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Morisaki T, Fukuhara T, Ehara H, Kataoka H, Koyama S, Fujiwara K. A Novel Concept for Surgical Management of a Traumatic Comminuted Cricoid Fracture. EAR, NOSE & THROAT JOURNAL 2024; 103:NP128-NP131. [PMID: 34467797 DOI: 10.1177/01455613211040579] [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] [Indexed: 11/16/2022] Open
Abstract
The cricoid plays 2 key roles: phonation and maintenance of the airway frame, both of which are lost in cases of comminuted cricoid fractures. The management of these 2 functions becomes a challenge in planning surgical treatment. We report the treatment course in a case of traumatic comminuted cricoid fracture that was resolved with good airway and phonatory functions. A 25-year-old man fell down the stairs and complained of respiratory discomfort and hoarseness of voice. A computed tomography scan showed comminuted cricoid fracture; therefore, surgery was performed to restore the patient's airway and phonation functions. We found that the airway was maintained by the anterior part and that the phonation depended on the posterior part of the cricoid. This novel concept helped clarify the treatment goal in this case of comminuted cricoid fractures. Furthermore, it is important that the anterior part of the cricoid is reconstructed with sufficient internal diameter, while the posterior part of the cricoid is reconstructed in the correct position.
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Affiliation(s)
- Tsuyoshi Morisaki
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Takahiro Fukuhara
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Hiroaki Ehara
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Hideyuki Kataoka
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Satoshi Koyama
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Kazunori Fujiwara
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
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Mäkitie RE, Nyman K, Ilmarinen T, Tapiovaara L. Changes in occurrence and management of laryngeal fractures at the Helsinki University Hospital during 25 years. Eur Arch Otorhinolaryngol 2024; 281:915-924. [PMID: 37923860 PMCID: PMC10796824 DOI: 10.1007/s00405-023-08298-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/17/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Laryngeal fracture is a rare but potentially life-threatening trauma. Fractures vary from mild to dislocated and extensive with risk of severe complications. This study investigated the occurrence, clinical characteristics and management of laryngeal fractures in the last 15 years. MATERIAL AND METHODS A retrospective population-based cohort study reviewing all laryngeal fractures at the Helsinki University Hospital in 2005-2019. Patient records and imaging studies were systematically reviewed for mode of injury, fracture type, secondary complications, treatment modality, possible airway management, length of stay, and mortality. Results were compared with corresponding data from 1995 to 2004. RESULTS Overall 80 fracture patients were recorded (5.3/year); 79% were men and mean age was 42 years (range 18-78). Altogether 91% were closed and 9% open. While unintentional traumas were most common (54%), an increasing proportion were from intentional injury (10%) or Schaefer Gr IV in severity (35%). Altogether 46% had compromised airway and 21% needed airway intervention; airway narrowing was more common with cricoid (p = 0.042) and multiple fractures (p = 0.07) and correlated positively with amount of dislocation (p = 0.001) and number of fracture lines (p = 0.006). Surgery was performed for 33%, of which 46% were Schaefer Gr IV and 62% from intentional trauma. Mortality was 1.4%. CONCLUSIONS Deliberate and violence-related laryngeal fractures have increased. These often result in more extensive injuries predisposing to compromised airway and requiring surgical intervention and longer treatment. Most fractures are still treated conservatively with good long-term outcomes. An observation period of 24 h is recommended to detect any delayed complications. Mortality remains low.
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Affiliation(s)
- Riikka E Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland.
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Kristofer Nyman
- Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Taru Ilmarinen
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
| | - Laura Tapiovaara
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
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3
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Chiba T, Endo T, Oka A, Kitamura H, Imanishi Y, Shiga T. Pain in the neck: Bench press injury. J Am Coll Emerg Physicians Open 2023; 4:e12937. [PMID: 37006915 PMCID: PMC10050962 DOI: 10.1002/emp2.12937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/08/2023] [Indexed: 03/31/2023] Open
Affiliation(s)
- Takuyo Chiba
- Department of Emergency MedicineInternational University of Health and Welfare, Narita HospitalNaritaChibaJapan
| | - Takuro Endo
- Department of Emergency MedicineInternational University of Health and Welfare, Narita HospitalNaritaChibaJapan
| | - Aiko Oka
- Department of Otorhinolaryngology—Head and Neck SurgeryInternational University of Health and Welfare, Narita HospitalNaritaChibaJapan
| | - Hiroshi Kitamura
- Department of Otorhinolaryngology—Head and Neck SurgeryInternational University of Health and Welfare, Narita HospitalNaritaChibaJapan
| | - Yorihisa Imanishi
- Department of Otorhinolaryngology—Head and Neck SurgeryInternational University of Health and Welfare, Narita HospitalNaritaChibaJapan
| | - Takashi Shiga
- Department of Emergency MedicineInternational University of Health and Welfare, Narita HospitalNaritaChibaJapan
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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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Phookan J, Talukdar R, Das HJ, Saikia N, Mili MK, Gohain M. Cut Neck, Department of E.N.T in a Tertiary Centre: How We Approach. Indian J Otolaryngol Head Neck Surg 2022; 74:2153-2159. [PMID: 36452850 PMCID: PMC9702379 DOI: 10.1007/s12070-020-02021-6] [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: 04/08/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022] Open
Abstract
Cut neck injury needs prolonged hospitalization, high cost care, reduced quality of life and above all death. Proper exploration is a must in preventing co-morbidities like shock, sepsis, laryngotracheal stenosis or fistula formation. Neck trauma can involve muscles, vessels, nerves, bone and hollow viscera. Though the repair of neck means planning and skill for repair of the structure, the tracheal repair needs special attention to avoid tracheal stenosis. 12 patients were included in the prospective study of 8 months. Management plan was undertaken which were thoroughly studied and discussed with respect to two tracheoplasty cases done in ENT OT, AMCH. Apart from haemodynamic stability all patients were assessed for injury to hollow viscera and planned accordingly as this centre is an important centre for airway reconstruction. Male female ratio was 11:1. Suicidal cut neck injury was the most common cause. Two cases were of tracheal stenosis post tracheostomy. One of the case had associated neurovascular injury but with patent airway. Rest of the cases were repaired under general and/or local anaesthesia. Primary aim should be to maintain airway and to look for the extent of injury to reduce morbidity. Expertise of surgeons' skill is developing every day hence the successfulness of repair will be tested by least of morbidity. From this institute which is skilled in airway reconstruction we could comment that airway reconstruction team should be an integral part of surgeons' team.
