1
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Moroco AE, Patel VA, Saadi RA, Gniady JP, Lighthall JG. Systematic Review of Laryngeal Fractures and Trends in Operative Management. Craniomaxillofac Trauma Reconstr 2023; 16:62-69. [PMID: 36824183 PMCID: PMC9941301 DOI: 10.1177/19433875221074847] [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: 11/17/2022] Open
Abstract
Study Design Systematic review of the literature. Objective The goal of this study is to review the current literature on the trends in management of laryngeal fractures following trauma. Methods Independent searches of the PubMed and MEDLINE databases were performed. Articles from the period of 1963 to 2020 were collected. All studies which described laryngeal fractures using the Boolean method and relevant search term combinations, including "Laryngeal", "Fracture", "Operative", and "Management" were collected. Results A total of 588 relevant unique articles were identified for analysis. Of these, 24 articles were deemed appropriate for inclusion in the literature review. Due to variability in study design and outcome measures, formal synthesis of data in the form of a meta-analysis was not possible. Conclusions Laryngeal fractures are rare traumatic injuries that require early identification and evaluation with complex management options. This comprehensive review aims to highlight the breadth of the topic with regard to presentation and clinical management. Though there remains no clear best practice for laryngeal fracture management, we review trends in clinical practice throughout the literature.
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Affiliation(s)
- Annie E. Moroco
- Department of Otolaryngology – Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vijay A. Patel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, UPMC Centers for Cranial Base Surgery & Sinonasal Disorders and Allergy, Pittsburgh, PA, USA
| | - Robert A. Saadi
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - John P. Gniady
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Jessyka G. Lighthall
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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2
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Blunt and Penetrating Airway Trauma. Emerg Med Clin North Am 2023; 41:e1-e15. [PMID: 36639169 DOI: 10.1016/j.emc.2022.10.001] [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: 01/13/2023]
Abstract
Airway injury, be that penetrating or blunt, is a high-stakes high-stress management challenge for any airway manager and their team. Penetrating and blunt airway injury vary in injury patterns requiring prepracticed skills and protocols coordinating care between specialties. Variables including patient cooperation, coexisting injuries, cardiorespiratory stability, care location (remote vs tertiary care center), and anticipated course of airway injury (eg, oxygenating well and comfortable vs increasing subcutaneous emphysema) all play a role in determining airway if and when airway management is required. Direct airway trauma is relatively infrequent, but its presence should be accompanied by in-person or virtual otolaryngology support.
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3
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Laora AD, Capitaine A, Lacour M, Trijolet J. Cricohyoidoepiglottopexy in an emergency scenario: Evaluation and management of a severe laryngeal trauma. Clin Case Rep 2022; 10:e6304. [PMID: 36237941 PMCID: PMC9536432 DOI: 10.1002/ccr3.6304] [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: 05/04/2022] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 11/05/2022] Open
Abstract
We describe the clinical evaluation and the management of a severe laryngeal trauma in a suicidal patient. We aim to demonstrate how the cricohyoidoepiglottopexy, which is a surgical technique mainly performed for oncological purposes, can be successfully used in this emergency setting.
