Injuries of the Larynx and Trachea

The larynx and trachea may be injured by: 1 penetrating wounds, e.g. gunshot or cut throat injuries (Fig. 32.1); 2 blunt trauma, especially from road traffic accidents; 3 inhaled flames or hot vapours; 4 swallowed corrosive poisons; 5 endotracheal tubes and inflatable cuffs. MANAGEMENT The diagnosis of laryngeal trauma is often missed amid other serious injuries, but should always be suspected when injury to the neck has occurred. Cricotracheal separation may not cause immediately obvious signs but may lead to asphyxia. Fractures of the larynx will produce hoarseness and stridor, and tracheostomy may be needed urgently. In cases of cut throat, it may be possible to intubate the larynx through the wound, prior to formal tracheostomy and laryngeal repair. The two priorities of treatment are: 1 to protect the airway by intubation or tracheostomy; 2 to restore laryngeal function by careful repair of the injury. Laryngeal stenosis may result, despite repair of the larynx, and a permanent tracheostomy is sometimes necessary. 124 Fig. 32.1 A self-inflicted cut throat, giving a good view of the anatomy. Various manoeuvres for the correction of laryngeal stenosis have been devised, most depending on widening the lumen with some form of skeletal graft, such as rib cartilage or the hyoid bone. INTUBATION A particular problem is that posed by long-term endotracheal intubation of patients on intensive care units. The avoidance of red rubber tubes and awareness of the need to control cuff pressures have led to a reduction in the incidence of stenosis, and with modern tube design, tracheostomy can usually be postponed for 2–3 weeks. Once a problem mainly limited to adult intensive-care units, there has been an increased incidence of subglottic stenosis among very premature babies as a result of improved survival rates, owing to the excellent care of neonatologists. Prolonged endotracheal ventilation for broncho-pulmonary dysplasia and respiratory distress syndrome has inevitably resulted in cases of laryngeal stenosis in tiny infants, the care of whom is highly specialized and beyond the scope of this book.

Download Files

32-injuries-of-the-larynx-and-trachea.ppt (0.61 MB )