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Affiliation(s)
- Jyotirmoy Phookan
- Department of ENT, Assam Medical College and Hospital, Dibrugarh, Assam 786002 India
| | - Rakesh Talukdar
- Department of ENT, Assam Medical College and Hospital, Dibrugarh, Assam 786002 India
| | - Hirak Jyoti Das
- Department of ENT, Assam Medical College and Hospital, Dibrugarh, Assam 786002 India
| | - Nabajyoti Saikia
- Department of ENT, Assam Medical College and Hospital, Dibrugarh, Assam 786002 India
| | - Mohan Kr. Mili
- Department of ENT, Assam Medical College and Hospital, Dibrugarh, Assam 786002 India
| | - Mridusmita Gohain
- Department of ENT, Assam Medical College and Hospital, Dibrugarh, Assam 786002 India
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Muacevic A, Adler JR. Laryngeal Trauma, Its Types, and Management. Cureus 2022; 14:e29877. [PMID: 36348916 PMCID: PMC9629857 DOI: 10.7759/cureus.29877] [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: 08/23/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023] Open
Abstract
Laryngotracheal wounds are rare; however, they have a significant mortality rate. These wounds can be blunt or penetrating. Usually, the larynx is protected from blunt trauma by the sternum and jaw. A "clothesline" injury happens when the exposed neck is struck by a hard object, such as a wall wire or tree branch, or when an attack is intended to damage the larynx. Additionally, injuries may occur when the neck is stressed due to damage, such as in a rear-end accident that causes a whiplash-like injury or when the larynx is intentionally targeted for harm. Penetrating neck trauma may result in injury to the larynx. Assume a patient has suffered a penetrating or severe neck injury. It is usually evident from their medical history or a quick trauma evaluation in that case. However, it is recommended to be cautious for anterior neck injuries in general and to have a low threshold for establishing a surgical airway. The priority is securing an airway when a patient with a laryngeal injury arrives in the emergency room. The operating surgeon may request any flexible laryngoscopy, computed tomography (CT), esophagram, and chest X-ray for additional examination, depending on the nature of the damage and the patient's health. After the examination, the initial step in treating laryngeal injuries should be to locate and secure the airway. According to the evaluation and management based on the Schaefer classification system for laryngeal injury, the patient is treated based on whether the patient has impending airway obstruction or a stable airway. Medical management or observation and surgical management depend on the site and severity of the injury, patient condition, and type of injury. There are several complications related to laryngotracheal trauma, which can be minor or even fatal. Following successful treatment, postoperative and rehabilitative care, vocal rest, speech therapy, and swallowing therapy may be necessary.
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Bourdillon AT, Kafle S, Salehi PP, Steren B, Pei KY, Azizzadeh B, Lee YH. Characterization of Laryngotracheal Fractures and Repairs: A TQIP Study. J Voice 2022:S0892-1997(22)00163-1. [PMID: 35817623 DOI: 10.1016/j.jvoice.2022.06.007] [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: 03/14/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Laryngotracheal trauma is poorly studied and associated with serious morbidity and mortality. This study reports features associated with laryngotracheal fractures, and factors associated with laryngeal fracture repair. STUDY DESIGN Retrospective database study SETTING: American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP®) METHODS: ACS-TQIP® 2014-2015 participant user data files were queried for laryngotracheal fractures using the International Classification of Diseases (ICD) 9th edition encodings. Demographic, diagnostic and procedure characteristics were analyzed with univariate chi-squared analysis and multivariate logistic regression. RESULTS We extracted 635 cases of laryngotracheal injury, with a median Injury Severity Score of 16 (IQR: 10 - 25). Most were caused unintentionally (65.7%), followed by assault (28.8%). Blunt trauma (79.5%) was more common than penetrating trauma (20.0%). These trends were upheld in the subgroup of repaired fractures, which made up 12.6% (80/635) of cases. The median length of hospital stay was 6 days (IQR: 3 - 13) in all fractures and 10 days (IQR: 6 - 14) in the subgroup of repaired fractures, while the median length of ICU stay was 4 days (IQR: 2 - 9) in all fractures and 4.5 (IQR: 6 - 14.3) in the subgroup of repaired fractures. Cut/pierce injuries (OR: 4.7, P < 0.001) and ISS (OR: 0.97, pP = 0.026) significantly affected rate of laryngeal fracture repair. CONCLUSION Laryngotracheal fractures are uncommon but serious injuries. Our results show that penetrating causes of injuries have the shortest time to repair, and that a higher ISS score is negatively associated with repair.
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Affiliation(s)
| | - Samipya Kafle
- Yale School of Medicine, Yale University, New Haven, CT
| | - Parsa P Salehi
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT
| | | | - Kevin Y Pei
- Department of Surgery, Parkview Health, Fort Wayne, IN
| | - Babak Azizzadeh
- Center for Advanced Facial Plastic Surgery, Beverley Hills, CA; Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Yan Ho Lee
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT.
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8
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Management of paediatric laryngotracheal trauma. The Journal of Laryngology & Otology 2022; 136:1125-1129. [DOI: 10.1017/s0022215121003972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Objective
To summarise and describe the clinical presentations, diagnostic approaches and airway management techniques in children with laryngotracheal trauma.
Methods
The clinical data related to laryngotracheal trauma diagnosed and treated at the Beijing Children's Hospital, between January 2013 and July 2018, were retrospectively reviewed. Disease diagnosis, treatment, management and outcomes were analysed.
