laryngeal trauma
Introduction
Introduction to laryngeal trauma Laryngeal trauma refers to the violent injury of the throat, resulting in damage to the structure of the throat, bleeding, difficulty breathing, and hoarseness or loss of sound. If the laryngeal trauma has injured the laryngeal cartilage and the blood vessels in the neck, it is urgent and complicated in handling. Improper handling can endanger the patient's life or cause sequelae such as narrow throat. Therefore, it is necessary to make a correct diagnosis and timely treatment of laryngeal trauma in clinical practice. Most of the laryngeal trauma is mechanical trauma, caused by direct external violence, such as traffic accidents, accidental injuries during sports, industrial accidents, war wounds, and suicide. When patients have combined trauma, they should deal with severe trauma such as central nervous system injury (such as coma), spinal fracture, pneumothorax, visceral rupture or large abdominal cavity, and then treat laryngeal trauma. basic knowledge The proportion of illness: 0.085% Susceptible people: no special people Mode of infection: non-infectious Complications: septic shock
Cause
Cause of laryngeal trauma
The causes of laryngeal trauma are mostly the result of direct violence, such as a traffic accident, a stab wound in an industrial accident, self-destruction or bruise, and a boxing or blunt blow. According to the direction of the external force, different degrees of contusion can occur. For example, the external force comes from the side, because the throat can move to the opposite side, the injury is light, and there is often no fracture. Only the laryngeal mucosal injury and the ankle joint dislocation occur. When subjected to an external force from the front, the injury is often severe, resulting in a longitudinal fracture in the middle of the thyroid cartilage, a fracture in the posterior part of the cartilage, and a lesion in the larynx.
Prevention
Laryngeal trauma prevention
1. Pay attention to the general condition of the patient and do psychological care: such as severe open laryngeal trauma, immediately assist the doctor to rescue and observe the changes of vital signs and respiratory blood pressure pulse to the emergency oxygen inhalation while the nervous and orderly rescue operation Appropriately give patients psychological comfort so that patients can see the fire and hope of life in extreme pain and fear. The patient's body and mind are in good stress. The body is tolerant to ischemia and hypoxia pain to gain more rescue. opportunity.
2. Keep the airway open: In the emergency, quickly insert the hollow tube (such as plastic tube) from the wound into the throat or the inner and outer end of the trachea. Fix the airway first and keep the tracheotomy bag ready for the tracheotomy. .
3. Open the intravenous channel infusion and other corrective patients with hemorrhagic shock: input antibiotic hormone and fresh blood while paying attention to blood pressure, taking the head low position.
4. Hospitalization preparation: When you need to be hospitalized after emergency treatment in the outpatient department, you should first notify the ward to send an experienced medical staff to escort to prevent accidents.
5. Observe the changes of the condition at any time after admission: If you find that the bleeding is poor or the casing is out again, report it to the doctor and assist in the treatment to save the patient's life.
6. For patients with tracheotomy: a routine of tracheotomy should be performed.
Complication
Laryngeal trauma complications Complications septic shock
Infection leads to cartilage necrosis, or due to improper treatment of early wounds, sequelae, larynx, trachea, esophageal scar stenosis, fistula formation or vocal folds and other sequelae.
Symptom
Symptoms of laryngeal trauma Common symptoms Sore throat, hoarseness, difficulty breathing, laryngeal edema, throat congestion, mucosal congestion, subcutaneous emphysema
Acute laryngeal trauma is divided into two categories: laryngeal soft tissue contusion and laryngeal cartilage fracture. The clinical manifestations and treatment methods are different.
(1) Acute laryngeal soft tissue contusion
1. Symptoms: mainly sore throat and hoarseness. Acute laryngeal soft tissue contusion is the most common pure laryngeal injury, which can present superficial laryngeal mucosal rupture, epiglottis wrinkles, rupture, and vocal cord hematoma. When performing direct laryngoscopy, pay attention to whether the bilateral vocal cords are at the same level and their ability to move, and check the passive activity of the cleft palate.
