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Whipple MT, Feden JP. Acute Emergent Airway Issues in Sports. Clin Sports Med 2023; 42:373-384. [PMID: 37208053 DOI: 10.1016/j.csm.2023.02.004] [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: 05/21/2023]
Abstract
Emergent airway issues are rare in competitive sports. However, when airway compromise occurs, the sideline physician will be relied upon to manage the situation and the airway. . The sideline physician is tasked with not only the evaluation of the airway, but also management until the athlete can get to a higher level of care. Familiarity with the assessment of the airway and the various techniques for the management of airway compromise on the sideline are of the utmost importance in the unlikely event that an airway emergency should occur.
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Affiliation(s)
- Mary Terese Whipple
- Department of Emergency Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52246, USA; Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52246, USA.
| | - Jeffrey P Feden
- Department of Emergency Medicine, Alpert Medical School of Brown University, 593 Eddy Street, Davol 141, Providence, RI 02903, USA
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Kitamura T, Otani K. Airway Obstruction with Blunt Neck Trauma from an Accidental High Tackle in Rugby. Curr Sports Med Rep 2023; 22:100-104. [PMID: 36866953 DOI: 10.1249/jsr.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT Blunt neck trauma is an uncommon condition in sports yet life-threatening if left untreated; hence, early diagnosis and management is necessary once suspected. We report a collegiate rugby player tackled around the neck during intersquad scrimmage. He broke his cricoid and thyroid cartilage, resulting in cervical subcutaneous emphysema and pneumomediastinum and eventually, airway obstruction. Thus, he underwent cricothyroidotomy and emergency tracheotomy. After 20 d, the emphysema disappeared. However, dilation failure of the vocal cord remained, thereby requiring laryngeal reconstruction. In conclusion, blunt neck trauma can cause airway obstruction in various sports.
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Affiliation(s)
- Takuya Kitamura
- Department of Emergency Medicine, The Jikei University Daisan Hospital, Komae, Tokyo, Japan
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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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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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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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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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Blunt laryngeal trauma secondary to sporting injuries. The Journal of Laryngology & Otology 2017; 131:728-735. [PMID: 28595674 DOI: 10.1017/s0022215117001220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Laryngeal injury after blunt trauma is uncommon, but can cause catastrophic airway obstruction and significant morbidity in voice and airway function. This paper aims to discuss a case series of sports-related blunt laryngeal trauma patients and describe the results of a thorough literature review. METHOD Retrospective case-based analysis of laryngeal trauma referrals over six years to a tertiary laryngology centre. RESULTS Twenty-eight patients were identified; 13 (46 per cent) sustained sports-related trauma. Most were young males, presenting with dysphonia, some with airway compromise (62 per cent). Nine patients were diagnosed with a laryngeal fracture. Four patients were managed conservatively and nine underwent surgery. Post-treatment, the majority of patients achieved good voice outcomes (83 per cent) and all had normal airway function. CONCLUSION Sports-related neck trauma can cause significant injury to the laryngeal framework and endolaryngeal soft tissues, and most cases require surgical intervention. Clinical presentation may be subtle; a systematic approach along with a high index of suspicion is essential, as early diagnosis and treatment have been reported to improve airway and voice outcome.
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Abstract
On-the-field evaluation of facial trauma requires a focused initial assessment of the patient's airway and breathing with a knowledge of the critical associated injuries. The initial triage in facial trauma involves assessing and protecting the athlete's airway, breathing, and cervical spine. The algorithm then requires a repeat evaluation for subtle causes of airway obstruction and aspiration risks. Final steps include control of hemorrhage, recognition of neurologic and ophthalmologic disability, and complete exposure of the athlete to examine for other associated injury. The ABC repeat ABCDE mnemonic allows providers to avoid missing critical injuries that require immediate intervention.
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Affiliation(s)
- Kristi Colbenson
- Mayo Clinic, 1216 2nd Street Southwest, Generose Building 410, Rochester, MN 55902, USA.
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Laryngeal Injury in a Male Lacrosse Player: A Case for Prevention. Pediatr Emerg Care 2017; 33:185-187. [PMID: 28248757 DOI: 10.1097/pec.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Lacrosse has become increasingly popular among US children and teens. Because a lacrosse ball can serve as a projectile, neck injuries, although uncommon, can cause a severe and long-lasting injury. We report the case of a 16-year-old adolescent who experienced direct neck trauma while playing lacrosse. The clinical presentation, treatment strategies, and intubation considerations are reviewed. Finally, a call to action to prevent future, similar injuries is discussed.
