Malvi Abhinav, Jain Shraddha
Department of Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND.
Cureus. 2022 Oct 3;14(10):e29877. doi: 10.7759/cureus.29877. eCollection 2022 Oct.
Laryngotracheal wounds are rare; however, they have a significant mortality rate. These wounds can be blunt or penetrating. Usually, the larynx is protected from blunt trauma by the sternum and jaw. A "clothesline" injury happens when the exposed neck is struck by a hard object, such as a wall wire or tree branch, or when an attack is intended to damage the larynx. Additionally, injuries may occur when the neck is stressed due to damage, such as in a rear-end accident that causes a whiplash-like injury or when the larynx is intentionally targeted for harm. Penetrating neck trauma may result in injury to the larynx. Assume a patient has suffered a penetrating or severe neck injury. It is usually evident from their medical history or a quick trauma evaluation in that case. However, it is recommended to be cautious for anterior neck injuries in general and to have a low threshold for establishing a surgical airway. The priority is securing an airway when a patient with a laryngeal injury arrives in the emergency room. The operating surgeon may request any flexible laryngoscopy, computed tomography (CT), esophagram, and chest X-ray for additional examination, depending on the nature of the damage and the patient's health. After the examination, the initial step in treating laryngeal injuries should be to locate and secure the airway. According to the evaluation and management based on the Schaefer classification system for laryngeal injury, the patient is treated based on whether the patient has impending airway obstruction or a stable airway. Medical management or observation and surgical management depend on the site and severity of the injury, patient condition, and type of injury. There are several complications related to laryngotracheal trauma, which can be minor or even fatal. Following successful treatment, postoperative and rehabilitative care, vocal rest, speech therapy, and swallowing therapy may be necessary.
喉气管创伤较为罕见;然而,其死亡率颇高。这些创伤可为钝性或穿透性。通常,喉部受到胸骨和下颌的保护,免受钝性创伤。当暴露的颈部被硬物撞击,如墙壁电线或树枝,或当有人蓄意攻击喉部时,就会发生“晾衣绳”损伤。此外,当颈部因损伤而受力时,也可能发生损伤,比如在导致挥鞭样损伤的追尾事故中,或者当喉部被蓄意伤害时。穿透性颈部创伤可能导致喉部损伤。假设一名患者遭受了穿透性或严重的颈部损伤。在这种情况下,通常从他们的病史或快速创伤评估中就能明显看出。然而,一般来说,对于前颈部损伤应谨慎对待,建立手术气道的阈值要低。当喉部受伤的患者抵达急诊室时,首要任务是确保气道安全。根据损伤的性质和患者的健康状况,主刀医生可能会要求进行任何灵活喉镜检查、计算机断层扫描(CT)、食管造影和胸部X光检查以作进一步检查。检查后,治疗喉部损伤的第一步应该是找到并确保气道安全。根据基于Schaefer喉部损伤分类系统的评估和管理,根据患者是否有即将发生的气道阻塞或气道稳定来对患者进行治疗。药物治疗或观察以及手术治疗取决于损伤的部位和严重程度、患者状况以及损伤类型。与喉气管创伤相关的并发症有多种,可能轻微甚至致命。成功治疗后,术后和康复护理、声带休息、言语治疗和吞咽治疗可能是必要的。