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Nganzeu C, Esce A, Abu-Ghanem S, Meiklejohn DA, Sims HS. Laryngeal Trauma. Otolaryngol Clin North Am 2023; 56:1039-1053. [PMID: 37442662 DOI: 10.1016/j.otc.2023.06.001] [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: 07/15/2023]
Abstract
Laryngeal trauma is rare but potentially fatal. Initial evaluation includes efficient history and physical examination, imaging, bedside flexible laryngoscopy, and if necessary, operative endoscopic evaluation. Multiple classification systems exist for laryngeal trauma, and each has its merits. We recommend a patient-centered approach, rather than using the classification alone. Secure airways are the primary goal of acute management, with awake tracheostomy more often indicated over oral intubation compared with traumas not involving the larynx. More severe injuries typically require surgical intervention. Early intervention results in optimal voice and airway outcomes.
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Affiliation(s)
- Claude Nganzeu
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico; Department of Surgery ENT 1, University of New Mexico, MSC10, 5610, Albuquerque, NM 87131, USA
| | - Antoinette Esce
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico; Department of Surgery ENT 1, University of New Mexico, MSC10, 5610, Albuquerque, NM 87131, USA
| | - Sara Abu-Ghanem
- Laryngology and Bronchoesophagology, Department of Otolaryngology, SUNY Downstate & Maimonides Health, 185 Montague Street, 5th Floor, Brooklyn, NY 11220, USA
| | - Duncan A Meiklejohn
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico; Department of Surgery ENT 1, University of New Mexico, MSC10, 5610, Albuquerque, NM 87131, USA
| | - H Steven Sims
- University of Illinois Hospital and Health Service Systems, 1855 West Taylor Street, Room 3.87, Chicago, IL 60612, USA.
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Rolfs-Schrum K, Scheidmann R, Flügel T, Böschen E, Betz C, Stock P. [Infantile laryngeal fracture - Its surgical management and tracheal cannula management]. Laryngorhinootologie 2023; 102:124-129. [PMID: 36126934 DOI: 10.1055/a-1873-2584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Kari Rolfs-Schrum
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Roman Scheidmann
- Pädiatrische Pneumologie und Intensivmedizin, AKK Altonaer Kinderkrankenhaus gGmbH, Hamburg, Germany
| | - Till Flügel
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Eicke Böschen
- Pädiatrische Pneumologie und Intensivmedizin, AKK Altonaer Kinderkrankenhaus gGmbH, Hamburg, Germany
| | - Christian Betz
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Philippe Stock
- Pädiatrische Pneumologie, AKK Altonaer Kinderkrankenhaus gGmbH, Hamburg, Germany
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An Updated Review of Subglottic Stenosis: Etiology, Evaluation, and Management. CURRENT PULMONOLOGY REPORTS 2022; 11:29-38. [PMID: 35261874 PMCID: PMC8892813 DOI: 10.1007/s13665-022-00286-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 12/27/2022]
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Complete Tracheal Transection in a 3-Year-Old After Blunt Neck Trauma: a Case Report. Rom J Anaesth Intensive Care 2020; 27:4-10. [PMID: 34056117 PMCID: PMC8158306 DOI: 10.2478/rjaic-2020-0003] [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: 11/20/2022] Open
Abstract
Pediatric laryngotracheal injuries from blunt force trauma are rare but can lead to significant morbidity and mortality. In pediatric patients with severe laryngotracheal disruption, extracorporeal membrane oxygenation has been used to improve oxygenation and ventilation until definitive repair can be performed. We describe the case of a 3-year-old girl with blunt neck trauma secondary to an all-terrain vehicle accident in which her neck was clotheslined against a fence, leading to a complete tracheal transection at the C7-T1 level. Emergent extracorporeal membrane oxygenation cannulation was initiated. We discuss the evaluation and management of tracheal injuries and the requisite multidisciplinary team approach. Pediatric patients with laryngotracheal trauma require definitive airway management, which should be performed by skilled personnel.