Results
A total of 13 cases were enrolled, including 7 cases of penetrating laryngotracheal trauma. The six cases of blunt laryngotracheal trauma were caused by collisions with hard objects. In all cases, voice, airway and swallowing outcomes were graded as ‘good’, except for one patient who had residual paralysis of the vocal folds.
Conclusion
Flexible fibre-optic laryngoscopy and computed tomography can play an important role in diagnosing laryngotracheal trauma. The airway should be secured and, if necessary, opened by tracheal intubation or tracheostomy.
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9
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Wang AA, Feng AL, Rao V, Naunheim MR, Juliano AF, Song PC. Clinical, Radiologic, and Endolaryngeal Findings in Laryngeal Fractures: A 15-Year Case Series. OTO Open 2022; 6:2473974X221080164. [PMID: 35237739 PMCID: PMC8883307 DOI: 10.1177/2473974x221080164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Laryngeal fractures are rare injuries; recent data describing these injuries and associated examination findings are limited. This study aims to describe injury etiology and outcomes associated with laryngeal fractures. Study Design Retrospective case series. Setting Academic tertiary center. Methods Patients with laryngeal fractures from 2005 to 2020 were identified in a retrospective chart review. Patient demographics, injury mechanisms, management, and voice outcomes were examined. Fracture type, radiologic, and endolaryngeal examination findings were analyzed for associations between fracture etiology and examination characteristics. Results Laryngeal fractures most commonly occurred at the thyroid cartilage. Fractures were most commonly due to sport-related injuries. Mechanism of injury was not associated with specific radiologic or endolaryngeal findings. Mechanism of injury was additionally not significantly associated with the need for intubation, surgical intervention, or tracheotomy. Fracture location was significantly associated with intubation requirement (P = .015), with 40% of patients with concomitant thyroid and cricoid fractures requiring intubation. Mechanism of injury significantly correlated with dysphonia at follow-up (P = .033). Mechanism of injury, fracture location, and surgical management were not associated with increased vocal fold injury or dysphonia. Conclusion There are no significant correlations between injury mechanism and fracture location, characteristics, radiologic findings, or endolaryngeal findings. These features emphasize the importance of a thorough and comprehensive laryngeal examination.
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Affiliation(s)
| | - Allen L. Feng
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Vishwanatha Rao
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew R. Naunheim
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy F. Juliano
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Phillip C. Song
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Qiu ZH, Zeng J, Zuo Q, Liu ZQ. External penetrating laryngeal trauma caused by a metal fragment: A Case Report. World J Clin Cases 2022; 10:1394-1400. [PMID: 35211575 PMCID: PMC8855201 DOI: 10.12998/wjcc.v10.i4.1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/08/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although external penetrating laryngeal trauma is rare in the clinic, such cases often result in a high mortality rate. The early recognition of injury, protection of the airway, one-stage laryngeal reconstruction with miniplates and interdisciplinary cooperation are important in the treatment of such patients.
CASE SUMMARY A 58-year-old male worker sustained a penetrating injury in the left neck. After computed tomography scanning at a local hospital, he was transferred to our hospital, where he underwent tracheotomy, neck exploration, extraction of the foreign object, debridement and repair of the thyroid cartilage using titanium miniplates. An endo laryngeal stent was inserted, which was removed 12 days later. The patient recovered well and his voice rapidly improved after surgery.
CONCLUSION Penetrating laryngeal trauma is uncommon. We successfully treated a patient with early laryngeal reconstruction and management by interdisciplinary cooperation.
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Affiliation(s)
- Zi-Han Qiu
- Department of Otolaryngology-Head and Neck Surgery, the First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Jin Zeng
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Qiang Zuo
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Zhong-Qi Liu
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing 100191, China
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Khalid N, Bilal M, Umer M. Non-Traumatic Laryngeal Fractures: A Systematic Review. Turk Arch Otorhinolaryngol 2021; 59:65-75. [PMID: 33912863 PMCID: PMC8054934 DOI: 10.4274/tao.2020.6093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/27/2020] [Indexed: 12/01/2022] Open
Abstract
Non-traumatic laryngeal fractures are an extremely uncommon presentation, and the diagnosis can be missed. Recognizing these fractures is important to appropriately direct management because most have a good prognosis and result in complete recovery. This article aimed to review the characteristics of all documented cases of non-traumatic fractures of the larynx. We sought to address questions related to the etiology, clinical presentation, and diagnostic assessment of this condition and provide recommendations about the management of these fractures. Electronic databases, mainly PubMed and Google Scholar, were searched for relevant literature with no language or time restrictions. Since 1950, 15 cases of non-traumatic laryngeal fractures have been documented in the medical literature. Out of these, thyroid cartilage fractures have been described in 14 patients, while only one instance demonstrated a fracture in the cricoid cartilage. Patients were managed conservatively using voice rest and observation with complete recovery in all cases. All patients who present with odynophagia, hoarseness, and tenderness over the thyroid cartilage after an episode of severe coughing or sneezing, should be evaluated for a thyroid cartilage fracture using laryngoscopy and computed tomography scan. Management of the airway should be the primary priority in any laryngeal injury, and further management performed after the airway is stable.
