Laryngeal Trauma
- Divided into External or Internal
Internal
- Thermal- Foods andl Liquids. Laser surgery.
- Chemical burns- mucosal injury by chemical agents
- Aspiration or Vomiting. → Opens Sphincter of glottis usually protects lower airways,
Etiology: household cleansers, suicide attempts by acid or alkali ingestion
Symptoms: Acute airway obstruction → mucosal swelling, Systemic effects of chemical compounds ingested
Diagnosis: Endoscopy done after first 24hrs (risk of perforation)
- 2ⁿᵈ endoscopy done 10-14 days after
Treatment: Establish secure airway
- Systemic therapy (parenteral fluid replacement),
- Costicosteroids & broad spectrum antibiotics to reduce risk of infection
- Mechanical damage
- Forceful or prolonged intubation, surgeries)
Etiology: Prolonged intubation, endoscopy, foreign body extraction → damage mucosa
- Acute injuries to mucosal lining heal rapidly w/o treatment. The deeper the wound, the ↑ risk for granuloma formation + infection risk to cartilage & articular structures
Symptoms:Chronic changes 2-6weeks after removal of tube:
- hyperaemia, Edema, discolouration of Mucosa, Ulceration even Necrosis of mucos.
Treatment: Treatment should be postponed until the affected site is no longer inflamed.
- To treat stenosis → major surgical procedure is required
- By: 1) Resection or 2) expansion- splitting cricoid cartilage & adding anterior or posterior costal cartilage implant
External
- Closed injuries/ non-penetrating: Motor car accidents, blows and strangulation.
- Open injuries/ penetrating: Stabs, cut throat and gunshots.
Clinical picture:
- Hoarseness
- Dysphagia
- Hemoptysis due to hemorrhage
- respiratory distress
- edema→ airway obstruction
- injury to vocal cord or recurrent laryngeal nerve
- cutaneous emphysema due to thetears in wall and mucosa of larynx,
- tracheoesophageal fistula
Diagnosis: Endoscopic examination & CT
Treatment: establish secure airway
- if possible, endoscopy of larynx performed under controlled conditions, tracheotomy if needed