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Kaintura M, Wadhera R, Hernot S. Our 12 year experience with Montgomery T-tube in the management of acute blunt laryngotracheal trauma patients. Braz J Otorhinolaryngol 2020; 88:316-330. [PMID: 32788060 PMCID: PMC9422666 DOI: 10.1016/j.bjorl.2020.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction The Montgomery T-tube is a device used as a combined tracheal stent and tracheostomy tube to prevent post-operative tracheal stenosis. Objectives The purpose of this retrospective study is to evaluate the outcome following Montgomery T-tube stenting performed in for neck and airway injury in patients with acute blunt laryngotracheal trauma over a period of 12 years. Methods Between 2005 and 2017, 19 patients with acute blunt laryngotracheal trauma underwent Montgomery T-tube stenting. All 19 laryngotracheal trauma patients had undergone a preoperative tracheostomy in the emergency department by an ENT surgeon. Montgomery T-tube stenting was done later through an external approach. The follow up period ranged from 2 to 10 years. The Montgomery T-tube was removed after a period ranging from 6 months to 1½ year. Results The majority of patients in the study were in the age group of 21–30 years. A preoperative tracheostomy was done in all 19 patients. All patients except 3 underwent successful decannulation, and experienced long-term satisfactory result. Conclusion Management of acute blunt laryngotracheal trauma is a challenging problem that demands a multidisciplinary approach. The ideal treatment option should be individualized according to the patient's condition and characteristics of injury. According to our study we suggest that cases of acute blunt laryngotracheal trauma patients should be managed following the protocol as mentioned in our study, and we strongly emphasize that Montgomery T-tube should be left for at least 1 complete year in the airway as it results in negligible chances of post-traumatic stenosis of airway later.
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Affiliation(s)
- Madhuri Kaintura
- Pandit Bhagwat Dayal Post-Graduate Institute of Medical Sciences, Department of ENT, Rohtak, Haryana, India
| | - Raman Wadhera
- Pandit Bhagwat Dayal Post-Graduate Institute of Medical Sciences, Department of ENT, Rohtak, Haryana, India
| | - Sharad Hernot
- Pandit Bhagwat Dayal Post-Graduate Institute of Medical Sciences, Department of ENT, Rohtak, Haryana, India; Shri Guru Ram Rai Institute of Medical and Health Sciences, Department of ENT, Dehradun, Uttarakhand, India.
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Scott B, Isaiah A, Johnson R, Mitchell RB. Laryngeal Trauma in a 7-Year-Old Child. EAR, NOSE & THROAT JOURNAL 2019; 98:326-327. [PMID: 31309867 DOI: 10.1177/0145561318823974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Brian Scott
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX, USA
| | - Amal Isaiah
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX, USA
| | - Romaine Johnson
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX, USA
| | - Ron B Mitchell
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, TX, USA
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Abstract
OBJECTIVES Hanging may inflict laryngotracheal injuries and increase the potential for difficult airway management. We describe the management of pediatric hangings attended by an urban physician-led prehospital trauma service to provide information on a clinical situation encountered infrequently by most acute care clinicians. METHODS Retrospective trauma registry-based observational study of all children younger than 16 years attended with hanging as mechanism of injury in the period between 2000 and 2014. RESULTS Twenty-three thousand one hundred thirty patients were attended; 2415 (10%) of which were children. Of these, 32 cases (<1%) were pediatric hanging (1 case excluded due to missing data). There were 22 (71%) boys and 9 (29%) girls. Median age was 13 years. There was suicidal intent in 23 (74%) cases, and in 8 (26%) cases, hanging was accidental. There were 17 (55%) deaths, of which 14 (82%) were suicides.The doctor-paramedic team intubated 25 (80%) patients, with a 100% success rate. One (3%) patient was managed with a supraglottic airway device, and 5 (16%) patients did not require any advanced airway management. CONCLUSIONS Pediatric hanging is rare, but has a high mortality rate. Attempted suicide is the leading cause of hangings in children and preventive measures should target psychiatric morbidity. Despite concerns about airway edema or laryngeal injury, experienced doctor-paramedic teams had no failed airway attempts.