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Affiliation(s)
- Andrea Di Laora
- Department of ENT and Head & Neck SurgeryGroupe Hospitalier Littoral AtlantiqueLa RochelleFrance
| | - Anne‐Laure Capitaine
- Department of ENT and Head & Neck SurgeryGroupe Hospitalier Littoral AtlantiqueLa RochelleFrance
| | - Mathilde Lacour
- Department of RadiologyGroupe Hospitalier Littoral AtlantiqueLa RochelleFrance
| | - Jean‐Paul Trijolet
- Department of ENT and Head & Neck SurgeryGroupe Hospitalier Littoral AtlantiqueLa RochelleFrance
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4
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Muacevic A, Adler JR. Laryngeal Trauma, Its Types, and Management. Cureus 2022; 14:e29877. [PMID: 36348916 PMCID: PMC9629857 DOI: 10.7759/cureus.29877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023] Open
Abstract
Laryngotracheal wounds are rare; however, they have a significant mortality rate. These wounds can be blunt or penetrating. Usually, the larynx is protected from blunt trauma by the sternum and jaw. A "clothesline" injury happens when the exposed neck is struck by a hard object, such as a wall wire or tree branch, or when an attack is intended to damage the larynx. Additionally, injuries may occur when the neck is stressed due to damage, such as in a rear-end accident that causes a whiplash-like injury or when the larynx is intentionally targeted for harm. Penetrating neck trauma may result in injury to the larynx. Assume a patient has suffered a penetrating or severe neck injury. It is usually evident from their medical history or a quick trauma evaluation in that case. However, it is recommended to be cautious for anterior neck injuries in general and to have a low threshold for establishing a surgical airway. The priority is securing an airway when a patient with a laryngeal injury arrives in the emergency room. The operating surgeon may request any flexible laryngoscopy, computed tomography (CT), esophagram, and chest X-ray for additional examination, depending on the nature of the damage and the patient's health. After the examination, the initial step in treating laryngeal injuries should be to locate and secure the airway. According to the evaluation and management based on the Schaefer classification system for laryngeal injury, the patient is treated based on whether the patient has impending airway obstruction or a stable airway. Medical management or observation and surgical management depend on the site and severity of the injury, patient condition, and type of injury. There are several complications related to laryngotracheal trauma, which can be minor or even fatal. Following successful treatment, postoperative and rehabilitative care, vocal rest, speech therapy, and swallowing therapy may be necessary.
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5
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Retinasekharan S, Dompok TM, Mansor M. Total Laryngectomy Following Severe Laryngeal Trauma: A Case of Surgical Dilemma. Indian J Otolaryngol Head Neck Surg 2022; 74:2649-2651. [PMID: 36452743 PMCID: PMC9702428 DOI: 10.1007/s12070-021-02371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/04/2021] [Indexed: 11/26/2022] Open
Abstract
External laryngeal trauma is a rather rare occurrence, and comprises a varying severity of injuries. Every laryngeal injury is unique and the management can be invariably complex. For the most severe forms of external laryngeal trauma, reparative procedures and laryngeal stenting (after control of the airway) are considered standard treatment. We present a case of a complex laryngeal trauma with extensive loss of tracheal cartilage and soft tissues which was treated with total laryngectomy.
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Affiliation(s)
- Senthilraj Retinasekharan
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Duchess of Kent, KM 3.2, Jalan Utara, 90000 Sandakan, Sabah Malaysia
| | - Tracey May Dompok
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Duchess of Kent, KM 3.2, Jalan Utara, 90000 Sandakan, Sabah Malaysia
| | - Masaany Mansor
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Universiti Teknologi Mara (UiTM), Sungai Buloh, Selangor Malaysia
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6
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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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7
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Petrone P, Velaz-Pardo L, Gendy A, Velcu L, Brathwaite CEM, Joseph DK. Diagnosis, management and treatment of neck trauma. Cir Esp 2019; 97:489-500. [PMID: 31358299 DOI: 10.1016/j.ciresp.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/27/2019] [Accepted: 06/02/2019] [Indexed: 11/15/2022]
Abstract
Trauma injuries to the neck account for 5-10% of all trauma injuries and carry a high rate of morbidity and mortality, as several vital structures can be damaged. Currently, there are several treatment approaches based on initial management by zones, initial management not based on zones and conservative management of selected patients. The objective of this systematic review is to describe the management of neck trauma.
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Affiliation(s)
- Patrizio Petrone
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU..
| | - Leyre Velaz-Pardo
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Amir Gendy
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Laura Velcu
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Collin E M Brathwaite
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - D'Andrea K Joseph
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
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8
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Al-Khalifa M, Buali F, Alshehabi M. Common Findings in Blunt Thyroid Fracture. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2017; 5:267-270. [PMID: 30787800 PMCID: PMC6298297 DOI: 10.4103/1658-631x.213306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although blunt neck trauma is known to be rare, occurring in approximately 5% of all neck traumas, undiagnosed cases may have a devastating outcome. Physicians need to fully understand the mechanism of the injury and the external laryngeal trauma signs. A physician's precise diagnosis and proper management are necessary to avoid long-term complications or death. Although blunt laryngeal injuries are uncommon, prompt recognition of the subtle signs is crucial to avoid the catastrophic complications associated with such injuries. This case report aims to demonstrate the symptoms and signs of laryngeal injury in a young healthy male following a road traffic accident.
