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Laryngotracheal trauma

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Laryngotracheal trauma

  1. 1. LARYNGOTRACHEAL TRAUMA DEPT OF OTORHINOLARYNGOLOGY JJM M C DAVANAGERE
  2. 2. 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
  3. 3. CLASSIFICATIONCan be classified as1. Supraglottic2. Glottic3. Subglottic4. Mixed OR1. Skeleton2. Soft tissue
  4. 4. 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
  5. 5. PATHOLOGY• Other pathological changes include Haematoma Edema Subcutaneous emphysema Joint dislocations cricoarytenoid, cricothyroid ( may cause RLN palsy), arytenoid avulsions
  6. 6. PATHOLOGY Fracture of hyoid Fracture of thyroid cartilage vertical or transverse Fracture of cricoid Fracture of upper tracheal rings Laryngotracheal separation
  7. 7. CLINICAL FEATURES- SYMPTOMS• Respiratory distress• Hoarseness or aphonia• Painful and difficulty to swallow with aspiration of food• Haemoptysis (mucosal tear)
  8. 8. 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
  9. 9. DIAGNOSIS• IDL examination• Direct laryngoscopy / fibreoptic laryngoscopy• X-ray• CT scan• Associated injuries
  10. 10. TREATMENT- CONSERVATIVE• Hospitalization• Voice rest• Humidification• Steroids• antibiotics
  11. 11. 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
  12. 12. 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
  13. 13. COMPLICATIONS• Laryngeal stenosis• Perichondritis• Vocal cord paralysis
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