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Zawadzka-Glos L, Jakubowska A, Frackiewicz M, Brzewski M. External laryngeal injuries in children--comparison of diagnostic methods. Int J Pediatr Otorhinolaryngol 2013; 77:1582-4. [PMID: 23931984 DOI: 10.1016/j.ijporl.2013.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/09/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The injuries of the larynx constitute around 1% of all injuries. The great majority of the injuries of the larynx happens during playing. The effects of these injuries may appear insignificant however, not always the direct clinical symptoms correlate with the degree of respiratory tract failure. The symptoms of laryngeal injuries depend on the extension and strength of the trauma and always relate to impair patency of respiratory tract. The aim of the study is to compare two diagnostic methods: laryngoscopy and ultrasonography in evaluation of laryngeal injuries in children. METHODS In the Department of Pediatric Otolaryngology, Medical University of Warsaw, in the period between 2004 and 2010 there were hospitalised 15 children with external injury of the larynx. RESULTS From among 15 hospitalized children, 7 were qualified as not serious trauma and were treated preservatively and the other 8 as sever trauma. The mechanism of traumas was diverse. Dyspnea was a predominating symptom, the others included hoarsness, change in voice quality, even aphonia, pain while speaking and swallowing, cough and hemoptysis. CONCLUSIONS Direct laryngoscopy is a standard in diagnostics of the injuries of the larynx. Ultrasonography of the larynx is recommended in every case of laryngeal injury as an additional non-invasive complementary diagnostic examination.
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Affiliation(s)
- L Zawadzka-Glos
- Department of Pediatric Otolaryngology, Medical University of Warsaw, Poland.
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Sidell D, Mendelsohn AH, Shapiro NL, St. John M. Management and Outcomes of Laryngeal Injuries in the Pediatric Population. Ann Otol Rhinol Laryngol 2011; 120:787-95. [DOI: 10.1177/000348941112001204] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Pediatric laryngeal trauma is an uncommon event. The purpose of this study was to identify outcomes following surgical procedures for pediatric laryngeal trauma, and to provide an in-depth review of the literature. Methods: The National Trauma Data Bank was utilized to identify pediatric laryngeal trauma incidents with admission years 2002 through 2006. Patient demographics, injury type, surgical procedures, hospital and intensive care unit durations, ventilator duration, and discharge disposition were abstracted. Results: There were 69 laryngeal trauma incidents identified, with a median patient age of 12.8 years and an overall mortality rate of 8.7%. Laryngeal injury was frequently blunt-force in nature (82.8%) and often occurred in conjunction with trauma to multiple organ systems (76.8%). Tracheotomy (16 procedures), laryngeal suturing (13 procedures), and laryngeal fracture repair (10 procedures) were the most frequent procedures identified. Laryngeal fracture repair was noted to increase the overall hospital duration (p = 0.040). The communication scores were affected only by tracheotomy (p = 0.013). Surgical intervention did not significantly affect the frequency of home discharge. Conclusions: Pediatric laryngeal trauma is an uncommon event that can be evaluated with the National Trauma Data Bank. Although patients who undergo laryngeal fracture repair appear to have an increased duration of hospitalization, patients who undergo tracheotomy or laryngeal suturing do not have increased durations of ventilator dependence, stay in an intensive care unit, or hospitalization.
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Paediatric blunt laryngeal trauma: a review. Int J Otolaryngol 2011; 2011:183047. [PMID: 22164168 PMCID: PMC3227439 DOI: 10.1155/2011/183047] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 08/23/2011] [Accepted: 09/21/2011] [Indexed: 11/17/2022] Open
Abstract
Paediatric blunt laryngeal trauma is infrequently encountered; however, it can have fatal consequences if managed inappropriately. This paper provides an overview of the relatively limited literature available on the subject and highlights current controversies and recent advances in the management of these injuries.