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Affiliation(s)
- Noor Khalid
- Department of Otorhinolaryngology, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Muhammad Bilal
- Department of Otorhinolaryngology, Foundation University Medical College, Islamabad, Pakistan
| | - Muhammad Umer
- Department of Otorhinolaryngology, Army Medical College, Rawalpindi, Pakistan
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Mortensen M, Browne N, Hutnik R, Far SM. Unexpected blunt neck trauma resulting in laryngeal fracture, the case of the dangerous wooden box: A case report. Trauma Case Rep 2021; 32:100439. [PMID: 33681442 PMCID: PMC7918679 DOI: 10.1016/j.tcr.2021.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 10/26/2022] Open
Abstract
Background Laryngeal fracture is a rare condition but is potentially lethal. These injuries are usually caused by major blunt trauma from motor vehicle accidents, physical assaults, or sports injuries. The high mortality associated with these injuries requires prompt recognition and treatment. Case report We present a case of laryngeal fracture caused by falling from standing height and landing onto the edge of a wooden box- a seemingly minor blunt trauma. The patient fractured her thyroid lamina and had a comminuted fracture of the cricoid cartilage. The patient was able to be decannulated and required injection augmentation for return of normal voice. Conclusion This case highlights the importance of maintaining a high level of suspicion for laryngeal fracture in a patient that falls and strikes the anterior neck. Early identification of laryngeal fractures not only allows for airway protection but helps ensure the preservation of voice, swallowing and airway functions.
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Affiliation(s)
- Melissa Mortensen
- Albany Medical College, Department of Otolaryngology, Albany, NY, United States of America
| | - Nicholas Browne
- Stony Brook Medicine, Department of Surgery, Stony Brook, NY, United States of America
| | - Robert Hutnik
- Stony Brook Medicine, Department of Surgery, Stony Brook, NY, United States of America
| | - Sina Mehraban Far
- Stony Brook Medicine, Department of Surgery, Stony Brook, NY, United States of America
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13
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Famokunwa B, Kemp S, Selby J, Madani G, Sandhu G, Hull JH. Life-threatening laryngeal injury in Elite Rugby Union: Prevention and management laryngeal trauma in rugby. Clin Case Rep 2021; 9:494-498. [PMID: 33489203 PMCID: PMC7813074 DOI: 10.1002/ccr3.3565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/18/2020] [Accepted: 10/26/2020] [Indexed: 11/07/2022] Open
Abstract
Laryngeal trauma is a life-threatening injury in contact sports. Due to its potentially devastating consequences, the prevention, diagnosis, and management of neck trauma both pitch side and at the hospital are essential for athletes.
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Affiliation(s)
| | | | - Julia Selby
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK
| | - Gitta Madani
- Department of RadiologyCharing Cross HospitalLondonUK
| | - Guri Sandhu
- Department of ENT Charing Cross HospitalLondonUK
| | - James H. Hull
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK
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14
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Feng AL, Parikh A, Gadkaree SK, Naunheim MR, Song PC. Laryngeal fractures in professional and semiprofessional ice hockey players. Laryngoscope Investig Otolaryngol 2020; 5:1110-1116. [PMID: 33364401 PMCID: PMC7752032 DOI: 10.1002/lio2.474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/16/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Injuries in professional ice hockey players are common, however significant laryngeal trauma is rare. Here, we present a case series of professional and semiprofessional ice hockey players to demonstrate the mechanism and nature of laryngeal injuries they sustain during play, and to recommend best practices for treatment, prevention, and return to the ice. METHODS A retrospective case review was done of hockey-related laryngeal injuries between 2016 and 2019 at a tertiary laryngology practice. Only semiprofessional and professional hockey players were included. RESULTS In total, four cases were included. All cases involved trauma from a hockey puck to the neck. No cases were the result of punching, fighting, high sticks or routine checking. Notably, 1 of 4 presented with severe airway compromise, requiring urgent intubation, whereas most presented with pain or a significant voice complaint. Two patients required operative intervention with open reduction and internal fixation of significantly displaced fractures. One patient experienced significant mucosal disruption with cartilaginous exposure at the posterior vocal complex requiring microflap. The average return to ice was 6 weeks for those who required operative intervention and 4 weeks for those who were managed conservatively. One patient had persistent mild dysphonia and all others had a return to baseline phonation. None were wearing neck guards or other protective equipment at the time of injury. CONCLUSION Though voice and airway injuries are rarely sustained by ice hockey players, they may require urgent intervention. We recommend that protective equipment be worn and improved to prevent laryngeal trauma. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Allen L. Feng
- Department of OtolaryngologyMassachusetts Eye and Ear, Harvard Medical SchoolBostonMassachusettsUSA
| | - Ayush Parikh
- Department of OtolaryngologyMassachusetts Eye and Ear, Harvard Medical SchoolBostonMassachusettsUSA
| | - Shekhar K. Gadkaree
- Department of OtolaryngologyMassachusetts Eye and Ear, Harvard Medical SchoolBostonMassachusettsUSA
| | - Matthew R. Naunheim
- Department of OtolaryngologyMassachusetts Eye and Ear, Harvard Medical SchoolBostonMassachusettsUSA
| | - Phillip C. Song
- Department of OtolaryngologyMassachusetts Eye and Ear, Harvard Medical SchoolBostonMassachusettsUSA
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Balai E, Bhamra N, Gupta KK, Jolly K, Barraclough J. A Case of Laryngeal Fracture Precipitated by Swallowing. Cureus 2020; 12:e10303. [PMID: 33052266 PMCID: PMC7544551 DOI: 10.7759/cureus.10303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report the case of a non-traumatic laryngeal fracture precipitated by swallowing where the symptoms were initially misinterpreted as representing a possible laryngeal malignancy. By the time of diagnosis, the injury was associated with an anterior neck abscess that required urgent surgical intervention. A 61-year-old male presented with dysphonia, odynophagia and neck swelling that had begun shortly after feeling a sudden crack in his neck upon swallowing. This was initially suspected to represent a laryngeal malignancy until, while awaiting outpatient investigation, the patient re-presented with rapid progression of his symptoms. Urgent CT scan revealed a vertical fracture of the thyroid cartilage, and a large anterior neck abscess causing posterior displacement. This required urgent surgical drainage. No underlying neoplasm was found, and the patient made a full recovery with complete resolution of symptoms. Non-traumatic laryngeal fractures are extremely rare. This case demonstrates the diagnostic challenge they can pose and is the first to describe the presentation and surgical management of a case with fracture displacement due to localised infection.
