Laryngeal Trauma Research Articles

Pediatric Acute External Laryngeal Trauma

Larynx and adjacent anatomical structures have complicated physiological functions and mechanical features. Traffic accidents, penetrating stab wounds and shot wounds, sports matches, and occupational accidents cause external laryngeal trauma. In the management of laryngeal trauma, maintenance of airway patency has priority. In this case report, we will mention of a 15-year-old male patient with a blunt laryngeal trauma and also the approach to laryngeal traumas.

Arytenoid cartilage dislocation from external blunt laryngeal trauma: evaluation and therapy without laryngeal electromyography.

BackgroundIntubation trauma is the most common cause of arytenoid dislocation. The aim of this study was to investigate the diagnosis and treatment of arytenoid cartilage dislocation from external blunt laryngeal trauma in the absence of laryngeal electromyography (LEMG) and to explore the role of early attempted closed reduction in arytenoids cartilage reposition.Material/MethodsThis 15-year retrospective study recruited 12 patients with suspected arytenoid dislocation from external blunt laryngeal trauma, who were evaluated through 7 approaches: detailed personal history, voice handicap index (VHI) test, indirect laryngoscope, flexible fiberoptic laryngoscope, video strobolaryngoscope, and/or high-resolution computed tomography (CT), and, most importantly, the outcomes after attempted closed reduction under local anesthesia. They were divided into satisfied group (n=9) and dissatisfied group (n=3) based on their satisfied with voice qualities at 1 week after the last closed reduction manipulation.ResultsEach patient was diagnosed with arytenoid dislocation caused by external blunt laryngeal trauma. In the satisfied group, VHI scores and maximum phonation time (MPT) at 1 week after the last reduction were significantly improved compared with those before the procedure (P<0.05). Normal or improved mobility and length of the affected vocal fold were also noted immediately after the end of the last closed reduction. The median time interval between injury and clinical intervention in satisfied group was 43.44±34.13 days, much shorter than the median time of 157.67±76.07 days in the dissatisfied group (P<0.05).ConclusionsMultimodality assessment protocols are essential for suspected arytenoid dislocation after external blunt laryngeal trauma. Early attempted closed reduction should be widely recommended, especially in health facilities without LEMG, mainly, because it could be helpful for early diagnosis and treatment of this disease. In addition, early closed reduction could also improve the success of arytenoid reduction.

Efficacy of Intensive Phonatory-Respiratory Treatment (LSVT) for Presbyphonia: Two Case Reports

Research evidence has shown that neither traditional voice therapy nor surgery was efficacious in managing age-related dysphonia, specifically for more severe cases with pronounced fold atrophy or larger glottal gaps. The purpose of this study was to examine the efficacy of intensive respiratory-phonatory treatment (Lee Silverman voice treatment [LSVT]) for glottal incompetence associated with presbyphonia. Nonrandomized prospective study. Two subjects with age-related vocal fold bowing received 4 weeks of the LSVT. Strobolaryngoscopic examination, phonatory function measurement, acoustical analyses, and perceptual judgments of voice were obtained at baseline and 2 weeks posttreatment. Additional acoustic measures of phonatory function, including vocal intensity, maximum phonation time, and pitch range, were also obtained during 16 treatment sessions. Both subjects exhibited significant improvements in glottal closure, phonatory function, acoustic features, and perceptual ratings of voice after treatment. Significant changes of phonatory function measures were noticed relatively early and remained steady throughout the course of treatment. These findings provide solid evidence that speakers with age-related vocal fold bowing and dysphonia may improve glottal competence and related vocal function with neither laryngeal trauma nor maladaptive laryngeal hyperfunction after the LSVT.

MDCT in the Assessment of Laryngeal Trauma: Value of 2D Multiplanar and 3D Reconstructions

The purpose of this study was to analyze fracture patterns and related effects of laryngeal trauma and to assess the value of 2D multiplanar reformation (MPR) and 3D reconstruction. Among 4222 consecutively registered trauma patients who underwent emergency MDCT, 38 patients had presented with laryngeal trauma. Axial, 2D MPR, 3D volume-rendered, and virtual endoscopic images were analyzed retrospectively by two blinded observers according to predefined criteria. Laryngeal fractures, soft-tissue injuries, and airway compromise were evaluated and correlated with clinical, endoscopic, surgical, and follow-up findings. Fifty-nine fractures (37 thyroid, 13 cricoid, nine arytenoid) were present in 38 patients. They were isolated in 21 (55%) patients. The other 17 (45%) patients had additional injuries to the neck, face, brain, chest, or abdomen. Laryngeal fractures were bilateral in 31 (82%) patients and were associated with hyoid bone fractures in nine (24%) patients. Arytenoid luxation was present in eight cartilages. Axial imaging missed 7 of 59 (12%) laryngeal fractures, six of eight (75%) arytenoid luxations, and four of nine (44%) hyoid bone fractures. Additional 2D MPR imaging missed 5 of 59 (8%) laryngeal fractures, five of eight (62.5%) arytenoid luxations, and two of nine (22%) hyoid bone fractures, whereas 3D volume-rendered images depicted them all. Virtual endoscopy and 3D volume rendering added diagnostic accuracy with respect to the length, width, shape, and spatial orientation of fractures in 22 of 38 (58%) patients; arytenoid luxation in six of eight (75%) luxations; and the evaluation of airway narrowing in 19 of 38 (50%) patients. Three-dimensional volume rendering was not of additional value in evaluation of the cricoid cartilage. The use of 2D MPR and 3D volume rendering with or without virtual endoscopy improved assessment of thyroid and hyoid bone fractures, arytenoid luxations, and laryngotracheal narrowing, providing helpful data for optimal management.

