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Shen Y, Li K, Chen P, Yu Y, Chen F. Asphyxia caused by delayed subglottic stenosis after neck trauma. Forensic Sci Med Pathol 2021; 17:481-485. [PMID: 34263414 DOI: 10.1007/s12024-021-00391-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 10/20/2022]
Abstract
Delayed subglottic stenosis (SGS) is an unusual complication. Here, we report a particular case of delayed SGS. A 17-year-old female suffered extensive injuries including severe neck trauma in a car accident, and complained of dyspnea after 30 days. Tracheal stenosis was observed by fiber optic bronchoscopy, but no specific treatment was administered to the patient. While being transferred to a tertiary hospital 3 days later, the patient fell into deep coma due to hypoxia, and died of hypoxic-ischemic encephalopathy and severe pulmonary infection in the intensive care unit (ICU) 58 days later. Postmortem autopsy and pathological investigation revealed tracheal stenosis 3.0 cm below the vocal cords with a diameter of 0.5 cm, which was caused by a cricoid cartilage fracture, fibrous tissue proliferation and inflammatory cell infiltration. We believed that external forces caused the cricoid fracture and mucosal damage, and after a month of fibrous repair, scar tissue formed the stenosis and caused her death. This report describes a rare condition in which slowly progressive intralaryngeal stenosis formation after external neck trauma could cause asphyxial death in a previously asymptomatic adult.
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Affiliation(s)
- Yueyao Shen
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, 200063, China.,Department of Forensic Medicine, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Kai Li
- Department of Forensic Medicine, Nanjing Medical University, Nanjing, 211166, Jiangsu, China.,Forensic Expertise Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Peng Chen
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, 200063, China.,Department of Forensic Medicine, Nanjing Medical University, Nanjing, 211166, Jiangsu, China.,Forensic Expertise Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Youjia Yu
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, 200063, China. .,Department of Forensic Medicine, Nanjing Medical University, Nanjing, 211166, Jiangsu, China. .,Forensic Expertise Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
| | - Feng Chen
- Department of Forensic Medicine, Nanjing Medical University, Nanjing, 211166, Jiangsu, China. .,Forensic Expertise Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China. .,Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, 211166, Jiangsu, 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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