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Affiliation(s)
- Edward Balai
- Department of Otolaryngology, The Royal Wolverhampton NHS Trust, Birmingham, GBR
| | - Navdeep Bhamra
- Department of Otolaryngology, The Royal Wolverhampton NHS Trust, Birmingham, GBR
| | - Keshav K Gupta
- Department of Otolaryngology, The Royal Wolverhampton NHS Trust, Birmingham, GBR
| | - Karan Jolly
- Department of Otolaryngology, The Royal Wolverhampton NHS Trust, Birmingham, GBR
| | - James Barraclough
- Department of Otolaryngology, The Royal Wolverhampton NHS Trust, Birmingham, GBR
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16
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Matsuo Y, Yamada T, Hiraoka E. Unique presentation of cricoid cartilage fracture causing intermittent dyspnea without preceding trauma. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 81:687-691. [PMID: 31849386 PMCID: PMC6892678 DOI: 10.18999/nagjms.81.4.687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cricoid cartilage fracture is generally caused by significant neck trauma and causes continuous dyspnea, neck pain, or hoarseness developing immediately after the traumatic episode. A 69-year-old woman without any history of trauma was admitted to our hospital with intermittent dyspnea. Six months before admission she had started to complain of dyspnea occurring several times a month without warning, improving spontaneously within a few hours without treatment. Her primary care doctor diagnosed asthma and she was treated with inhaled short-acting beta agonists and glucocorticoids, without improvement. On initial evaluation at our hospital, the cause of dyspnea was unclear. Laryngoscopy was performed, which excluded vocal cord dysfunction. A further attack of dyspnea occurred on the fourth admission day. Stridor was evident during the attack, and bronchoscopy revealed subglottic narrowing of the trachea on both inspiration and expiration with no mass or foreign objects. Computed tomography (CT) of the neck revealed cricoid cartilage fracture causing airway narrowing and dyspnea. She was orally intubated, and tracheostomy was performed 2 weeks later to maintain her airway, which resolved her dyspnea. This patient's presentation was unique in two aspects. First, there was no history of trauma that may cause her cricoid cartilage fracture. Second, her symptoms of dyspnea were intermittent rather than continuous. These aspects led to suspicions of other diseases such as asthma or vocal cord dysfunction, thus delaying the diagnosis. Cricoid cartilage fracture should be considered in patients with dyspnea of unknown cause, irrespective of continuous or intermittent symptoms and preceding traumatic episodes.
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Affiliation(s)
- Yuichiro Matsuo
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Toru Yamada
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan.,Department of General Medicine/Family and Community Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
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Abstract
External laryngeal trauma is a rare but potentially fatal event that presents several management challenges. This retrospective observational case series conducted at a level-1 trauma center over a 12-year period consists of 62 cases of acute external laryngeal trauma. Patient demographics, mode and mechanisms of injury, presenting signs and symptoms, initial imaging results, airway management, time to surgical management, and 6-month outcomes including airway status, deglutition status, and voice quality were investigated. No difference was found in mortality or 6-month outcomes between patients requiring surgical repair and/or tracheostomy versus patients with less severe injuries managed conservatively.
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18
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Blunt neck trauma at a level I trauma centre: six-year retrospective case note review. The Journal of Laryngology & Otology 2019; 133:943-947. [PMID: 31607275 DOI: 10.1017/s0022215119001993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Blunt neck trauma can cause serious morbidity and mortality rates of up to 40 per cent, but there is a paucity of literature on the topic. METHOD A retrospective case note review was performed for all blunt neck trauma cases managed at the Queen Elizabeth Hospital Birmingham between 1st January 2011 and 31st December 2017. RESULTS Seventeen cases were managed, with no mortality and limited morbidity. Most patients were male (70.6 per cent) and road traffic accidents were the most common cause of injury (41.2 per cent). The median age of patients was 40.6 years (range, 21.5-70.3 years). Multidetector computed tomography angiography of the neck was performed in 9 patients (52.9 per cent) with 'hot' reports made by on-duty radiology staff matching consultant reports in all but 1 case. Six patients underwent operative exploration yielding a negative exploration rate of 33.3 per cent. Imaging reports matched operative findings in 3 cases (60 per cent). CONCLUSION Blunt neck trauma is uncommon but usually presents in polytrauma. Imaging has inaccuracies when compared with operative findings, regardless of radiological experience.
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19
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Go JL, Acharya J, Branchcomb JC, Rajamohan AG. Traumatic Neck and Skull Base Injuries. Radiographics 2019; 39:1796-1807. [PMID: 31589581 DOI: 10.1148/rg.2019190177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patients with blunt and penetrating traumatic injuries to the skull base and soft tissues of the neck present to the emergency department every day. Fortunately, truly life-threatening injuries to these regions are relatively uncommon. However, when encountered and not correctly diagnosed, these entities may result in severe morbidity or mortality. The radiologist plays a critical role recognizing these injuries, in which findings may often be subtle and the anatomy potentially challenging to identify. Multisection CT and CT angiography are commonly performed to assess these injuries in the emergency department. Vascular injury to the neck may result in dissection, occlusion, pseudoaneurysm formation, or frank extravasation resulting in stroke or death. Airway compromise may result from laryngotracheal injury. Injuries to the pharynx and esophagus may result in perforation. Injuries to the temporal bone may result in vascular injury to the internal carotid artery or facial nerve injury, which would require immediate surgery or intervention to prevent paralysis.©RSNA, 2019.