Cricoid and Thyroid Cartilage Fracture, Cricothyroid Joint Dislocation, Pseudofracture Appearance of the Hyoid Bone: CT, MRI and Laryngoscopic Findings

Laryngeal trauma is extremely rare and usually occurs as a result of blunt trauma. The most common cause of the blunt laryngeal trauma is a motor vehicle accident but it can also occur as a result of relatively minor insults to the anterior neck that cause posterior compression of the larynx against the spine. Injury to the larynx may range from simple mucosal tears to laryngeal cartilage fracture and dislocation. It may be associated with hyoid fractures, epiglottic injury, cervical spine fractures and esophageal or vascular injuries. As it may lead to life-threatening airway obstruction, rapid and accurate diagnosis is essential for proper treatment. We report computed tomography (CT), magnetic resonance imaging (MRI) and serial endoscopic findings of a patient with cricoid and thyroid cartilage fracture and cricothyroid joint dislocation after blunt neck trauma. Case Report

The reconstruction of thyroid cartilage defect due to penetrating laryngeal trauma using a autogenous septal cartilage graft

The reconstruction of thyroid cartilage defect due to penetrating laryngeal trauma using a autogenous septal cartilage graft

Conservative management of laryngeal dog bite*

Dog bites represent an important public health issue, causing injuries from trivial to fatal. The true incidence is unknown due to the lack of national and local reporting system. School children, mostly male, are more commonly affected with the majority of injuries occurring in the head and neck area, followed by the limbs and trunk. The conservative management of a 6-year-old girl who sustained a fracture of her laryngeal structure from an attack by her neighbours' dog is described. Only a 1 cm visible puncture wound in the midline of her neck with air escaping through the wound was seen at presentation. Ten days were spent in hospital including the first four in intubated Paediatric Intensive Care Unit. Initial microlaryngoscopy and bronchoscopy (MLB) showed a swelling in the right anterior subglottis not reducible by manipulation. She was re-intubated with progressively larger naso-tracheal tube until the fracture was fully reduced on her 3rd MLB. Three months post-injury, there is no evidence of airway narrowing. The literature advocates early surgical management of laryngeal trauma including dog bites. Conservative management of laryngeal fracture from a dog bite is feasible and associated with a good outcome and no long-term sequela.

Management of acute blunt and penetrating external laryngeal trauma

Improve the care of acute external laryngeal trauma by reviewing controversies and the evolution of treatment. Internet-based search engines, civilian and military databases, and manual search of references from these sources over the past 90 years. Utilizing the above-mentioned sources, electronic and manual searches of primary topics such as laryngeal trauma or injury, emergency tracheotomy, airway trauma, intubation versus tracheotomy, cricothyrotomy, esophageal trauma, and emergent management of airway injuries in civilian and combat zones. Citations were reviewed, selected reports analyzed, and the most relevant articles referenced. Optimal treatment of acute laryngeal trauma includes early identification of injuries utilizing a directed history and physical examination. Timely management of the wounded airway is essential. The choice of intubation, tracheotomy, or cricothyrotomy must be individualized. Computed tomography (CT) may assist in differentiating patients who can be observed versus those who require surgical exploration. In selected patients, laryngeal electromyography and stroboscopy may also be useful. Surgery should begin with direct laryngoscopy and rigid esophagoscopy to evaluate the hard and soft tissues of the larynx, and to visualize the pharynx and esophagus. Minor endolaryngeal lacerations and abrasions may be observed, whereas more significant injuries require primary closure via a thyrotomy. Laryngeal skeletal fractures should be reduced and fixated. Endolaryngeal stenting is reversed for massive mucosal trauma, comminuted fractures, and traumatic anterior commissure disruption. Acute external injury to the larynx is both life threatening and a potential long-term management challenge. Although a rare injury, sufficient experience now exists to recommend specific treatments, and to preserve voice and airway function.