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Affiliation(s)
- Muneera Al-Khalifa
- Department of ENT and Head and Neck Surgery, Bahrain Defense Force Hospital, Riffa, Kingdom of Bahrain
| | - Fatima Buali
- Department of ENT and Head and Neck Surgery, Bahrain Defense Force Hospital, Riffa, Kingdom of Bahrain
| | - Mohamed Alshehabi
- Department of ENT and Head and Neck Surgery, Bahrain Defense Force Hospital, Riffa, Kingdom of Bahrain
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9
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Jain S, Singh P, Gupta M, Kamble B, Phatak SS. Comminuted Laryngeal Fracture Following Blunt Trauma: A Need for Strict Legislation on Roads! Ann Maxillofac Surg 2017; 7:124-128. [PMID: 28713750 PMCID: PMC5502499 DOI: 10.4103/ams.ams_60_15] [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: 11/04/2022] Open
Abstract
Laryngeal fracture is a rare condition with potential life-long implications related to airway patency, voice quality, and swallowing. Rarity of the condition leads to lack of consensus on the most suitable way to manage this injury. The mode of injury can be prevented by strict legislation on the roads. We report a case of a 28-year-old Indian male who sustained a comminuted displaced fracture of the thyroid cartilage with disruption of anterior commissure due to blunt trauma caused by the metallic side rod of a ladder projecting from the rear of a vehicle in front of the bike on which he was riding. He presented with breathing difficulty, change in voice, surgical emphysema, and pneumomediastinum, but without any skin changes over the neck. His airway could be restored due to early tracheostomy and open reduction with internal fixation with sutures along with laryngeal stenting. He has no significant swallowing or breathing problem and reasonably good voice 6 months after surgery. This case highlights the need for strict legislation on roads in India and the importance of high level of suspicion for laryngeal fracture in acute trauma patient. Early identification and timely internal fixation not only restore the airway but also improve long-term voice and airway outcomes.
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Affiliation(s)
- Shraddha Jain
- Department of Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, DMIMSU, Wardha, Maharashtra, India
| | - Pragya Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, DMIMSU, Wardha, Maharashtra, India
| | - Minal Gupta
- Department of Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, DMIMSU, Wardha, Maharashtra, India
| | - Bhavna Kamble
- Department of Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, DMIMSU, Wardha, Maharashtra, India
| | - Suresh S Phatak
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, DMIMSU, Wardha, Maharashtra, India
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10
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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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11
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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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12
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Laryngeal Fracture after Blunt Cervical Trauma in Motorcycle Accident and Its Management. Case Rep Otolaryngol 2017; 2017:9321975. [PMID: 28261512 PMCID: PMC5312043 DOI: 10.1155/2017/9321975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/04/2017] [Indexed: 11/18/2022] Open
Abstract
Laryngeal fracture is a rare traumatic injury, potentially fatal, with an estimated incidence of 1 in 30,000 patients admitted to severe trauma centers. Because of the rarity of this injury, physician may be not aware of its existence, leading to a late diagnosis of this entity. We report a case of a 59-year-old woman admitted to the emergency room after a motorcycle accident with cervical trauma. The patient presented with dysphonia, hemoptysis, cervical subcutaneous emphysema, and increasing respiratory distress that led to the intubation of the patient. CT-scan demonstrated displaced fracture of the cricoid and thyroid cartilage. The patient was submitted to tracheostomy and the fracture was surgically repaired. Tracheostomy was removed in third postoperative month. The patient presented a good recovery, reporting only hoarseness but without swallowing or breathing problems at 6-month follow-up.