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Affiliation(s)
- John L Go
- From the Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif, and LAC+USC Medical Center, 1983 Marengo Street, D and T Tower, Room 3D321, Los Angeles, CA 90033
| | - Jay Acharya
- From the Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif, and LAC+USC Medical Center, 1983 Marengo Street, D and T Tower, Room 3D321, Los Angeles, CA 90033
| | - Jasmine C Branchcomb
- From the Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif, and LAC+USC Medical Center, 1983 Marengo Street, D and T Tower, Room 3D321, Los Angeles, CA 90033
| | - Anandh G Rajamohan
- From the Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif, and LAC+USC Medical Center, 1983 Marengo Street, D and T Tower, Room 3D321, Los Angeles, CA 90033
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20
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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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21
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Shi J, Uyeda JW, Duran-Mendicuti A, Potter CA, Nunez DB. Multidetector CT of Laryngeal Injuries: Principles of Injury Recognition. Radiographics 2019; 39:879-892. [DOI: 10.1148/rg.2019180076] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Junzi Shi
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Jennifer W. Uyeda
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Alejandra Duran-Mendicuti
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Christopher A. Potter
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Diego B. Nunez
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
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Maxillofacial Fractures Associated With Laryngeal Injury: A Craniofacial Surgeon Should be Alert. Ann Plast Surg 2018; 82:S72-S76. [PMID: 30516562 DOI: 10.1097/sap.0000000000001720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Maxillofacial fractures with concomitant laryngeal injuries put both the quality and maintenance of life in jeopardy. Because of its low incidence, it is often overlooked in the clinical setting. The purpose of this study is to review the incidence, clinical presentations, managements, and outcomes of these patients. METHODS A retrospective analysis of medical records from 2008 to 2015 was conducted at a single institute. A case series (n = 12, which contributed 22.2% of laryngeal injuries in our institute) of these patients was presented, and propensity score matching was applied for further statistical analysis. RESULTS When comparing patients who sustained maxillofacial fractures with concomitant laryngeal injuries with patients with only maxillofacial fractures and no laryngeal injuries, subcutaneous emphysema (83.3% vs 4.2%, P < 0.001), neck pain (75.0% vs 6.3%, P < 0.001), dyspnea (75.0% vs 0%, P < 0.001), hoarseness (41.7% vs 0%, P < 0.001), neck swelling (66.7% vs 4.2%, P = 0.012), stridor (16.7% vs 0%, P = 0.037), hemoptysis (16.7% vs 0%, P = 0.037), and thoracic trauma (58.3% vs 10.4%, P = 0.001) all showed significant differences. The length of intensive care unit stay (7.42 days vs 3.21 days, P = 0.008), ventilator use (66.7% vs 18.8%, P = 0.002), and tracheostomy (58.3% vs 0%, P < 0.001) were also significantly different. CONCLUSIONS A significant portion of laryngeal injuries is concurrent with maxillofacial fractures. As a craniofacial surgeon, we should be alert to the signs of laryngeal injury. Diagnosis of laryngeal injuries should be established before definitive surgery for maxillofacial fractures.
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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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24
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Schulze K, Ebert LC, Ruder TD, Fliss B, Poschmann SA, Gascho D, Thali MJ, Flach PM. The gas bubble sign-a reliable indicator of laryngeal fractures in hanging on post-mortem CT. Br J Radiol 2018; 91:20170479. [PMID: 29327945 DOI: 10.1259/bjr.20170479] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The purpose was to evaluate the presence of gas in the tissue adjacent to the laryngeal structures, "the gas bubble sign", in cases of hanging as a diagnostic indicator of neck trauma. METHODS In this study, post-mortem CT (PMCT) scans and autopsies of 35 victims of hanging were examined to reveal age-dependent changes, laryngeal fracture, fracture location and the presence of gas. A matched group with cardiac arrest or intoxication was used as controls (n = 35). An autopsy was performed in each case. RESULTS Incomplete suspension was the most common method in hanging. The thyroid horns (90.5%) were identified as the most vulnerable location for fractures. Laryngeal deformity and dislocation, which was only detected on PMCT, was observed in 57.1% and was concomitant with fractures in 83.3%. Laryngeal fractures are more common with advanced age (>40 years, 88.9%) and less common in younger subjects (<40 years, 29.4%). The gas bubble sign with regard to laryngeal fractures yielded a sensitivity of 79.2%, a positive predictive value of 95%, a specificity of 90.9%, a negative predictive value of 34.5% and an accuracy of 83%. CONCLUSION The complex evaluation of the larynx is profoundly supported by PMCT and the detection of the gas bubble sign as a diagnostic indicator of neck trauma. This relevant diagnostic finding might aid in not only post-mortem cases but also clinical cases, for patients who survive an assault to the neck. Advances in knowledge: (1) The gas bubble sign is a diagnostic indicator of neck trauma in not putrefied bodies. (2) PMCT supports evaluation of trauma to the neck in hanging tremendously. (3) The diagnostic finding of gas located at the laryngeal structures may not only aid in post-mortem cases but also clinical cases of people who survive an assault to the neck.
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Affiliation(s)
- Katja Schulze
- 1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland
| | - Lars Christian Ebert
- 1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland
| | - Thomas Daniel Ruder
- 1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland.,2 Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern , Bern , Switzerland
| | - Barbara Fliss
- 1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland
| | | | - Dominic Gascho
- 1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland
| | - Michael Josef Thali
- 1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland
| | - Patricia Mildred Flach
- 1 Institute of Forensic Medicine and Imaging, University of Zurich , Zurich , Switzerland.,3 Clinic for Radiology and Nuclear Medicine, Kantonal Hospital St. Gallen , St. Gallen , Switzerland
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Matrka L, Li M. Laryngeal Fracture following Violent Sneeze: Management and Biomechanical Analysis. OTO Open 2018; 2:2473974X18757741. [PMID: 30480206 PMCID: PMC6239027 DOI: 10.1177/2473974x18757741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/02/2017] [Accepted: 01/17/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Laura Matrka
- Department of Otolaryngology, The Ohio
State University, Columbus, Ohio, USA
| | - Michael Li
- College of Medicine, The Ohio State
University, Columbus, Ohio, USA
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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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Hamilton NJI, Birchall MA. Tissue-Engineered Larynx: Future Applications in Laryngeal Cancer. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017; 5:42-48. [PMID: 28367360 PMCID: PMC5357481 DOI: 10.1007/s40136-017-0144-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose of Review This article reviews the latest developments in tissue engineering for the larynx with a specific focus on the treatment of laryngeal cancer. Recent Findings Challenges in tissue engineering a total larynx can be divided into scaffold design, methods of re-mucosalization, and how to restore laryngeal function. The literature described a range of methods to deliver a laryngeal scaffold including examples of synthetic, biomimetic, and biological scaffolds. Methods to regenerate laryngeal mucosa can be divided into examples that use a biological dressing and those that engineer a new mucosal layer de novo. Studies aiming to restore laryngeal function have been reported, but to date, the optimum method for achieving this as part of a total laryngeal transplant is yet to be determined. Summary There is great potential for tissue engineering to improve the treatments available for laryngeal cancer within the next 10 years. A number of challenges exist however and advances in restoring function must keep pace with developments in scaffold design.
