Laryngotracheal trauma.pptx
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This document discusses laryngeal trauma, including causes such as automobile accidents or strangulation. It describes the pathology of laryngeal injuries, which can range from bruising to fractures of cartilages like the thyroid or cricoid. Clinical features include respiratory distress, voice changes, pain with swallowing. Diagnosis involves laryngoscopy or CT imaging. Treatment may involve ventilation, steroids, antibiotics, or open reduction surgery to repair fractures or lacerations. Complications can include stenosis, perichondritis, abscess or vocal cord paralysis.
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The middle ear is a six-walled air-filled cavity located in the petrous part of the temporal bone between the inner and outer ear. It has three divisions - the epitympanum above the eardrum, the mesotympanum opposite the eardrum, and the hypotympanum below the eardrum. The middle ear contains the three ossicles (malleus, incus, stapes) that transmit sound vibrations from the eardrum to the inner ear. It is lined by epithelium and contains the tensor tympani and stapedius muscles that help dampen loud sounds. Blood supply comes from branches of the maxillary and posterior auricular arteries.
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- 1. DR SHAFIQ AHMAD ENT MMC MARDAN
- 2. AETIOLOGY 1.Automobile accidents. 2. Blow or kick on the neck. 3. Neck striking against a stretched wire or cable. 4. Strangulation. 5. Penetrating injuries with sharp instruments or gunshot wounds.
- 3. PATHOLOGY •The degree and severity of damage will vary from slight bruises externally or the tear and laceration of mucosa internally to a comminuted fracture of the laryngeal framework. • Laryngeal fractures are common after 40 years of age because of calcification of the laryngeal framework. In children, cartilages are more resilient and escape injury.
- 4. Pathological changes in laryngeal trauma are: 1. Haematoma and oedema of supraglottic or subglottic region. 2.Subcutaneous emphysema. 3. Dislocation of cricoarytenoid joints. 4. Dislocation of cricothyroid joint. This may cause recurrent laryngeal nerve paralysis, which traverses just behind this joint. 5. Fractures of the hyoid bone.
- 5. 6.Fractures of thyroid cartilage. Vertical Transverse. Fracture Of Upper Part Of Thyroid Cartilage : Result In Avulsion Of Epiglottis And One Or Both False Cords. Fractures Of Lower Part Of Thyroid Cartilage May Displace Or Disrupt The True Vocal Cords.
- 6. 7. Fractures of cricoid cartilage. 8. Fractures of upper tracheal rings. 9. Trachea may separate from the cricoid cartilage and retract into upper mediastinum. Injury to recurrent laryngeal nerve is often associated with laryngotracheal separation.
- 7. CLINICAL FEATURES Symptoms : 1. Respiratory distress. 2. Change in voice. Hoarseness or aphonia. 3. Painful and difficult swallowing. This is accompanied by aspiration of food. 4. Local pain in the larynx. 5. Hemoptysis.
- 8. External signs include: 1. Bruises or abrasions over the skin. 2. Palpation of the laryngeal area is painful. 3. Subcutaneous emphysema due to mucosal tears. It may increase on coughing. 4. Flattening of thyroid prominence and contour of anterior cervical region. Thyroid notch may not be palpable.
- 9. External signs include: 5. Fracture displacements of thyroid or cricoid cartilage or hyoid bone. Gap may be felt between the fractured fragments. 6. Bony crepitus between fragments of hyoid bone, thyroid or cricoid cartilages may sometimes be elicited. 7. Separation of cricoid cartilage from larynx or trachea
- 10. DIAGNOSTIC EVALUVATION Indirect laryngoscopy or rigid endoscopy of the larynx Flexible laryngoscopy through the nose CT of the larynx. Associated injuries. It is essential to examine for other injuries like injury to head, cervical spine, chest, abdomen and extremities. X-ray chest for pneumothorax and gastrograffin swallow for oesophageal tears may be required.
- 11. TREATMENT CONSERVATIVE 1. Patient should be hospitalized and observed for respiratory distress. 2. Voice rest is essential. 3. Humidification of inspired air is essential. 4. Steroid therapy should be started immediately and in full dose. 5. Antibiotics are given to prevent perichondritis & cartilage necrosis.
- 12. SURGICAL 1. Tracheostomy. 2. Open reduction. (a) Fractures of hyoid bone, thyroid or cricoid cartilage can be wired and replaced in their anatomic positions. Miniplates made of titanium can be used for immobilization of cartilaginous fragments. (b) Mucosal lacerations are repaired with catgut and any loose fragments of cartilage removed. (c) Epiglottis is anchored in its normal position and if already avulsed, may be excised. (d) Arytenoid cartilages can be repositioned in their normal position or may be removed if completely avulsed. (e) In laryngotracheal separation, end-to-end anastomosis can be done. (f) Internal splintage of laryngeal structures may be required. It is done with a laryngeal stent, or sili- cone tube which may have to be left for 2–6 weeks on an average. (g) Webbing of anterior commissure can be prevented by a silastic keel
- 13. COMPLICATIONS Laryngeal stenosis: supraglottic, glottic or subglottic. Perichondritis Laryngeal abscess. Vocal cord paralysis.