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Oosthuizen JC, Burns P, Russell JD. Endoscopic management of posttraumatic supraglottic stenosis in the pediatric population. Am J Otolaryngol 2011; 32:426-9. [PMID: 20888074 DOI: 10.1016/j.amjoto.2010.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 07/20/2010] [Accepted: 07/29/2010] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Pediatric blunt laryngeal trauma is a rare and potentially life-threatening entity. External injuries can be misleading, and a high index of suspicion, as well as early intervention, is essential to achieve the best possible outcome. The authors of this report review the management of blunt laryngeal trauma in the pediatric population and describe the endoscopic management of posttraumatic supraglottic stenosis. METHODS Methods used were case report from a tertiary referral institution and review of the literature. RESULTS We describe the case of a 13-year-old girl whom developed supraglottic stenosis following blunt laryngeal trauma. Innovative endoscopic techniques were used in the successful management of this exceedingly rare entity. CONCLUSION Early recognition and intervention are of paramount importance if successful endoscopic management of blunt laryngeal trauma is to be considered.
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Shires CB, Preston T, Thompson J. Pediatric laryngeal trauma: a case series at a tertiary children's hospital. Int J Pediatr Otorhinolaryngol 2011; 75:401-8. [PMID: 21242005 DOI: 10.1016/j.ijporl.2010.12.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 12/13/2010] [Accepted: 12/14/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pediatric blunt or sharp laryngotracheal injuries are infrequent because of the softer cartilages and the protection of the prominent mandible. These injuries usually occur secondary to striking furniture or via the "clothesline" injury. METHODS We present five cases of pediatric laryngotracheal injury (thyroid cartilage, true vocal cords, cricoid cartilage, cricotracheal junction, and posterior tracheal wall). RESULTS We examined the need for intubation, need for tracheostomy, length of intubation, length of hospital stay, interval until direct laryngoscopy, use of steroids, post-injury swallowing, and post-injury phonation. DISCUSSION Three of the five patients were intubated either prior to arrival or upon arrival to the emergency department. Two of the patients underwent direct laryngoscopy on the day of arrival. Three patients received steroids. CT (computed tomography) was not helpful in diagnosis or decision regarding treatment. The patients with thyroid cartilage fracture, cricoid cartilage fracture, cricotracheal separation, and posterior tracheal wall tear required open repair. The tracheal wall injury, cricoid fracture, and cricotracheal separation were repaired with sutures and the thyroid cartilage fracture with a plate and screws. One tracheal stent was placed. Two open repairs were performed within 24h of injury. The patient with posterior tracheal wall injury experienced persistent dysphagia and dysphonia, which may have been secondary to intraoperative dissection. CONCLUSION Dyspnea was not necessarily indicative of the severity of injury in our patients. CT added little information about the integrity of the larynx not already known by physical examination. Open repair was usually indicated for the blunt neck injuries in our series. Oral intubation proved less difficult than tracheostomy in our patient with cricoid cartilage fracture.
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Affiliation(s)
- Courtney B Shires
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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Transoral closure of a perforation of the hypopharynx from blunt trauma. J Pediatr Surg 2009; 44:2402-5. [PMID: 20006037 DOI: 10.1016/j.jpedsurg.2009.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/03/2009] [Accepted: 09/05/2009] [Indexed: 02/06/2023]
Abstract
Hypopharyngeal perforation secondary to blunt trauma is a rare injury. It can be managed operatively or expectantly without clear criteria for either approach. Here, we present a case of a 17-year-old adolescent boy who had a hypopharyngeal tear from direct blunt trauma to the anterior neck received during a high school football game. Physical examination demonstrated cervical crepitus, and neck radiograph revealed air in the retropharyngeal space. Rigid endoscopy diagnosed a 3-cm linear tear in the posterior hypopharynx. The tear was repaired transorally using laparoscopic instruments and visualized by a rigid endoscope, followed by anterior neck dissection and drain placement. Postoperatively, he was kept nil per os and received intravenous antibiotics. He was discharged home and returned to the football field the same fall.