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Harrel SK, Abraham CM, Rivera-Hidalgo F. Tissue resistance to soft tissue emphysema during minimally invasive periodontal surgery. J Contemp Dent Pract 2012; 13:886-91. [PMID: 23404021 DOI: 10.5005/jp-journals-10024-1247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM The aim of this study was to determine the pressure where oral soft tissue resistance will be overcome resulting in soft tissue emphysema and to measure the safety of an antifouling device for a videoscope used during minimally invasive periodontal surgery. MATERIALS AND METHODS Resistance was measured in vitro in porcine tissue. One study arm measured palatal tissue resistance to air applied through a needle. Another arm measured resistance in a surgical access for minimally invasive periodontal surgery (MIS). India ink was placed on the tissue,pressure at 0,3,10,15,20, and 25 pounds/square inch (psi)applied, and penetration of India ink into the tissue was measured. Three trials in three sites were performed at each pressure in both arms of the study. RESULTS Pressure applied to palatal tissue through a needle showed no significant penetration of India ink until 15 psi (0.90 ± 0.24 mm, p = 0.008). Penetration considered clinically significant was noted at 20 and 25 psi (4 to 6 mm, p ≤ 0.0001). No significant penetration was noted in minimally invasive incisions. CONCLUSION Within the test system, pressures of 15 psi or less seem unlikely to cause soft tissue emphysema. No evidence of tissue emphysema was noted with the video scope antifouling device. CLINICAL SIGNIFICANCE The use of pressures greater than 15 pounds per square inch should be avoided during surgical procedures. The antifouling device for a videoscope appears safe for use during minimally invasive periodontal surgery.
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Affiliation(s)
- Stephen K Harrel
- Department of Periodontology, Baylor College of Dentistry Texas, USA.
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The effect of laryngoscope handle size on possible endotracheal intubation success in university football, ice hockey, and soccer players. Clin J Sport Med 2012; 22:341-8. [PMID: 22627651 DOI: 10.1097/jsm.0b013e318257c9a8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the effectiveness of a standard long-handle laryngoscope and a short-handle laryngoscope on ease of possible intubation in football, ice hockey, and soccer players. DESIGN Prospective crossover study. SETTING University Sport Medicine Clinic. PARTICIPANTS Sixty-two university varsity football (62 males), 45 ice hockey (26 males and 19 females), and 39 soccer players (20 males, 19 females). INTERVENTIONS Athletes were assessed for different airway and physical characteristics. Three different physicians then assessed the use of laryngoscopes of different handle sizes in supine athletes who were wearing protective equipment while in-line cervical spine immobilization was maintained. MAIN OUTCOME MEASURES The ease of passage of a laryngoscope blade into the posterior oropharynx of a supine athlete was assessed using both a standard long-handle and a short-handle laryngoscope. RESULTS Use of a short-handle laryngoscope was easier for all physicians in all sports as compared with a standard-sized laryngoscope. Passage of a laryngoscope blade into the posterior oropharynx of a supine athlete was easiest in soccer players and most difficult in football and ice hockey players for both sizes of laryngoscope. Interference from chest or shoulder pads was a common cause for difficulty in passing the laryngoscope blade into the posterior oropharynx for football and ice hockey players. CONCLUSIONS In the rare instances that an endotracheal intubation is to be attempted on an unconscious athlete, a short-handle laryngoscope may provide the best chance for successful intubation.
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García-Zornoza R, Morales-Angulo C, González-Aguado R, Acle Cervera L, Cortizo Vázquez E, Obeso Agüera S. Neck injuries. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011; 63:47-54. [PMID: 22014642 DOI: 10.1016/j.otorri.2011.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 07/11/2011] [Accepted: 07/27/2011] [Indexed: 10/16/2022]
Abstract
INTRODUCTION AND OBJECTIVE Neck injuries are of great clinical interest because they can induce very significant consequences if not handled properly and can even lead to death. The aim of our study was to analyse external deep cervical trauma in our hospital. MATERIAL AND METHODS A retrospective study of all external deep neck injuries seen in a tertiary hospital over the course of 24 years that involved changes in structures related to otolaryngology. RESULTS Twenty patients were included in our study. From all the injuries, 45% were secondary to traffic accidents, 27% from assault with a knife and 23% from attempted suicide. The injuries were open in 15 (68%) cases and closed in 7 (32%). The most common symptom was bleeding (55%), followed by respiratory disorders (23%). On examination, the most frequent sign was the appearance of subcutaneous emphysema (27%). Only 50% of patients underwent imaging before treatment, most often a neck CT (27%). 59% of patients needed surgery, with 6 patients (27%) requiring a tracheotomy. Two of them died (9%) and 6 suffered permanent complications. CONCLUSIONS Cervical injuries involving ENT structures are rare in our environment, with the most common cause being traffic accidents. It is important to have standardised guidelines for the management of these patients, because they can often developed severe complications or even die if not treated properly very rapidly.
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Affiliation(s)
- Roberto García-Zornoza
- Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
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