1
|
|
2
|
Stassen NA, Hoth JJ, Scott MJ, Day CS, Lukan JK, Rodriguez JL, Richardson JD. Laryngotracheal Injuries: Does Injury Mechanism Matter? Am Surg 2004. [DOI: 10.1177/000313480407000612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Laryngotracheal injuries are potentially lethal injuries whose diagnosis can be difficult. The purpose of this study was to delineate the effect of injury mechanism on the types of injury sustained and patient outcome. Patient records during a 7-year period were reviewed for injury mechanism, patient demographics, clinical presentation, patient evaluation, injury location, associated injuries, operative interventions, and outcome. Fifteen patients with laryngotracheal injuries were studied. Blunt injuries were more common (60%). Patient demographics, mortality, average length of stay, and Injury Severity Score were similar for both groups. Prevalent physical findings on examination included subcutaneous air (53%), hoarseness (47%), stridor (20%), and neck tenderness (27%). Diagnosis was confirmed by CT scan of the neck (66% blunt, 33% penetrating) or bronchoscopy (44% blunt, 66% penetrating). Injury location, patient disposition, and associated injures were the same for both groups. The most frequent operative intervention performed for both groups consisted of a primary airway repair via a collar incision within 8 hours of injury. Only patients with a laryngeal injury required concomitant tracheostomy regardless of mechanism. Blunt and penetrating neck injuries resulted in similar types of tracheal and laryngeal injuries. Anatomic location of the injury determined the need for tracheostomy. Regardless of mechanism, the overall outcome for patients with laryngotracheal injuries is good when injuries are recognized and treated expeditiously. A high level of suspicion must be maintained when evaluating all potential laryngotracheal injury patients irrespective of the mechanism of injury.
Collapse
Affiliation(s)
| | - J. Jason Hoth
- Department of Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - Melanie J. Scott
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carolyn S. Day
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - James K. Lukan
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | | | | |
Collapse
|
3
|
Norwood SH, McAuley CE, Vallina VL, Berne JD, Moore WL. Complete cervical tracheal transection from blunt trauma. THE JOURNAL OF TRAUMA 2001; 51:568-71. [PMID: 11535912 DOI: 10.1097/00005373-200109000-00026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S H Norwood
- Division of Trauma Services, East Texas Medical Center, Tyler, TX 75701, USA.
| | | | | | | | | |
Collapse
|
4
|
Abstract
Chest radiographs remain the initial imaging modality to rapidly screen patients with blunt chest trauma. Spiral CT is more sensitive and specific in diagnosing most thoracic pathology seen in blunt trauma patients. This article reviews the major clinical and radiologic findings that occur with blunt injuries to the chest, excluding mediastinal vascular injuries.
Collapse
Affiliation(s)
- K Shanmuganathan
- Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, USA
| | | |
Collapse
|
5
|
Shaker KG, Hollingsworth HM, Irwin RS, Umali CB. Tracheobronchial Injuries Caused by Blunt Trauma. J Intensive Care Med 1995. [DOI: 10.1177/088506669501000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tracheobronchial injuries, once rare complications of blunt trauma to the anterior neck and chest, are becoming more common. Traffic accidents account for most of these injuries. There are several possible mechanisms for airway rupture, the site of which is dictated by the location of the trauma and the points of airway fixation. The vast majority of cervical tracheal injuries occur above the fourth tracheal ring, whereas thoracic tracheal and bronchial lesions tend to occur in the vicinity of the carina. The presence of respiratory distress and signs of air leak, such as subcutaneous emphysema and persistent pneumothorax despite thoracostomy tube drainage, characterize many of these injuries. In some patients, however, the paucity of clinical findings leads to a delay in diagnosis until a late complication, such as lung collapse or suppuration; occurs. Flexible bronchoscopy remains the most valuable tool for diagnosis. Early surgical repair is recommended except for some minor injuries, which can be managed expectantly and with close follow-up. Patients who reach the hospital alive have a good prognosis.
Collapse
Affiliation(s)
- Kamal G. Shaker
- Division of Pulmonary, Allergy, and Critical Care Medicine, and the Department of Radiology, University of Massachusetts Medical School, Worcester, MA
| | - Helen M Hollingsworth
- Division of Pulmonary and Critical Care Medicine, Boston University School of Medicine, Boston, MA
| | - Richard S. Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, and the Department of Radiology, University of Massachusetts Medical School, Worcester, MA
| | - Cynthia B. Umali
- Division of Pulmonary, Allergy, and Critical Care Medicine, and the Department of Radiology, University of Massachusetts Medical School, Worcester, MA
| |
Collapse
|
6
|
Mason AC, Mirvis SE, Templeton PA. Imaging of acute tracheobronchial injury: Review of the literature. Emerg Radiol 1994. [DOI: 10.1007/bf02614936] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
7
|
Abstract
A 21-year-old man presented to our emergency department with a two-day complaint of painful swelling and protrusion of the tongue, odynophagia, dysphagia, and difficulty with speech. A nonfluctuant area of tongue swelling was identified; needle aspiration of this site produced 5 mL of pus, with considerable amelioration of symptoms. Culture of the aspirate subsequently grew Hemophilus parainfluenzae, the first such reported case of this pathogen in a glossal abscess. Glossal abscess is a rare clinical entity that may result in airway compromise and disseminated infection to other systems. The presence of a glossal abscess should be considered in all cases of tongue swelling.
Collapse
Affiliation(s)
- R J Roberge
- Department of Emergency Medicine, Moses H. Cone Memorial Hospital, Greensboro, NC 27420
| | | | | |
Collapse
|