67 Laryngeal and Esophageal Trauma Flashcards
General classification of laryngeal and esophageal trauma: (2)
External - blunt or penetrating
Internal - Iatrogenic, thermal, caustic, foreign body
MC presenting symptom of laryngeal trauma:
Hoarseness (MC), followed by
Dysphagia
Pain
Sign of cartilaginous injury:
Failure of vocal cords to meet in the same horizontal plane
Evaluation of arytenoid abduction: (what do you have the patient do)
Sniff
Laryngeal trauma is associated with concomitant _____ In 10% of cases.
Cervical spine fracture
NEXUS low risk criteria components:
No posterior midline cervical tenderness
No evidence of intoxication
Normal level of alertness
No focal neurologic deficit
No painful distracting injuries
Cervical spine radiography is indicated for trauma pxs unless they exhibit ALL the listed criteria.
Schaefer - Fuhrman Classification of Laryngeal Trauma:
I: minor endo laryngeal hematoma/laceration, NO detectable fracture
V: complete laryngotracheal separation
II: edema, hematoma, minor mucosal disruption WITHOUT EXPOSED CARTILAGE, NON displaced fracture
III: massive edema, large mucosal lacerations, EXPOSED cartilage, DISPLACED fracture, Vocal cord immobility
IV: same as III but more severe, with - severe mucosal disruption, disruption of anterior commissure, unstable fx, two or more fracture lines
Components of conservative management for laryngeal trauma:
24 hr admission to high dependency unit with regular observations
serial flexible nasoendoscopy, humidified oxygen
Elevation of head to reduce edema
Corticosteroids w/in 24 hrs of injury
PPI
antibiotics if laryngeal mucosa breached
Delay in surgical management for laryngeal trauma can lead to this complication, which is a subsequently harder problem to correct.
Granulation, scar tissue formation —-> laryngeal stenosis
Indications for open laryngeal repair
Displaced, unstable or comminuted laryngeal fractures
Cricotracheal separation
Detachment of anterior commissure
Extensive mucosal disruption
Management of vocal cord immobility as a result of cricoarytenoid joint dislocation
Endoscopic manipulation and repair
Anterior vs Posterior arytenoid dislocation:
Cause:
Position of vocal fold:
Cause:
Anterior: injury from tip of the anesthetic laryngoscope at intubation
Affected side will lie higher
Posterior: extubation
Affected side will lie lower
Differences of pediatric with adult larynx:
Pediatric:
level of C3
Smaller in absolute and relative dimensions
Laryngeal mucosa is less firmly adherent to cartilaginous framework in infants and children
Most common cause of laryngeal trauma
Endotracheal intubation
ET intubation can cause what injuries?
Pharyngeal or laryngeal lacerations
Cricoarytenoid joint dislocation
Neurapraxia of lingual, hypoglossal and laryngeal nerves
Bilateral intubation granuloma