Laryngeal Trauma: Common Findings and Imaging Pearls

Laryngeal Trauma: Common Findings and Imaging Pearls

An observational clinical study in cats and rabbits of an anatomically designed supraglottic airway device for use in companion animal veterinary anaesthesia

In literature, there are many reports of complications following endotracheal intubation in human patients. Examples include oesophageal perforation (Ranchere and others 1992) and tracheal rupture (Austin 2010). Supraglottic airway devices...

Back To Blockers?

Back To Blockers?

Efficiency, Efficacy, and Safety of EZ-Blocker Compared with Left-sided Double-lumen Tube for One-lung Ventilation

Double-lumen tubes (DLTs) or bronchial blockers are commonly used for one-lung ventilation. DLTs are sometimes difficult or even impossible to introduce, and the incidence of postoperative hoarseness and airway injuries is higher. Bronchial blockers are more difficult to position and need more frequent intraoperative repositioning. The design of a Y-shaped bronchial blocker, the EZ-Blocker (Teleflex Life Sciences Ltd., Athlone, Ireland) (EZB), combines some advantages of both techniques. The objective of this study was to assess whether EZB performs clinically better than left-sided DLTs (Broncho-cath; Mallinckrodt, Athlone, Ireland) without causing more injury. Primary outcome was the frequency of initial malpositions. Eligible patients were adults scheduled for surgery requiring one-lung ventilation who met criteria for placement of both devices. In this parallel trial, 100 consecutive and blinded patients were assigned randomly using a computer-generated list to two groups. The incidence of malposition and ease and time of placement were recorded. Blinded assessors investigated quality of lung deflation, postoperative complaints, and damage to the airway. Placement of a DLT was unsuccessful twice. The incidence of initial malposition was high and comparable between EZBs (37 of 50) and DLTs (42 of 49) (P = 0.212). Placing single-lumen tubes and EZBs took more time but was rated easier. Quality of lung deflation was comparable. Fewer patients in the EZB group complained of sore throat at day 1. There was a higher incidence of tracheal hematoma and redness and bronchial hematoma in the DLT group. The EZB is an efficient and effective device for one-lung ventilation and causes less injury and sore throat than a DLT.

Management of Laryngeal Trauma in a Tertiary Hospital in the Niger-Delta Area of Nigeria

Management of Laryngeal Trauma in a Tertiary Hospital in the Niger-Delta Area of Nigeria Background: Although laryngeal injuries are uncommon in our environment, they are responsible for severe morbidity and fatalities when they occur. Aim: The aim of this study was to review cases of laryngeal injuries, the management protocol and outcome of the patients managed in our hospital within a 6-year period. Materials and Methods: A retrospective study of the case notes of patients that presented with laryngeal trauma at the University of Benin Teaching Hospital, Benin City, Nigeria, between 1st of March, 2006 and 29th of February, 2012 was carried out. Appropriate data were retrieved from the patients’ case notes. Results: Thirteen patients had laryngeal trauma during the study period, consisting of 10 males and 3 females, with a male to female ratio of 3.3:1. Ages of the patients ranged from 15 years to 50 years, with a mean age of 34.8 years. Whereas 8 patients had burns involving the head and neck region with inhalational injuries, 3 patients had blunt trauma to the larynx as the mechanism of the laryngeal injury. Twelve (12) out of the 13 patients had tracheostomy for relief of the upper airway obstruction, while from the available records only 5 patients were successfully decannulated of tracheostomy /endotracheal tubes. Conclusion: Males and young aged individuals are more prone to laryngeal trauma. Burns involving the head and neck with inhalational injury is the commonest cause of laryngeal injury. Tracheostomy was done for 12 out of 13 cases in this series. Patients with laryngeal trauma may recover fully, die or have difficulty in decannulation of a tracheostomy tube.

Stenting for the Management of Posttracheostomy Tracheomalacia: Case Report

In patients who undergo prolonged endotracheal intubation, tracheostomy is performed to prevent the tracheal and laryngeal trauma which may be caused by the intubation tube. In this report, a patient who was intubated after a cerebrovascular embolism and required a tracheostomy for 6 months due to decannulation problems is presented. The patient subsequently developed a tracheomalacia. A stent was inserted and seen to provide functional support. Upon removal of the stent, the tracheomalacia improved. Although surgical therapy is claimed to provide higher success rate, stenting may also be a viable option for the management of tracheomalacia and improve the quality of life in patients with good general condition.