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Laryngeal Fracture after Blunt Cervical Trauma in Motorcycle Accident and Its Management. Case Rep Otolaryngol 2017; 2017:9321975. [PMID: 28261512 PMCID: PMC5312043 DOI: 10.1155/2017/9321975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/04/2017] [Indexed: 11/18/2022] Open
Abstract
Laryngeal fracture is a rare traumatic injury, potentially fatal, with an estimated incidence of 1 in 30,000 patients admitted to severe trauma centers. Because of the rarity of this injury, physician may be not aware of its existence, leading to a late diagnosis of this entity. We report a case of a 59-year-old woman admitted to the emergency room after a motorcycle accident with cervical trauma. The patient presented with dysphonia, hemoptysis, cervical subcutaneous emphysema, and increasing respiratory distress that led to the intubation of the patient. CT-scan demonstrated displaced fracture of the cricoid and thyroid cartilage. The patient was submitted to tracheostomy and the fracture was surgically repaired. Tracheostomy was removed in third postoperative month. The patient presented a good recovery, reporting only hoarseness but without swallowing or breathing problems at 6-month follow-up.
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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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Thyrocricotracheal separation with bilateral recurrent laryngeal nerve transsection: report of a survivor. Am J Emerg Med 2015; 33:1849.e1-3. [PMID: 25976270 DOI: 10.1016/j.ajem.2015.04.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/16/2015] [Indexed: 11/22/2022] Open
Abstract
Thyrocricotracheal separation is an extremely fatal injury that has not been reported in the literature. Although timely and proper management of this injury is paramount to preserve the patient's life, airway, and voice, its rarity has resulted in a lack of consensus regarding the best management option. We report a case of thyrocricotracheal separation with bilateral recurrent laryngeal nerve transsection caused by a self-inflicted injury, which was treated with reanastomosis in conjunction with transverse laser cordotomy. The patient could achieve both decannulation and a serviceable voice and could return to a normal social life. The present case is the first report of a survivor with thyrocricotracheal separation with bilateral recurrent laryngeal nerve transsection. This findings show that appropriate management of the airway is the first step to ensure a successful outcome, and a step-by-step approach to detect and manage the associated injuries is paramount in cases showing the most severe form of laryngeal trauma.
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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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32
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Rapid detection of thyroid cartilage fracture by ultrasound in a multiple trauma patient. Intensive Care Med 2014; 40:1021-2. [DOI: 10.1007/s00134-014-3295-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
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33
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Management of supraglottic stenosis using a novel stent design. J Voice 2014; 28:515-7. [PMID: 24726332 DOI: 10.1016/j.jvoice.2013.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 12/30/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To present a novel design for a stent for management of a traumatic supraglottic web. METHODS Case report and literature review (PubMed 1964-2013). RESULTS A 48-year-old man was presented after penetrating laryngeal trauma. He had severe dysphonia and was tracheotomy dependent. He had been treated previously with open reduction and fixation of laryngeal fracture. On examination, we identified an avulsed left vocal fold and a supraglottic web. He initially underwent reapproximation of the avulsed left vocal fold, and subsequently, the supraglottic web was treated using a stent designed by the senior author (R.T.S.). In addition, he underwent later resection of scar tissue to improve dysphonia and then he was decanulated. CONCLUSIONS There are a few techniques presented in the literature and mostly are adaptations of subglottic stenosis management techniques. Individualized treatment is needed for these difficult cases. We present our experience with supraglottic web treatment to expand the literature on this uncommon disorder.
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MDCT in the assessment of laryngeal trauma: value of 2D multiplanar and 3D reconstructions. AJR Am J Roentgenol 2013; 201:W639-47. [PMID: 24059404 DOI: 10.2214/ajr.12.9813] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze fracture patterns and related effects of laryngeal trauma and to assess the value of 2D multiplanar reformation (MPR) and 3D reconstruction. MATERIALS AND METHODS Among 4222 consecutively registered trauma patients who underwent emergency MDCT, 38 patients had presented with laryngeal trauma. Axial, 2D MPR, 3D volume-rendered, and virtual endoscopic images were analyzed retrospectively by two blinded observers according to predefined criteria. Laryngeal fractures, soft-tissue injuries, and airway compromise were evaluated and correlated with clinical, endoscopic, surgical, and follow-up findings. RESULTS Fifty-nine fractures (37 thyroid, 13 cricoid, nine arytenoid) were present in 38 patients. They were isolated in 21 (55%) patients. The other 17 (45%) patients had additional injuries to the neck, face, brain, chest, or abdomen. Laryngeal fractures were bilateral in 31 (82%) patients and were associated with hyoid bone fractures in nine (24%) patients. Arytenoid luxation was present in eight cartilages. Axial imaging missed 7 of 59 (12%) laryngeal fractures, six of eight (75%) arytenoid luxations, and four of nine (44%) hyoid bone fractures. Additional 2D MPR imaging missed 5 of 59 (8%) laryngeal fractures, five of eight (62.5%) arytenoid luxations, and two of nine (22%) hyoid bone fractures, whereas 3D volume-rendered images depicted them all. Virtual endoscopy and 3D volume rendering added diagnostic accuracy with respect to the length, width, shape, and spatial orientation of fractures in 22 of 38 (58%) patients; arytenoid luxation in six of eight (75%) luxations; and the evaluation of airway narrowing in 19 of 38 (50%) patients. Three-dimensional volume rendering was not of additional value in evaluation of the cricoid cartilage. CONCLUSION The use of 2D MPR and 3D volume rendering with or without virtual endoscopy improved assessment of thyroid and hyoid bone fractures, arytenoid luxations, and laryngotracheal narrowing, providing helpful data for optimal management.
