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4/14/2009
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Laryngeal Trauma
Prof. M.HeshamDepartment of ORL-HNS
Alexandria Faculty of Medicine
What Makes the larynx vulnerable to trauma ?
•Cross road
•Rigid structures
•Subcutaneous
•Vertebral column•Vertebral column
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What protects the larynx against trauma ?
•Cartilage VS Ossified
•Mandible
•Sternum
•Vertebral column
Protective mechanisms
•Reflex closure of the laryngeal inlet
•C h r fl•Muscles
•Cough reflex
Types of laryngeal trauma
A. External trauma
1. Closed
2. Open
B. Internal trauma
1. Through upper air passages
2. Through upper food passages
C. Psychological trauma
D. Voice trauma
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Voice trauma•Voice users
•Singer’s nodes Screamer’s nodes•Singer s nodes Screamer s nodes
Closed external trauma
Trauma applied to the larynx through the frontTrauma applied to the larynx through the front of the neck while the skin of the neck is not cut.
•Blunt trauma
•Physical trauma y
•Burns
•Radiotherapy
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External blunt traumaMechanism
External blunt traumaCauses
•Motor car accidents
•Sport injuries
•Recreation vehicles
•Hanging and throttling
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External blunt traumaInjuries
More internal than external damage
•Soft tissue injuries•Hematoma•Dislocation
More internal than external damage
•Fractures•Esophageal tear
Cricotracheal separation Immediate death
External blunt trauma
Clinical picture
History of trauma to the necky
Asymptomatic in early cases
Symptoms:
•Dysphonia
•Dyspnoea
•Dysphagia•Dysphagia
•Cough
•Aspiration
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Neck SwellingEmphysemaEchymosisPain
Signs:•External
Do not move the neck until cervical fracturesDo not move the neck until cervical fractures ruled out
•Cervical emphysema Tear
•Edema Hemorrhage
•Loss of laryngeal prominence Fracture
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Signs:• Internal
Indirect Laryngoscopy
Hemorrhage
Laceration
Arytenoid dislocation
Immobility
Investigations
External blunt trauma
•Radiology
•Plain Xray•CT scan •Barium swallow
Air
Fractures
OOther injuries
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External blunt trauma
Management
Hospitalization
Observation
Secure airway
Even if the external signs are minimal
The patient may deteriorate rapidly
ManagementExternal blunt trauma
•Recognition of the extent of injury
•Stabilization of the airway
•Restoration of an intact cartilagenous framework
•Reestablishment of internal mucosal integrity
•Prevention of infection
•Prevention of stenosis
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External blunt traumaManagement
•Conservative
•Endoscopic
•Open surgery
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Open external trauma
Trauma to the larynx through the neck by a sharp y g y pobject that leads to cutting of the skin
•Gunshot
•Stab wound
•Cut throat
•Less dangerous than the closed trauma
•Suffocation
•Death from carotid bleeding
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Internal trauma•Foreign bodies
•Caustic soda or potashp
•Inhalational of caustic fumes and irritant gases
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Surgical trauma
ExternalExternal
Thyroidectomy
Open heart surgery
Tracheotomy
Internal
Endotracheal intubation
Endoscopy
Intubation injuries
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Intubation injuries
Immediate injuries
Lacerations, edema, hematoma
Dislocation
Delayed injuries
Intubation granuloma
Gl tti bGlottic webs
Joint fixation
Subglottic stenosis
Intubation granuloma
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Subglottic stenosis
Webs
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