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Coté CJ, Hartnick CJ. Pediatric transtracheal and cricothyrotomy airway devices for emergency use: which are appropriate for infants and children? Paediatr Anaesth 2009; 19 Suppl 1:66-76. [PMID: 19572846 DOI: 10.1111/j.1460-9592.2009.02996.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cricothyrotomy or insertion of a transtracheal device is a life-saving maneuver that may be performed on an emergent or semi-elective basis as a means of bypassing an obstructed upper airway. A surgeon is trained to perform this life-saving procedure whereas most anesthesiologists are not facile with the scalpel. It is for this reason that many percutaneous devices have been developed for use by surgeons and nonsurgeons alike. Unfortunately, the majority of such devices are designed for use in adults and/or teenagers but are not appropriate for neonates and infants. The unique anatomy of the infant larynx, the small size of the cricothyroid membrane, and the technical difficulty of locating the correct anatomical structures make the use of most of these devices impractical if not outright dangerous in neonates and infants. This paper will review many (but not all) of the available devices, associated literature, pitfalls and dangers. It is emphasized that each clinician should become familiar with the advantages and disadvantages of these devices and obtain training with simulators or animal models. A strategy for management of the 'cannot ventilate, cannot oxygenate, cannot intubate' situation should be developed with age and size appropriate equipment.
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Affiliation(s)
- Charles J Coté
- Department of Anesthesia and Critical Care, Division of Pediatric Anesthesia, The MassGeneral Hospital for Children, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Quesnel AM, Hartnick CJ. A contemporary review of voice and airway after laryngeal trauma in children. Laryngoscope 2009; 119:2226-30. [DOI: 10.1002/lary.20492] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mitrović SM. [Blunt external laryngeal trauma. Two case reports]. MEDICINSKI PREGLED 2007; 60:489-492. [PMID: 18265598 DOI: 10.2298/mpns0710489m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION External laryngeal trauma, blunt or penetrating, is rare but potentially life-threatening. Most frequently it occurs in motor vehicle accidents. The most common symptoms of external laryngeal injuries are: dysphagia, odynophagia, dysphonia, odynophonia, reduction of the laryngeal prominence, hemoptysis and neck crepitation. TWO CASE REPORTS This paper reviews two cases of blunt laryngeal injury caused by a direct blow to the neck. After admission, both patients underwent clinical examination, as well as radiography of the neck, and computer tomography of the neck and larynx. GIRBAS scale was used for voice analysis. In the first case, computer tomography showed a fracture of the right thyroid cartilage in the posterior lamina where it is attached to the upper horn. In the other case, the presence of air was confirmed by radiography of the upper aperture. Computerized tomography showed the presence of air in the neck, underneath the skin, which was probably the consequence of the larygeal valve mechanism trauma. Both patients were treated conservatively. DISCUSSION AND CONCLUSION The symptomatology of external larygeal trauma may include: hoarseness, swallowing difficulties and/or painful swallowing, painful phonation, neck pain, bloody sputum and breathing difficulties. The clinical symptoms of blunt laryngeal trauma may be hidden and non-specific, but also clear, indicating a larynx trauma, and vice versa. Quick diagnosis using computerized tomography, hospitalization and adequate therapy, can reduce the consequences of these injuries and increase the chances for a complete recovery of larygeal musculature and function.
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Affiliation(s)
- D C Bloom
- Pediatric Otolaryngology, Children's Hospital and Health Center, 3030 Children's Way, Suite 402, San Diego, CA 92123-4228, USA.
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