Neck Trauma: ENT Prospects

A Prospective Study of Management of Neck Trauma and its Complications : An Institutional Approach

Background: Assessment and immediate surgical management of laryngotracheal injuries is essential to minimize the risk of perioperative and long term complications [1]. The present study was conducted at tertiary care centre to assess the proportions of complications following neck injuries. Methodology: The study was conducted as a prospective study on 19 patients presenting with laryngotracheal injuries at Emergency department in NSCB Medical College, Jabalpur, India during the study period of 2 years. History was obtained in detail and depending upon the extent and nature of injury, patients were managed. Patients were followed up till discharge for assessment of any postoperative complications. Results: A total of 19 cases with neck trauma were enrolled during our study period with mean age of 27.37±8.88 years. Tracheal breach was noted in 78.9% cases. The most common site of airway injury was tracheal wall (47.3%), followed by Laryngeal trauma with unilateral or bilateral thyroid cartilage (15.8%). Major vessels injury was noted in 26.3% cases and injury to minor blood vessels was observed in 68.4% cases. Wound exploration followed by wound repair was done in 36.8% of the cases whereas emergency tracheostomy along with wound repair was done in 31.6% of the cases. During surgery, brachial plexus injury and surgical site infection were the surgical complications in 1 case each. However, anemia psychiatric tendency and symptoms due to alcohol withdrawal were the complications in 1 case each. Among postoperative complications, persistence of psychiatric symptoms, recurrent laryngeal nerve palsy, withdrawal symptoms, and complications due to brachial plexus injury persisted. Conclusion: Neck injuries and laryngotracheal injuries are rare but life threatening injuries, timely management of which is essentially important to avoid the occurrence of complications. Management often requires multidisciplinary approach due to associated complications. The complications may be immediate or remote which can be prevented if patients are managed timely.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03533-7.

Our Experience with Laryngotracheal Trauma (LTT) in a Tertiary Care Centre of Western Rajasthan

LTT is a life-threatening incident that is fortunately rare. The presenting symptoms might not correlate with the intensity of trauma and range from mild endolaryngeal edema to complete laryngotracheal transection. An early diagnosis and timely intervention is required for successful outcomes and minimizing complications. This retrospective audit was performed on 18 patients of LTT who presented to the emergency from January 2017 to December 2019. The history, clinical presentation, examination findings, degree and nature of trauma, diagnostic modalities, medical and surgical management, and outcomes were analyzed. A total of 13 males and 5 females were included in this audit, with a mean age of 38.7 years. The most common cause was accidental in 77.7% patients. 61.5% of patients presented with Schaefer grade 3 and higher. Out of which 46% underwent emergent neck exploration and repair. 27.7% (5/18) presented with sequelae which were managed either by T- tube stenting, endoscopic dilatation by coblation, or laryngotracheal resection (LTR) and end-to-end anastomosis (EEA). Out of 14 surgically reconstructed airways, successful decannulation was achieved in 57.1% (8) patients. High clinical suspicion, early referral with emergent intervention is paramount for successful outcomes, fewer recurrences, and reduction of hospital's and patient's financial burden as timely planning and intervention can ensure successful decannulation of around two thirds of the higher grades (grade 3-5) of laryngotracheal traumatic injuries. Early airway establishment is the most critical goal. Definitive treatment protocols are needed in this field which warrants further formulation of multicentric studies and audits.

A case report of cervicothoracic penetrating injury with retention of foreign body

BACKGROUND

Cervicothoracic penetrating injury, considered to be relatively rare, has a complicated mechanism that is difficult to treat. In this report, a special case of cervicothoracic injury caused by foreign body penetration was elucidated. In this case, the injury location and the involved foreign body were exceptionally particular, which induced a challenging process of diagnosis and treatment.

CASE PRESENTATION

A male patient suffered from a serious injury caused by a thick branch that pierced through his neck in a traffic accident between an electric car and a tricycle carrying wood. There were also local injuries in the left scapular region. After an emergency multidisciplinary consultation, the patient was diagnosed and subsequently treated with vascular exploration and repair (common carotid artery), intrathoracic foreign body extraction, chest exploration, debridement, and suture. After surgery, he was transferred to the emergency intensive care unit for anticoagulation and anti-infection treatment. Finally, after the improvement of his physical condition, the patient was transferred to the general ward for further treatment and was successfully discharged from the hospital. Once discharged, the patient lived a normal life, free from sequelae or complications.

CONCLUSION

It may be an extremely daunting task to cure cervicothoracic penetrating injury due to its rare occurrence in clinical practice. Different from the previous cervicothoracic traumas, the injury location in this case is exceedingly particular. In general, the common cervicothoracic trauma is associated with damage to the trachea, esophagus, throat, and other structures, easily resulting in dyspnea, which, however, does not occur in this case. The insertion position of foreign body is exceptionally particular as it does not pierce the common carotid artery but poses compression on it, which induces ischemia. It is essential for the successful treatment that the treatment plan is formulated via the detailed imaging examination and careful multidisciplinary consultation.

Diagnosis, management and treatment of neck trauma

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.

Management of Laryngotracheal Trauma: A Five-Year Single Institution Experience

INTRODUCTION

Laryngotracheal trauma is a rare life-threatening emergency that requires early identification and immediate intervention. Here, we present 26 patients with laryngotracheal trauma from a tertiary hospital in India. The aim was to describe the clinical presentation and management of laryngotracheal trauma patients.

MATERIALS AND METHODS

This was a retrospective study of laryngotracheal trauma patients treated between January 2011 and March 2016. Patients who presented with a breach in the laryngotracheal framework were included, while those who had penetrating neck injuries superficial to strap muscles/platysma, burn injuries, caustic ingestion, or endotracheal injuries were excluded from the study.

RESULTS

Of 253 patients with neck injury, 26 (23 adults, three children; 21 males, five females; age range, 5-60 years) presented with a breach in the laryngotracheal framework (15 blunt neck-trauma patients and 11 penetrating neck-trauma patients). The most common cause of neck injury was road traffic accidents, seen in 12 patients (46.2%). Computed tomography (CT) was performed in all blunt trauma cases and in four patients with penetrating trauma. All penetrating trauma patients underwent neck exploration. Twelve blunt trauma patients (46.1%) were managed conservatively, while three (11.5%) required surgical intervention. The most common neck exploration finding noted in patients with a penetrating injury was fracture of the thyroid cartilage, which was seen in eight patients (30.8%). Twenty patients (76.9%) had a normal voice, five patients (19.2%) had a hoarse voice, and one patient (3.8%) had a breathy voice post treatment.

CONCLUSION

Early intervention of laryngotracheal trauma is crucial. The role of a CT scan is essential in decision making in blunt trauma cases.