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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 hyoid Fracture of thyroid cartilage vertical or transverse Fracture of cricoid Fracture of upper tracheal rings Laryngotracheal 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
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