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Becker M, Leuchter I, Platon A, Becker CD, Dulguerov P, Varoquaux A. Imaging of laryngeal trauma. Eur J Radiol 2013; 83:142-54. [PMID: 24238937 DOI: 10.1016/j.ejrad.2013.10.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/18/2013] [Accepted: 10/15/2013] [Indexed: 12/28/2022]
Abstract
External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed.
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Affiliation(s)
- Minerva Becker
- Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Igor Leuchter
- Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Alexandra Platon
- Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Christoph D Becker
- Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Pavel Dulguerov
- Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Arthur Varoquaux
- Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
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Schaefer SD. Management of acute blunt and penetrating external laryngeal trauma. Laryngoscope 2013; 124:233-44. [PMID: 23804493 DOI: 10.1002/lary.24068] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/22/2013] [Accepted: 01/31/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVES/HYPOTHESIS Improve the care of acute external laryngeal trauma by reviewing controversies and the evolution of treatment. DATA SOURCE Internet-based search engines, civilian and military databases, and manual search of references from these sources over the past 90 years. REVIEW METHODS Utilizing the above-mentioned sources, electronic and manual searches of primary topics such as laryngeal trauma or injury, emergency tracheotomy, airway trauma, intubation versus tracheotomy, cricothyrotomy, esophageal trauma, and emergent management of airway injuries in civilian and combat zones. Citations were reviewed, selected reports analyzed, and the most relevant articles referenced. RESULTS Optimal treatment of acute laryngeal trauma includes early identification of injuries utilizing a directed history and physical examination. Timely management of the wounded airway is essential. The choice of intubation, tracheotomy, or cricothyrotomy must be individualized. Computed tomography (CT) may assist in differentiating patients who can be observed versus those who require surgical exploration. In selected patients, laryngeal electromyography and stroboscopy may also be useful. Surgery should begin with direct laryngoscopy and rigid esophagoscopy to evaluate the hard and soft tissues of the larynx, and to visualize the pharynx and esophagus. Minor endolaryngeal lacerations and abrasions may be observed, whereas more significant injuries require primary closure via a thyrotomy. Laryngeal skeletal fractures should be reduced and fixated. Endolaryngeal stenting is reversed for massive mucosal trauma, comminuted fractures, and traumatic anterior commissure disruption. CONCLUSIONS Acute external injury to the larynx is both life threatening and a potential long-term management challenge. Although a rare injury, sufficient experience now exists to recommend specific treatments, and to preserve voice and airway function.
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Affiliation(s)
- Steven D Schaefer
- New York Head and Neck Institute, Department of Otolaryngology-Head and Neck Surgery, Lenox Hill Hospital of the North Shore Long Island Jewish Health System and New York Medical College, New York, New York, U.S.A
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Near-complete supraglottic transection of the larynx after a motorbike accident. Case Rep Otolaryngol 2013; 2013:827902. [PMID: 23762706 PMCID: PMC3666302 DOI: 10.1155/2013/827902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 04/23/2013] [Indexed: 11/17/2022] Open
Abstract
Severe laryngeal trauma is rare in the civilian environment and requires appropriate and timely surgical intervention. We report a case from Sydney, Australia, which was managed with open reduction and internal fixation of the larynx with resorbable plates. The use of resorbable plates for operative fixation of the larynx has rarely been reported in literature but may be a viable alternative.
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Abstract
PURPOSE Laryngeal fracture is rare, but complications are frequent and severe. Controversy still exists in regards to its proper management. The aim of this study was to present the clinical findings and management of laryngeal fracture in Korea. MATERIALS AND METHODS We analyzed the medical records of 22 patients with laryngeal fracture at a tertiary care trauma center from 2000 to 2010 retrospectively. RESULTS In total, 22 patients (19 men and 3 woman) presented with laryngeal fractures caused by blunt (n=13) or penetrating (n=9) injury. Pain (68.1%), odynophagia (68.1%), hoarseness (18.1%), hemoptysis (13.6%), and subcutaneous emphysema (9%) were the common presenting symptoms and noncomminuted fracture was common. High velocity blunt trauma (mostly traffic accidents) patients had more extensive injury and poor voice outcomes. Penetrating trauma patients due to physical assault or suicide attempt demonstrated more frequently injuries on the left side. CONCLUSION In driver-caused traffic accidents, where injuries in a wide area within the larynx occurred, poor voice results were seen, and these injuries required aggressive treatment. When endotracheal intubation was performed at experienced emergency centers with fiberoptic laryngoscopes, airway management was safely achieved. In addition, if the fractured laryngeal framework was corrected at appropriate times, voice results were good.
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Affiliation(s)
- Jin Pyeong Kim
- Department of Otorhinolaryngology, Gyeongsang National University, Jinju, Korea
| | - Sang Jae Cho
- Department of Otorhinolaryngology, Gyeongsang National University, Jinju, Korea
| | - Hee Young Son
- Department of Otolaryngology, Thyroid/Head & Neck Cancer Center of The Dongnam Institute of Radiological & Medical Sciences (DIRAMS), Busan, Korea
| | - Jung Je Park
- Department of Otorhinolaryngology, Gyeongsang National University, Jinju, Korea
| | - Seung Hoon Woo
- Department of Otorhinolaryngology, Gyeongsang National University, Jinju, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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Alexander VRC, Toynton S. Spontaneous fracture of the larynx after coughing. Otolaryngol Head Neck Surg 2012; 147:801-2. [PMID: 22535917 DOI: 10.1177/0194599812445744] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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