LARYNGOTRACHEAL TRAUMA

DEPT OF OTORHINOLARYNGOLOGY

J J M M CDAVANAGERE

EPIDEMIOLOGY• Penetrating injuries knife,

gunshot, wires• Blunt injuries high velocity low velocityBlunt injuries are due to1. Automotive accidents2. Blow or kick on the neck3. Strangulation

CLASSIFICATIONCan be classified as1. Supraglottic2. Glottic3. Subglottic4. Mixed OR1. Skeleton2. Soft tissue

PATHOLOGY

• Pathological changes that may be seen in laryngotracheal trauma vary from slight bruises externally or laceration of laryngeal mucosa internally to comminuted fracture of laryngeal framework

• Laryngeal fractures are common after 40 years of age because of calcification of laryngeal framework

PATHOLOGY• Other pathological changes include Haematoma Edema Subcutaneous emphysema Joint dislocations cricoarytenoid,

cricothyroid ( may cause RLN palsy), arytenoid avulsions

PATHOLOGY

Fracture of hyoidFracture of thyroid cartilage vertical

or transverseFracture of cricoidFracture of upper tracheal ringsLaryngotracheal separation

CLINICAL FEATURES- SYMPTOMS

• Respiratory distress• Hoarseness or aphonia• Painful and difficulty to

swallow with aspiration of food

• Haemoptysis (mucosal tear)

CLINICAL FEATURES-SIGNS

• Bruises abrasion of skin• Tenderness• Surgical emphysema• Deformed contour of laryngeal

framework• Fracture displacement thyroid, hyoid

and other cartilages• Laryngotracheal separation• Granulations over injured cartilages

DIAGNOSIS

• IDL examination• Direct laryngoscopy /

fibreoptic laryngoscopy• X-ray• CT scan• Associated injuries

TREATMENT- CONSERVATIVE

• Hospitalization• Voice rest• Humidification• Steroids• antibiotics

TREATMENT- SURGICAL

• TRACHEOSTOMY endotracheal intubation is difficult and may be hazardous

• Open reduction it is done 3-5 days after injury and if possible should not be delayed beyond 10 days

• Fractures of hyoid, thyroid, cricoid are repaired by wiring, miniplates of titanium are used to immobilize cartilagenous fragments

TREATMENT- SURGICAL

• Mucosal lacerations are repaired by catgut• Epiglottis anchored to normal position or even can

be excised if severely injured• Arytenoids repositioned in their normal position or

may be removed if completely avulsed• In laryngotracheal separation end to end

anastomosis can be done• Internal splintage of laryngeal structures using

laryngeal stent or silicone tube• Webbing of anterior commissure prevented by a

silastic keel

COMPLICATIONS

• Laryngeal stenosis• Perichondritis• Vocal cord paralysis