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Watts E, Little L, Bewick J, Chin J, Jonas N. Successful management of an unstable paediatric laryngeal injury in a low-resource setting. Trop Doct 2023; 53:288-290. [PMID: 36654497 DOI: 10.1177/00494755221131686] [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: 01/20/2023]
Abstract
Laryngeal injury is rare but has a very high mortality rate. Compared to adults, laryngeal injury in children is more uncommon due to both behavioural and anatomical reasons. Severe laryngeal injury may require surgical repair, intensive care support and tracheostomy care, all of which are difficult to achieve in a low resource setting. We report a case of successful management of laryngeal trauma in a child involving an emergency tracheostomy insertion, open repair of thyroid cartilage fracture, tracheal stenting and successful decannulation after 8 weeks post-injury with full recovery.
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Affiliation(s)
- E Watts
- Department of Surgery, Hopitaly Vaovao Mahafaly (The Good News Hospital), Mandritsara, Madagascar
| | - L Little
- Department of Surgery, Hopitaly Vaovao Mahafaly (The Good News Hospital), Mandritsara, Madagascar
| | - J Bewick
- Department of Paediatric Otolaryngology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Jwe Chin
- Department of Surgery, Hopitaly Vaovao Mahafaly (The Good News Hospital), Mandritsara, Madagascar.,Department of Anaesthesia, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - N Jonas
- Department of Paediatric Otolaryngology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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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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Noel CW, Pooboni SK, Metwalli Metwalli G, Kherani S. Blunt laryngeal trauma presenting as bilateral massive pneumothoraces and subcutaneous emphysema: a multidisciplinary approach to management. BMJ Case Rep 2020; 13:13/3/e234623. [PMID: 32234865 DOI: 10.1136/bcr-2020-234623] [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: 11/03/2022] Open
Abstract
A 3-year-old boy had an unwitnessed fall from a highchair. The child had no loss of consciousness, vomiting, stridor or respiratory distress but within a few minutes had significant swelling in the neck, scalp and around the eyes. He was brought immediately to the emergency room where he deteriorated rapidly and was intubated with a cuffed oral endotracheal tube. A clinical diagnosis of blunt laryngeal trauma was made. Imaging showed no laryngeal disruption, but did reveal massive bilateral pneumothoraces, that were managed with chest tube. A multidisciplinary meeting with family led to a watchful waiting approach. The patient was successfully extubated at 1 week and healed with a clear voice.
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Affiliation(s)
- Christopher W Noel
- Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Safeena Kherani
- Otolaryngology - Head and Neck Surgery, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
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Cheng J, Cooper M, Tracy E. Clinical considerations for blunt laryngotracheal trauma in children. J Pediatr Surg 2017; 52:874-880. [PMID: 28069269 DOI: 10.1016/j.jpedsurg.2016.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 12/22/2016] [Accepted: 12/26/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Systematic review of blunt pediatric laryngeal and tracheal trauma and development of proposed evaluation and management strategy. STUDY DESIGN Systematic review and proposed clinical consideration algorithm. DATA SOURCES PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. REVIEW METHODS A medical librarian was utilized. RESULTS 329 titles and abstracts were identified, and 50 reports were included. A total of 66 children were identified, with a majority of males (76.1%). Average age was 9.5±4.4years [range 2-17]. CT was employed in 66.7% of cases. False negative CT occurred in 29.5% of cases. Treatment consisted of observation (9.1%), endoscopy alone (31.8%), endoscopic repair (7.6%), and open neck exploration with repair/open reduction internal fixation (ORIF) (51.5%). Tracheotomy was utilized in 33.3% of the cases. Mortality was rare, with only one (1.5%) reported and occurred within one hour after presentation. CONCLUSIONS Significant deviation and variation from recommended previously proposed management algorithms exists in reported cases. Awareness of the natural clinical history, potential for severe morbidity or mortality, and associated complications are extremely important. CT and fiberoptic, bedside laryngoscopy may not play a significant role but may add to clinical evaluation prior to operative intervention. If employed, care must be taken to not create an unstable clinical scenario. Operative endoscopy is recommended in cases with positive physical examination findings, and treatment tailored to extent of injury. LEVEL OF EVIDENCE IV. TYPE OF STUDY Systematic review.
