottic hematoma (7), focal subglottic hematoma (4), or edema with non-focal hemorrhage (13). CONCLUSIONS Thyroid cartilage fractures were the most frequently encountered fracture, followed by cricoid cartilage fractures. Cricoid fractures always occurred with soft tissue abnormalities. Recognition of fracture patterns in the setting of laryngeal trauma and associated patterns of soft tissue injury is important for practicing radiologists for early diagnosis of these conditions and reduction of associated morbidity. KEY POINTS • Acute fractures to the larynx may be isolated fractures or occur as multi-focal fractures. • Thyroid cartilage fractures are the most frequent fractures followed by cricoid cartilage fractures. • Cricoid cartilage fractures always occurred in association with soft tissue abnormalities.
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Petrone P, Velaz-Pardo L, Gendy A, Velcu L, Brathwaite CEM, Joseph DK. Diagnosis, management and treatment of neck trauma. Cir Esp 2019; 97:489-500. [PMID: 31358299 DOI: 10.1016/j.ciresp.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/27/2019] [Accepted: 06/02/2019] [Indexed: 11/15/2022]
Abstract
Trauma injuries to the neck account for 5-10% of all trauma injuries and carry a high rate of morbidity and mortality, as several vital structures can be damaged. Currently, there are several treatment approaches based on initial management by zones, initial management not based on zones and conservative management of selected patients. The objective of this systematic review is to describe the management of neck trauma.
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Affiliation(s)
- Patrizio Petrone
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU..
| | - Leyre Velaz-Pardo
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Amir Gendy
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Laura Velcu
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Collin E M Brathwaite
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - D'Andrea K Joseph
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
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Sethi RKV, Khatib D, Kligerman M, Kozin ED, Gray ST, Naunheim MR. Laryngeal fracture presentation and management in United States emergency rooms. Laryngoscope 2019; 129:2341-2346. [PMID: 30623434 DOI: 10.1002/lary.27790] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/28/2018] [Accepted: 12/13/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVES/HYPOTHESIS There are limited data on laryngeal fracture presentation and management in US emergency departments (EDs). We aimed to characterize patients who are diagnosed with laryngeal fractures in the ED and identify management patterns. STUDY DESIGN Retrospective review of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011. METHODS The NEDS was queried for patient visits with a primary diagnosis of open or closed laryngeal fracture (International Classification of Diseases, Ninth Revision codes 807.5 and 807.6). Patient demographics, comorbidities, ED management, and hospital characteristics were extracted. RESULTS There were 3,102 ED visits with a diagnosis of laryngeal fracture during the study period. Mean patient age was 40.9 years (range, 3-93 years). The majority of patients were male (85.5%) and sustained a closed (vs. open) fracture (91.4%), with an overall mortality rate of 3.8%. The majority of patients were treated for more than one injury during the same visit (76.2%). Most patients were evaluated at a trauma hospital (53.9%), and most patients were admitted to the hospital (71.9%). Emergent intubation or tracheostomy was rarely reported (2.6% and 0.1% of all cases), and a minority of patients underwent fiberoptic flexible laryngoscopy in the ED (1.9%). Laryngeal fractures occurred more frequently during summer months (28.2%). Mean charge for the entirety of the ED stay was $4,957.34. CONCLUSIONS Laryngeal fracture is rare and frequently associated with other injuries. The frequency of emergent airway procedure, imaging, and flexible fiberoptic laryngoscopy is lower than expected, raising concerns about appropriate workup and management or recognition of injury in the ED setting. LEVEL OF EVIDENCE NA Laryngoscope, 129:2341-2346, 2019.
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Affiliation(s)
- Rosh K V Sethi
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Dara Khatib
- Georgetown University School of Medicine, Washington, DC, U.S.A
| | - Maxwell Kligerman
- Department of Otolaryngology, Stanford University, Palo Alto, California, U.S.A
| | - Elliott D Kozin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Matthew R Naunheim
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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Injuries to the Aerodigestive Tract. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0118-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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