E.N.T 5th year, 2nd lecture/part one (Dr. Hiwa)
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The lecture has been given on Feb. 21st, 2011 by Dr. Hiwa.
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E.N.T 5th year, 2nd lecture/part one (Dr. Hiwa)
- 1. Neck Trauma prepared by: Dr. Hiwa As’ad
- 4. Anatomy and Physiology of Larynx
- 12. Anatomy
- 16. Signs of Injury: Vascular Shock, Profuse bleeding, Evolving stroke, Expanding hematoma, hemoptysis, hematemesis, unequal pulses, bruits or thrills
- 17. Signs of Injury: Subcutaneous emphysema, Hoarseness, Respiratory distress, Stridor Neck pain, Blood in saliva, Fever, Odynophagia
- 19. Physical Exam
- 24. CT Scan
- 26. Laryngeal Trauma Asymptomatic or minimal symptoms F/L CT scan Mild Edema Small hematoma Non-displaced linear fracture Intact mucosa Small lacerations Displaced fracture (by CT or exam) Loss of mucosa or extensive laceration Bleeding Exposed cartilage Bed rest Cool mist Antibiotics Steroids Anti-reflux Tracheotomy Panendoscopy Explore
- 27. Laryngeal Trauma Respiratory distress, open wounds, bleeding Tracheotomy Panendoscopy Explore
- 29. Laryngeal exploration and repair
- 30. Laryngeal exploration and repair
- 31. Laryngeal exploration and repair
- 32. Laryngeal exploration and repair
Editor's Notes
- Figure 8-60 p. 844 clin. Oriented anatomy
- The laryngotracheal complex can be injured when the usually protective mandible is raised leaving the LT complex venerable to injury. Fractures occur in patterns according to the point of impact, particularly when the larynx is calcified (Calcification usually begins at age 21 years). Midline and paramedian fractures of the thyroid cartilage are the most common, but other fractures can involve the hyoid bone and cricoid cartilage which is the only complete ring in the larygotracheal complex supplying support. Blunt trauma to the anterior neck can result in laryngeal injury by 3 methods: compression over the spine, static lateral force and laryngotracheal separation which is the most serious injury resulting in airway compromise.
- An ant blow to the neck can drive the thyroid cartilage and esophagus back against the vertebral bodies which forces the posterior lamina apart. This may ultimately result in rupture of the vocal cords and dislocation of the aryatenoid cartilage.
- A lateral blow to the neck causes inward fracture of the thyroid ala and hematoma of the vocal cord.
- 2 basic types of weapons – low and high velocity. As shown by formula, velocity is more important than mass in the amount of energy carried by a weapon.
- Cavitation – tissue flows forward and outward and creates a temporary vacuum cavity that sucks in contaminants and transmits a shock wave. Note the small entry and exit wounds.
- Also lends to decreased predictability of trajectory.
- First divided into zones in a paper from Monson et al Cook County Hospital 1969 Zone I clavicles to cricoid – Zone II – cricoid to angle of the mandible Zone III – angle of the mandible to the base of the skull
- This is an example of when a CT scan is useful. Patient is a 23 year old female who is a school teacher. She was playing flag football with her husband and her brothers. She was hit in the neck with a long hard pass. HSe was hoarse and complained of pain. Her laryngeal edema revealed edema and it was suspected that she had a fracture. CT scan helped to identify her fractures
- This is an endoscopic view of a patient with mild trauma. One can see small bilateral hematomas on Vc edema. This is an exam of a patient with more significant trauma. One can see blood in the airway and exposed cartilage.
- CT scanning of the larynx is most useful in those patients whose course of treatment is uncertain following physical exam. It helps with identification of occult fractures or dislocations of the airway cartilages or confirmation of suspected laryngeal fractures. It is most often used in patients with laryngeal tenderness, endolaryngeal edema or small hematomas.
- When trauma is extensive there is no question that surgical treatment is necessary. The real question is ‘How minimal of a laryngeal injury detected by CT scan requires surgical treatment?” It has been shown by Hirano and Stanley and colleagues that voice is greatly improved with repair of displaced fractures of 1mm and therefore our protocol is repair non displaced fractures involving the median and paramedian thyroid ala in order to stablized the AP dimension of the thyroid cartilage
- Bailey’s atlas p607
- Bailey’s atlas p607
- Bailey’s atlas p607
- Bailey’s atlas p607
- Displaced fracture of the R thyroid ala caused by blunt trauma. Used a Vitallium H type place (1.3mm) the suture was placed at the thyroid notch to stabilize the fracture during plating.
- Displaced fracture of the R thyroid ala caused by blunt trauma. Used a Vitallium H type place (1.3mm) the suture was placed at the thyroid notch to stabilize the fracture during plating.
- Figure 68.6 BAILEY