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Affiliation(s)
- Jeffrey Cheng
- Pediatric Otolaryngology, Department of Surgery, Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC 27710, United States.
| | - Matthew Cooper
- Department of Surgery, Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC 27710, United States
| | - Elisabeth Tracy
- Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States
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Ostwani W, Novis S, Brady A, Brown DJ, Mohr BA. Case Report: Neonate With Stridor and Subcutaneous Emphysema as the Only Signs of Physical Abuse. Pediatrics 2015; 136:e523-6. [PMID: 26169428 DOI: 10.1542/peds.2014-3954] [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] [Accepted: 04/23/2015] [Indexed: 11/24/2022] Open
Abstract
A stridulous, dysphonic cry with no external signs of trauma is a unique and unusual presenting sign for physical abuse. We report a previously healthy neonate with unremarkable birth history and medical history who presented with stridor and hypopharyngeal perforation due to physical abuse. This case highlights the need for further evaluation for traumatic injuries in the setting of unexplained new-onset stridor and consideration of physical abuse in the differential diagnosis.
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Affiliation(s)
| | - Sarah Novis
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan; and
| | | | - David J Brown
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan; and
| | - Bethany A Mohr
- Hospital Medicine (Child Protection Team), Department of Pediatrics and Communicable Diseases, and
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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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Chess MA, Chaturvedi A, Stanescu AL, Blickman JG. Emergency pediatric ear, nose, and throat imaging. Semin Ultrasound CT MR 2013; 33:449-62. [PMID: 22964411 DOI: 10.1053/j.sult.2012.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pediatric ear, nose, and throat emergencies broadly comprise infection, trauma, and airway obstruction secondary to a multitude of etiologies. Imaging occupies center stage in the diagnosis of many of these conditions and their complications, making it imperative for radiologists and other physicians covering the pediatric emergency department to familiarize themselves with the imaging appearances of these entities. Toward this goal, this article describes the imaging features of common pediatric ear, nose, and throat emergencies. Differential considerations, potential fallacies, and complications have been discussed when appropriate. Because a sound knowledge of the most relevant, efficient, time, and cost-effective imaging modality is of undisputable value in the acute setting, the preferred modality for each specific condition has been outlined. Finally, in alignment with our commitment to using radiation judiciously, we have suggested using ultrasonography and magnetic resonance instead of computed tomography, where possible, to optimize cost-benefit ratio for our young patients.
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Affiliation(s)
- Mitchell A Chess
- Department of Diagnostic Imaging Sciences, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY 14642, USA.
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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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Wootten CT, Bromwich MA, Myer CM. Trends in blunt laryngotracheal trauma in children. Int J Pediatr Otorhinolaryngol 2009; 73:1071-5. [PMID: 19501418 DOI: 10.1016/j.ijporl.2009.02.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 02/17/2009] [Accepted: 02/27/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the presentation, mechanisms, and management of blunt laryngotracheal trauma in a pediatric population, emphasizing the rise in severity. DESIGN Retrospective analysis of laryngotracheal trauma evaluated from 1995 to 2008. The presentation, mechanism, management and outcomes data are detailed. SETTING Tertiary medical center. PATIENTS Thirty-five patients were identified with major laryngotracheal trauma. MAIN OUTCOME MEASURES Surgical results, airway patency, voicing, swallowing and other residual disabilities are tabulated. RESULTS Average age was 10.8 years, with boys outnumbering girls 22-13. In cases of major trauma, mechanisms were related to motor vehicle accidents (MVAs) in seven patients. Five of 11 major trauma victims were unconscious at presentation. Definitive airway reconstruction involved laryngotracheoplasty and tracheal resection/reanastomosis. Ten of 11 remain decannulated. CONCLUSIONS In an increasingly mobile society, major laryngotracheal trauma is occurring in a younger population. Victims of major laryngotracheal trauma may be unconscious or have other injuries that obscure airway injury, highlighting the need for vigilance. Once the airway is secured and the patient stabilized, airway reconstruction is undertaken, achieving decannulation in most patients. Hoarseness is often a lasting morbidity.
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Affiliation(s)
- Christopher T Wootten
- Otolaryngology Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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