Acute external laryngotracheal trauma: Diagnosis and management

Head and Neck Institute, The Cleveland Clinic, 9500 Euclid Ave., Desk A-71, Cleveland, OH 44195, USA.
Ear, nose, & throat journal (Impact Factor: 1). 04/2006; 85(3):179-84.
Source: PubMed


Laryngotracheal trauma may result in lifelong complications or even death if diagnosis or treatment is delayed. Emergency room physicians, trauma surgeons, anesthesiologists, and especially otolaryngologists should maintain a high level of awareness of and suspicion for laryngotracheal trauma whenever a patient presents with multiple trauma in general or with cervical trauma in particular. Although there is some controversy regarding care, treatment in experienced hands will usually result in a favorable outcome. In this article, we review and update the diagnosis and management of acute external laryngotracheal trauma.

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    • "Motor vehicle accidents are the most common cause of laryngotracheal injury, but it also occurs in violent sports, assaults, hanging, and strangulation.1,3,6,16 Associated findings can include cartilage necrosis, voice alteration, cord paralysis, aspiration, and airway compromise.2,9 Less than 50% of the fractures occur in the cricoid cartilage.12 "
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    ABSTRACT: Laryngotracheal trauma is a rare condition that accounts for less than 1% of blunt trauma. Laryngotracheal fractures are uncommon in sports, even in settings where athletes are more vulnerable, including football, basketball, and hockey. If a laryngeal injury is suspected, immediate evaluation is required to avoid a delay in the diagnosis of a potentially life-threatening injury. A collegiate basketball player sustained an unusual fracture involving the cricoid and thyroid cartilage during practice. This case illustrates the importance of rapid identification and early management of patients with blunt laryngotracheal trauma in sports.
    Sports Health A Multidisciplinary Approach 05/2013; 5(3):273-275. DOI:10.1177/1941738112473417
    • "Apart from clinical signs, radiological imaging indicating the presence of tissue pneumatosis with associated fracture of the upper ribs should raise the suspicion of an underlying airway injury. Endoscopic and CT assessment of the airway is indicated to ascertain the level and nature of injury.[3] "
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    ABSTRACT: Survival following tracheoesophageal transection is uncommon. Establishing a secure airway has the highest priority in trauma management. Understanding the mechanism of the incident can be a useful adjunct in predicting the likelihood and severity of specific anatomical patterns of injuries. We discuss published literature on combined tracheoesophageal injuries after blunt neck trauma and their outcome. A search of MEDLINE for papers published regarding tracheoesophageal injury was made. The literature search identified 14 such articles referring to a total of 27 patients. Age ranged from 3-73 years. The mechanism of injury was secondary to a rope/wire in 33%, metal bar in 4% of cases and unspecified in 63%. All of the patients were managed surgically. A number of tissues were used to protect the anastomosis including pleural and sternocleidomastoid muscle flaps. There were no reported mortalities. Patients with combined tracheoesophageal injury after blunt neck trauma require acute management of airway along with concomitant occult injuries.
    Journal of Emergencies Trauma and Shock 04/2013; 6(2):117-22. DOI:10.4103/0974-2700.110774
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    • "In the literature, blunt trauma has been reported to be the most frequent cause of laryngeal fracture. For this type of trauma, the proportion of injuries caused by driver-caused traffic accidents is decreasing, and thus, laryngeal fractures caused by general blunt trauma are also decreasing.12 This is thought to be due to improvement of airbags and abundant safety devices for riders. "
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    ABSTRACT: Laryngeal fracture is rare, but complications are frequent and severe. Controversy still exists in regards to its proper management. The aim of this study was to present the clinical findings and management of laryngeal fracture in Korea. We analyzed the medical records of 22 patients with laryngeal fracture at a tertiary care trauma center from 2000 to 2010 retrospectively. In total, 22 patients (19 men and 3 woman) presented with laryngeal fractures caused by blunt (n=13) or penetrating (n=9) injury. Pain (68.1%), odynophagia (68.1%), hoarseness (18.1%), hemoptysis (13.6%), and subcutaneous emphysema (9%) were the common presenting symptoms and noncomminuted fracture was common. High velocity blunt trauma (mostly traffic accidents) patients had more extensive injury and poor voice outcomes. Penetrating trauma patients due to physical assault or suicide attempt demonstrated more frequently injuries on the left side. In driver-caused traffic accidents, where injuries in a wide area within the larynx occurred, poor voice results were seen, and these injuries required aggressive treatment. When endotracheal intubation was performed at experienced emergency centers with fiberoptic laryngoscopes, airway management was safely achieved. In addition, if the fractured laryngeal framework was corrected at appropriate times, voice results were good.
    Yonsei medical journal 09/2012; 53(5):992-8. DOI:10.3349/ymj.2012.53.5.992 · 1.29 Impact Factor
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