Trauma neck larynx and trachea Flashcards
The Battle sign refers to what physical examination
finding?
Postauricular ecchymosis that suggests a basilar skull
fracture
After a head trauma, the patient experiences
massive hemorrhage from the ear canal with
postauricular ecchymosis. What is the next step in
this patient’s treatment?
Pack the ear canal to control bleeding, and perform an
arterial angiogram to examine for petrous carotid injury.
Subcutaneous emphysema that extends from the
neck into the face travels in what plane?
Along the platysma and subcutaneous musculoaponeurotic
system (SMAS)
Describe the anatomical boundaries of the three
zones of the neck used for the evaluation and
treatment of penetrating neck trauma.
● Zone I: Clavicle and sternal notch to cricoid cartilage
● Zone II: Cricoid cartilage to angle of mandible
● Zone III: Angle of mandible to skull base
With penetrating injuries to zone I of the neck,
what structures are at risk of damage?
Aortic arch, carotid and vertebral arteries, subclavian vessels, innominate vessels, lung apices, esophagus, trachea, brachial plexus, recurrent laryngeal nerves, and thoracic duct are at risk
With penetrating injuries to zone II of the neck,
what structures are at risk of damage?
Common carotid artery with both internal and external branches, phrenic nerve, vagus nerve, hypoglossal nerve,
internal jugular vein, larynx, hypopharynx, and proximal esophagus are at risk.
With penetrating injuries to zone III of the neck,
what structures are at risk of damage?
Distal internal carotid artery, external carotid artery with major branches, vertebral artery, jugular vein with contributing venous drainage (retromandibular, facial, etc.), prevertebral venous plexus, parotid gland, and facial nerve are at risk.
Of the neck zones, which is the most surgically
accessible?
Zone II
Describe the main factors that influence the injury
incurred from ballistic strike.
Kinetic energy (KE) (velocity is more important than mass),
design of projectile, composition of receiving tissue KE = (1⁄2)
(mass) (velocity)2
What commonly used radiographic technique has been shown to reduce significantly the number of negative surgical neck explorations in penetrating
neck trauma?
CT angiography
When performing esophagography in a patient with penetrating neck trauma, why is it important to use a water-soluble contrast agent?
Extravasation of barium into the mediastinum can cause
mediastinitis and fibrosis. This risk is mitigated by the use of
water-soluble contrast agents (Gastrografin). However,
barium is less toxic to the lungs if it is aspirated.
In penetrating neck trauma, which structure, if it is not violated, significantly decreases the probability of aerodigestive or vascular injury?
Platysma
Review the signs of carotid vascular injury after penetrating neck trauma.
Hematoma/ecchymosis, hypovolemic shock, external
hemorrhage, absent carotid pulse, carotid bruit or thrill, diminished ipsilateral radial pulse, contralateral hemiparesis, and altered mental status
Review the signs of aerodigestive injury in
penetrating neck trauma.
Dysphagia, hoarseness, subcutaneous emphysema/crepitus, hemoptysis, hematemesis, gas escape from neck wound, dyspnea, airway obstruction, and stridor
What are the indications for immediate surgical
exploration after penetrating neck injury?
An unstable patient with significant hemorrhage, expanding hematoma, nonexpanding hematoma with hemodynamic instability, hemomediastinum, hemothorax, airway decompensation
What are common findings in blunt laryngeal
trauma?
Subcutaneous emphysema, dysphagia, dysphonia, dyspnea,
stridor, hemoptysis, neck swelling
Describe the Schaefer classification system of
laryngeal injury.
● Group I: Minor endolaryngeal hematoma without detectable fracture
● Group II: Edema, hematoma, minor mucosal disruption
without exposed cartilage, nondisplaced fractures
● Group III: Massive edema, mucosal disruption, exposed
cartilage, vocal fold immobility, displaced fracture
● Group IV: Group III with two or more fracture lines or massive trauma to laryngeal mucosa
● Group V: Complete laryngotracheal separation
List conservative therapies that should be considered when treating a patient with a laryngeal fracture.
Voice rest, humidified blow-by, steroids, antibiotics, anti-
reflux medications
Review the symptoms of laryngeal fracture.
Dysphonia, neck pain, odynophagia, dyspnea, dysphagia
Review the signs of laryngeal fracture.
Hemoptysis, neck tenderness, subcutaneous emphysema,
anterior neck ecchymosis, laryngeal deviation, loss of
laryngeal prominence, stridor
What is the most important imaging study for evaluating laryngeal trauma?
Fine-cut CT
Which age group tends to have the highest
mortality after laryngeal trauma?
Patients older than 70 years of age
Describe the reasons why children rarely sustain
laryngeal fractures.
Their larynx is situated higher in the neck and is therefore
more protected by the mandible; cartilages are not ossified
and therefore are more resistant to fracture.
Describe the mechanism of injury for laryngeal
fractures.
Compression of the larynx between an intrusive object and
the rigid cervical spine
The degree of injury depends on the amount of compressive force and degree of cartilage ossification.
What is the preferred method of airway management for patients with advanced laryngeal trauma?
Awake tracheotomy in the operating room
List the potential pitfalls and complications associated with endotracheal intubation in patients with laryngeal trauma.
Cervical spine injuries, laryngeal lacerations and hemorrhage, displaced laryngeal architecture, and cricotracheal separation
Describe the steps to repair advanced laryngeal
fractures.
Secure the airway with awake tracheotomy, direct laryngoscopy with rigid bronchoscopy, neck exploration, laryngotracheal/endolaryngeal repair, cartilage stabilization
How long are stents usually left in place after
laryngeal fracture repair?
In general, 2 to 3 weeks
During an open laryngeal repair, a keel is useful in
preventing what type of complication?
Anterior glottic web
