Trauma neck larynx and trachea

Question 1

The Battle sign refers to what physical examination

finding?

Answer 1

Postauricular ecchymosis that suggests a basilar skull

fracture

Question 2

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?

Answer 2

Pack the ear canal to control bleeding, and perform an

arterial angiogram to examine for petrous carotid injury.

Question 3

Subcutaneous emphysema that extends from the

neck into the face travels in what plane?

Answer 3

Along the platysma and subcutaneous musculoaponeurotic

system (SMAS)

Question 4

Describe the anatomical boundaries of the three
zones of the neck used for the evaluation and
treatment of penetrating neck trauma.

Answer 4

● 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

Question 5

With penetrating injuries to zone I of the neck,

what structures are at risk of damage?

Answer 5

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

Question 6

With penetrating injuries to zone II of the neck,

what structures are at risk of damage?

Answer 6

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.

Question 7

With penetrating injuries to zone III of the neck,

what structures are at risk of damage?

Answer 7

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.

Question 8

Of the neck zones, which is the most surgically

accessible?

Answer 8

Zone II

Question 9

Describe the main factors that influence the injury

incurred from ballistic strike.

Answer 9

Kinetic energy (KE) (velocity is more important than mass),
design of projectile, composition of receiving tissue KE = (1⁄2)
(mass) (velocity)2

Question 10

What commonly used radiographic technique has been shown to reduce significantly the number of negative surgical neck explorations in penetrating
neck trauma?

Answer 10

CT angiography

Question 11

When performing esophagography in a patient with penetrating neck trauma, why is it important to use a water-soluble contrast agent?

Answer 11

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.

Question 12

In penetrating neck trauma, which structure, if it is not violated, significantly decreases the probability of aerodigestive or vascular injury?

Answer 12

Platysma

Question 13

Review the signs of carotid vascular injury after penetrating neck trauma.

Answer 13

Hematoma/ecchymosis, hypovolemic shock, external
hemorrhage, absent carotid pulse, carotid bruit or thrill, diminished ipsilateral radial pulse, contralateral hemiparesis, and altered mental status

Question 14

Review the signs of aerodigestive injury in

penetrating neck trauma.

Answer 14

Dysphagia, hoarseness, subcutaneous emphysema/crepitus, hemoptysis, hematemesis, gas escape from neck wound, dyspnea, airway obstruction, and stridor

Question 15

What are the indications for immediate surgical

exploration after penetrating neck injury?

Answer 15

An unstable patient with significant hemorrhage, expanding hematoma, nonexpanding hematoma with hemodynamic instability, hemomediastinum, hemothorax, airway decompensation

Question 16

What are common findings in blunt laryngeal

trauma?

Answer 16

Subcutaneous emphysema, dysphagia, dysphonia, dyspnea,

stridor, hemoptysis, neck swelling

Question 17

Describe the Schaefer classification system of

laryngeal injury.

Answer 17

● 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

Question 18

List conservative therapies that should be considered when treating a patient with a laryngeal fracture.

Answer 18

Voice rest, humidified blow-by, steroids, antibiotics, anti-

reflux medications

Question 19

Review the symptoms of laryngeal fracture.

Answer 19

Dysphonia, neck pain, odynophagia, dyspnea, dysphagia

Question 20

Review the signs of laryngeal fracture.

Answer 20

Hemoptysis, neck tenderness, subcutaneous emphysema,
anterior neck ecchymosis, laryngeal deviation, loss of
laryngeal prominence, stridor

Question 21

What is the most important imaging study for evaluating laryngeal trauma?

Answer 21

Fine-cut CT

Question 22

Which age group tends to have the highest

mortality after laryngeal trauma?

Answer 22

Patients older than 70 years of age

Question 23

Describe the reasons why children rarely sustain

laryngeal fractures.

Answer 23

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.

Question 24

Describe the mechanism of injury for laryngeal

fractures.

Answer 24

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.

Question 25

What is the preferred method of airway management for patients with advanced laryngeal trauma?

Answer 25

Awake tracheotomy in the operating room

Question 26

List the potential pitfalls and complications associated with endotracheal intubation in patients with laryngeal trauma.

Answer 26

Cervical spine injuries, laryngeal lacerations and hemorrhage, displaced laryngeal architecture, and cricotracheal separation

Question 27

Describe the steps to repair advanced laryngeal

fractures.

Answer 27

Secure the airway with awake tracheotomy, direct laryngoscopy with rigid bronchoscopy, neck exploration, laryngotracheal/endolaryngeal repair, cartilage stabilization

Question 28

How long are stents usually left in place after

laryngeal fracture repair?

Answer 28

In general, 2 to 3 weeks

Question 29

During an open laryngeal repair, a keel is useful in

preventing what type of complication?

Answer 29

Anterior glottic web