Case Report: Traumatic Pneumomediastinum Following Emesis Two Years After Laryngeal Fracture Repair

Case Report: Traumatic Pneumomediastinum Following Emesis Two Years After Laryngeal Fracture Repair Isolated laryngeal trauma is exceedingly rare. Significant morbidity associated with this type of injury necessitates early recognition of symptoms and swift surgical intervention. With such low incidence and limited experience of physicians, proper management of laryngeal trauma is controversial. Here we present a case of a young adult male who sustained fracture of the larynx while playing flag-football, requiring surgical repair. This patient presents 2 years later with extensive pneumomediastinum after an episode of retching. Our immediate and long-term management of a case of laryngeal fracture is presented in hopes that it may help determine optimal treatment protocols in the future. Specifically, the importance of classic presentation and early recognition of symptoms, preferred imaging modalities, possible post-operative complications and current trends in surgical management are discussed.

Late manifestation of bilateral laryngeal nerve palsy after thyroidectomy

Respiratory distress is a feared complication after thyroid surgery. Differential diagnosis includes bilateral recurrent laryn-geal nerve palsy (BRLNP), local hematoma, vocal cord edema and laryngeal trauma. BRLNP results from intraoperative irritation without physical injury (neurapraxia), or intraoperative partial or complete transsection (axonotmesis and neuro-tmesis, respectively) of the recurrent laryngeal nerve (RLN). RLN palsy typically manifests immediately in the postoperative course. However, in rare cases there is a delayed, progressive development of BRLNP, potentially leading to respiratory failure in emergency setting weeks after initial surgery. Herein we report on a patient developing massive respiratory distress secondary to BRLNP 5 weeks after thyroidectomy for massive goiter. With the current tendency to decrease the length of hospital stay after thyroid surgery, late onset palsy of the RLN should be included into the differential diagnosis for acute respiratory distress in patients with recent history of thyroid surgery.&nbsp;

A Rare Laryngeal Trauma: Complete Cricolaryngeal Separation

Laryngeal trauma is a rare but life threatening injury. In cut throat, laryngeal injury should be suspected and investigated. The first priority in management is to secure airway. Associated injuries should be searched for. Treatment may be conservative or surgical depending upon the site, magnitude of injury and stability of laryngeal framework. Here we present a rare form of penetrating laryngeal injury with complete disruption between cricoid and thyroid cartilages

Does the site of anterior tracheal puncture affect the success rate of retrograde intubation? A prospective, manikin-based study.

Background. Retrograde intubation is useful for obtaining endotracheal access when direct laryngoscopy proves difficult. The technique is a practical option in the “cannot intubate / can ventilate” scenario. However, it is equally useful as an elective technique in awake patients with anticipated difficult airways. Many practitioners report difficulty successfully advancing the endotracheal tube due to anatomical obstructions and the acute angle of the anterograde guide. The purpose of this study was to test whether a more caudal tracheal puncture would increase the success rate. Methods. Twenty-four anesthesiology residents were randomly assigned to either a cricothyroid or a cricotracheal puncture group. Each was instructed how to perform the technique and then attempted it on a manikin at their assigned site. Data collection included whether the trachea was intubated, the number of attempts required, and the total time. Results. Both groups displayed a high degree of success. While the group assigned to the cricotracheal site required significantly more time to perform the procedure, they accomplished it in fewer attempts than the cricothyroid group. Conclusion. Retrograde intubation performed via a cricotracheal puncture site, while more time consuming, resulted in fewer attempts to advance the endotracheal tube and may reduce in vivo laryngeal trauma.

Near-Complete Supraglottic Transection of the Larynx after a Motorbike Accident

Severe laryngeal trauma is rare in the civilian environment and requires appropriate and timely surgical intervention. We report a case from Sydney, Australia, which was managed with open reduction and internal fixation of the larynx with resorbable plates. The use of resorbable plates for operative fixation of the larynx has rarely been reported in literature but may be a viable alternative.

Multidetector computed tomography in nonmalignant laryngeal disease

Multidetector computed tomography (MDCT) is the examination of choice for laryngeal imaging in benign and malignant lesions. This review gives an overview of the MDCT scanning technique and discusses the advantages and disadvantages in investigation of benign lesions of the larynx. MDCT is not the primary diagnostic method for benign lesions on the vocal folds. However, CT is indispensable for the diagnostic investigation of immobility of the vocal fold, for laryngoceles, and for laryngeal trauma, and may allow the exact delineation of extension and nature of benign laryngeal disease. The improved spatial resolution with consecutive high-quality two-dimensional (2D) and three-dimensional (3D) reconstructions using thin-slice MDCT allows a better detection of laryngeal anatomic structures and benign pathologies. The investigation of choice in diagnosing the cause of hoarseness is laryngoscopy and/or laryngostroboscopy, respectively. Nevertheless, thin-slice MDCT with multiplanar 2D and 3D volume-rendered reconstructions is essential for exact anatomic definition and extension and diagnosis of subtle benign laryngeal diseases.