Laryngotracheal trauma
-
Upload
anwaaar -
Category
Health & Medicine
-
view
17 -
download
2
Transcript of Laryngotracheal trauma
Laryngotracheal trauma
Brig Anwar ul haq
Laryngotracheal Trauma
Brig Anwar ul Haq00923018513303
PAKISTAN
Laryngotracheal trauma
Brig anwar ul haq
E:\presentations\animations\larynx\normal larynx during phonation.Flv
Types Chemical Thrermal Physical
Aetiology Automobile accidents
Blow or kick on the neck. Striking against a stretched wire or
cable. Strangulation. Penetrating injuries with
Sharp instruments gunshot wounds
Pathology Haematoma and oedema of
Suprag lottic or subglottic region. Tears in laryngeal or pharyngeal mucosa
leading subcutaneous emphysema.
Dislocation of cricoarytenoid joints Arytenoid
Cartilage may be displaced anteriorly Dislocated Avulsed
Dislocation of cricothyroid joint Recurrent laryngeal nerve paralysis traverses just behind this joint.
Fractures of the hyoid bone
Pathology Fractures of thyroid cartilage.
Vertical Transverse. Fracture of upper part of thyroid cartilage
May result in avulsion of epiglottis One or both false cords.
Fractures of lower part of thyroid Displace or disrupt the true vocal cords. Fractures of cricoid cartilage.
Fractures of upper tracheal rings. Trachea may separate from the cricoid
cartilage Retract into upper mediastinum Injury to recurrent laryngeal
Clinical features Respiratory distress. Hoarseness of voice or aphonia. Painful swallowing. Aspiration of food. Local pain in the larynx
Marked on speakingSwallowing.
HaemoptysisTears in laryngeal or tracheal
mucosa.
External signs Bruises or abrasions over the skin. Tenderness Subcutaneous emphysema due to mucosal
tears Flattening of thyroid prominence Loss of contour of anterior cervical region. Thyroid notch may not be palpable Fracture displacements of thyroid or cricoid Fracture of hyoid bone. Gap may be felt between the fractured
fragments. Bony crepitus Separation of cricoid cartilage from larynx
or trachea.
Diagnostic evaluation Indirect laryngoscopy Direct laryngoscopy X-rays. Soft tissue CT scan
Associated injuries Examine for other injuries like
Injury to head Cervical spine Chest Abdomen and extremities.
X-ray chest for pneumothorax Gastrograffin swallow for
oesophageal tears
Treatment - conservative Patient should be hospitalised and
observed for Respiratory distress. Voice rest is essential. Humidification of inspired air is e en
ria\. Steroid therapy
Immediatelly Full dose Reduce edeme Prevent scarring and stenosis.
Antibiotics - Perichondritis and Cartilage necrosis.
Treatment - surgical Tracheostomy Endotracheal intnbation
Difficult Hazardous. Tracheostomy is preferred
Open reduction 3-5 days after injury Should not be delayed beyond 10 days.
Fixation Wired Miniplates
Open reductio and fixation Mucosal lacerations repaired - catgut Loose fragments of cartilage removed. Epiglottis
Anchored Excised.
Arytenoid cartilages – repositioned Laryngotracheal separation,
End to end anastomosis Lntemal splintage Laryngeal stent Silicone tube which - 2 to 6 weeks on an average .. Webbing Prevented by a silastic keel.
Complications Laryngeal stenosis,
Supraglottic Glottic Subglottic.
Perichondritis Laryngeal abscess. Vocal cord paralysis.
Thank You