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13
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Ferreira E, Nabuco Araújo C, Agostinho S, Santos AR. Cricohyoidoepiglottopexy in Laryngeal Trauma. Otolaryngol Head Neck Surg 2016; 155:886-887. [DOI: 10.1177/0194599816659059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 06/21/2016] [Indexed: 01/29/2023]
Affiliation(s)
- Eduardo Ferreira
- Otorhinolaryngology Department, Hospital de Santa Maria, Lisbon, Portugal
| | | | - Sandra Agostinho
- Otorhinolaryngology Department, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
| | - Ana Rita Santos
- Otorhinolaryngology Department, Hospital de Santa Maria, Lisbon, Portugal
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14
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Wang TC, Kuo CL. Rapid airway compromise caused by neck trauma: A case report. J Acute Med 2016. [DOI: 10.1016/j.jacme.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Fracture du cartilage thyroïde. ANNALES FRANCAISES DE MEDECINE D URGENCE 2015. [DOI: 10.1007/s13341-015-0501-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Schaefer N, Griffin A, Gerhardy B, Gochee P. Early recognition and management of laryngeal fracture: a case report. Ochsner J 2014; 14:264-265. [PMID: 24940139 PMCID: PMC4052596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Laryngeal fracture is a rare condition that can lead to significant problems with airway patency, voice production, and swallowing. Conflict in the literature exists regarding the most suitable way to manage this injury. CASE REPORT We present the case of a 29-year-old Caucasian man who sustained a displaced fracture of the thyroid cartilage due to blunt trauma. He reported no swallowing, breathing, or voice problems after 1 year, and his recovery can be attributed to the early recognition and proper management of his condition. CONCLUSION This case illustrates the importance of ensuring a high level of suspicion for laryngeal fracture in the acute trauma patient. Early identification of this injury allows early intervention that not only protects the airway but also improves long-term voice and airway outcomes.
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Affiliation(s)
- Nathan Schaefer
- Department of Plastic and Reconstructive Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Aaron Griffin
- Department of Otolaryngology, Cairns Base Hospital, Cairns North, Queensland, Australia
| | - Benjamin Gerhardy
- Department of Medicine, Cairns Base Hospital, Cairns North, Queensland, Australia
| | - Peter Gochee
- Department of Otolaryngology, Cairns Base Hospital, Cairns North, Queensland, Australia
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17
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Krishnan DG. Systematic Assessment of the Patient with Facial Trauma. Oral Maxillofac Surg Clin North Am 2013; 25:537-44. [DOI: 10.1016/j.coms.2013.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Abstract
PURPOSE To overcome the potential disadvantages of the use of foreign materials and autologous fat or collagen, we introduce here an autologous plasma gel for injection laryngoplasty. The purpose of this study was to present a new injection material, a plasma gel, and to discuss its clinical effectiveness. MATERIALS AND METHODS From 2 mL of blood, the platelet poor serum layer was collected and heated at 100°C for 12 min to form a plasma gel. The plasma gel was then injected into a targeted site; the safety and efficacy thereof were evaluated in 30 rats. We also conducted a phase I/II clinical study of plasma gel injection laryngoplasty in 11 unilateral vocal fold paralysis patients. RESULTS The plasma gel was semi-solid and an easily injectable material. Of note, plasma gel maintains the same consistency for up to 1 year in a sealed bottle. However, exposure to room air causes the plasma gel to disappear within 1 month. In our animal study, the autologous plasma gel remained in situ for 6 months in animals with minimal inflammation. Clinical study showed that vocal cord palsy was well compensated for with the plasma gel in all patients at two months after injection with no significant complications. Jitter, shimmer, maximum, maximum phonation time (MPT) and mean voice handicap index (VHI) also improved significantly after plasma gel injection. However, because the injected plasma gel was gradually absorbed, 6 patients needed another injection, while the gel remained in place in 2 patients. CONCLUSION Injection laryngoplasty with autologous plasma gel may be a useful and safe treatment option for temporary vocal cord palsy.
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Affiliation(s)
- Seung Hoon Woo
- Department of Otolaryngology, Gyeongsang National University, Jinju, Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Jin Pyeong Kim
- Department of Otolaryngology, Gyeongsang National University, Jinju, Korea
| | - Jung Je Park
- Department of Otolaryngology, Gyeongsang National University, Jinju, Korea
| | - Phil-Sang Chung
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Dankook University, Cheonan, Korea
| | - Sang-Hyuk Lee
- Department of Otorhinolaryngology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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19
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Near-complete supraglottic transection of the larynx after a motorbike accident. Case Rep Otolaryngol 2013; 2013:827902. [PMID: 23762706 PMCID: PMC3666302 DOI: 10.1155/2013/827902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 04/23/2013] [Indexed: 11/17/2022] Open
Abstract
Severe laryngeal trauma is rare in the civilian environment and requires appropriate and timely surgical intervention. We report a case from Sydney, Australia, which was managed with open reduction and internal fixation of the larynx with resorbable plates. The use of resorbable plates for operative fixation of the larynx has rarely been reported in literature but may be a viable alternative.
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