2. Treatment: This type of injury does not require surgical repair. Physiotherapy or heat application can be performed 24 hours after injury to promote the absorption of hematoma. The passive activity of the cleft palate is limited. When the double vocal cord is at the same level, it is generally considered to be caused by a local massive hematoma. After the hematoma disappears, the cleavage movement can be restored. If the vocal cords of the ankle joint dislocation are not at the same level, the joint should be restored under the direct laryngoscope. In patients with acute laryngeal soft tissue contusion with obvious laryngeal obstruction, tracheotomy should be performed, and the tracheal cannula should be removed after the hematoma subsides.
(B) acute laryngeal cartilage fracture external force impact throat
Laryngeal cartilage fractures can occur when the throat is in contact with the cervical spine. After the fracture, the perichondrium, mucosa or outer perichondrium of the laryngeal cartilage can be ruptured, resulting in submucosal hemorrhage, subcutaneous emphysema, and perichondritis.
1. Symptoms: Laryngeal pain, swallowing pain, hemoptysis, and difficulty breathing are the main symptoms of laryngeal cartilage fractures. Different degrees of dyspnea due to different degrees of laryngeal edema and submucosal hematoma. At the time of examination, the soft tissue swelling and skin ecchymosis were observed. When there is bleeding and emphysema in the soft tissue of the throat, the neck is thick.
The thyroid cartilage on the thyroid cartilage fracture disappeared, and the annular cartilage arch disappeared when the cartilage fracture occurred. The palpation can be found in cartilage friction. Subcutaneous emphysema and hemoptysis occur between the ring cartilage and the tracheal. Indirect laryngoscopy or fiber laryngoscopy revealed laryngeal mucosal laceration, mucosal edema, and submucosal hematoma. During the examination, attention should be paid to the ability of the double vocal cords to move and whether they are at the same level and whether there is exposed cartilage. According to the condition, chest X-ray, cervical vertebra, laryngeal layer, cervical soft tissue, esophagography, and CT scan of the larynx can be taken. When examining patients, pay attention to the patient's state of consciousness, sensation, and motor nerves, so as to detect and treat severe trauma of other organs with early detection of laryngeal trauma.
2. Complications: laryngeal cartilage fractures, acute complications can be complicated by local infection, subcutaneous emphysema, major bleeding (when the large blood vessels are damaged). In the late stage of laryngeal cartilage fracture, the throat may be narrowed or form a throat, and the vocal cords may be fixed or paralyzed, causing hoarseness, difficulty in breathing, and difficulty in swallowing.
Examine
Laryngeal trauma examination
Flat film performance
In the acute phase, laryngeal soft tissue edema deformation and laryngeal stenosis can be seen. Calcified laryngeal cartilage fractures can show that the fracture line and misplaced neck emphysema are distributed along the neck muscle space, showing strips of gas. In the late stage, the structure of the laryngeal cavity is asymmetrical, deformed or partially disappeared, and functional activities are limited. If accompanied by granulation, a soft tissue mass with a different range and a narrow airway can be seen.
2.CT performance
In the early stage of injury, hemorrhage and edema are characterized by diffuse thickening of the mucosa, increased density of the anterior and posterior epiglottis, stenosis of the larynx, and dislocation of the laryngeal cartilage. Separation of the bone fragments, accumulation of soft tissue around the throat, often honeycomb Or strip air shadow. After the healing of the deformity, CT can determine the thickening and adhesion of the various structures and the extent of involvement.
3. MRI performance
According to the signal changes, hematoma, mucosal edema and soft tissue damage can be distinguished. The three-dimensional image RJ clearly distinguishes the cartilage fracture and its displacement direction.
Diagnosis
Diagnosis and diagnosis of laryngeal trauma
The diagnosis of open throat injury is not difficult. Closed laryngeal injury is easily misdiagnosed because there is no wound on the skin of the neck. Therefore, there is a history of trauma to the neck, blood in the sputum after the injury, hoarseness, subcutaneous emphysema in the neck should be further examined, and a neck X-ray photograph of the laryngotracheal tube can be diagnosed.
Clinical diagnosis should also provide a detailed understanding of the nature, location, extent, and cartilage fractures of the injury, which is important for determining the treatment policy. Generally, according to the local examination, the X-ray photograph can be clearly defined, but if necessary, the fiber can be used for fiber bronchoscopy or CT scanning to help determine the extent of the injury.
