blunt throat trauma
Introduction
Brief introduction to laryngeal contusion Contusionoflarynx, also known as closed larynx injury, is a type of laryngeal trauma. When multiple traumas are combined, such as head, chest, abdomen and limb injuries, throat contusions are easily overlooked due to serious conditions. Sometimes only a tracheotomy is performed, the laryngeal obstruction is relieved, and the laryngeal injury is not treated in time to form a traumatic laryngeal stenosis with serious consequences. basic knowledge The proportion of the disease: the probability of the population is 0.02% Susceptible people: no specific population Mode of infection: non-infectious Complications: mediastinal emphysema, pneumothorax, recurrent laryngeal nerve injury, fracture
Cause
Cause of blunt laryngeal injury
(1) Causes of the disease
The throat is generally not susceptible to contusion due to its own mobility and cartilage elasticity, as well as the protection of the mandible, sternum stem, clavicle and cervical vertebrae. The blunt laryngeal contusion is common in traffic accidents, industrial trauma, sports trauma, earthquake trauma, Fall injuries, boxing injuries and injuries.
1. Occurrence According to the relationship between the body and the object, there are five cases of blunt laryngeal injury:
(1) The hard object of the activity hits the human body.
(2) The active human body hits a hard object.
(3) The human body collides with each other.
(4) crush injury.
(5) Endogenous damage.
The damage of industrial trauma and earthquake trauma is diverse. The car accident is more common and the damage mechanism is more complicated. When the car suddenly brakes, the patient's head leans back, the throat protrudes forward, and it hits the car. On the hard object, the structure of the laryngeal cartilage is squeezed before the cervical vertebral body, leading to laryngeal cartilage fracture and soft tissue contusion. Because the thyroid cartilage is more prominent, it is more susceptible to damage than the annular cartilage. The aged laryngeal cartilage is calcified, and the elasticity is poor. People are prone to cartilage fractures. If the direction of violence is low, it can lead to fracture of the cartilage or separation of the trachea from the cartilage.
2. Type Narries and other according to the injury mechanism, injury site and clinical manifestations, the pharyngeal contusion is divided into 4 types, upper glottic tear and fracture; subglottic injury; annular cartilage fracture; tracheal and annular cartilage separation .
(1) Upper and upper glottic tears and fractures: blunt force upwards and backwards, pushing the hyoid bones to the upper back, which can cause fractures of the hyoid bone, tearing of the thyroid lingual periosteum, fracture of the thyroid cartilage or upper part of the thyroid cartilage Fractures, fracture fragments can be trapped in the larynx, and hematoma can occur in various parts of the upper glottis and in the anterior epiglottis.
(2) Injury across the glottic area: the blunt object impacts the thyroid cartilage at right angles, and various fractures and displacements occur. The thyroid cartilage wing in the elderly is most vulnerable to linear fracture, and the fragment is displaced backward and inside. Forming a step-like deformity, the anteroposterior diameter of the vocal door is obviously shortened, and the cartilage elasticity of adolescents is better, and a wide range of soft tissue tears are prone to occur. The nailfold and nailfold ligaments can be broken at any position, and the sacral cartilage can be outward. After the or the glottic area is displaced, the scorpion will be disgusted, the piriform crypt and the upper end of the esophagus may also tear, and the hematoma may form in the soft tissue around the glottic area. When the thyroid cartilage rebounds forward, the inner side of the cartilage The membrane can be peeled off, and the airway is blocked, and the thyroid ligament is easily torn off, so that the adipose tissue and the honeycomb tissue in the anterior epiglottis can be squeezed into the larynx, and the upper region of the glottis can be blocked.
(3) Annular cartilage fracture: The posterior plate fracture of the ring cartilage is rare. The cartilage of the cartilage often exists simultaneously with thyroid cartilage and tracheal injury. It is necessary to identify the fracture of the cartilage in time. Therefore, the cartilage maintains the integrity of the larynx and up and down. The structure plays a stabilizing role, and the collapse of the fracture piece can significantly narrow the airway, causing severe neck emphysema and dyspnea, and often combined with sacral cartilage injury and ankle joint dislocation, anterior dislocation of the sacral cartilage It can also block the airway. The granulation scar tissue can pull the sacral cartilage to fix the vocal cord in the midline position. In severe cases, the fracture piece can tear the esophageal mucosa.
(4) separation of trachea and annular cartilage: sudden blunt force pushes the cartilage to the upper rear, which separates the cartilage from the trachea, and can be combined with a ring cartilage fracture. This kind of injury is sometimes difficult to detect immediately, and generally has severe neck and facial subcutaneous gas. Swelling, often with recurrent laryngeal nerve injury, breathing difficulties are very serious, if the trachea and annular cartilage are completely separated and contracted downward, you can immediately suffocate and die.
(two) pathogenesis
After the contusion of the throat, there is no obvious scar on the surface, but there may be edema and hematoma inside the larynx. The edema often peaks at 48h. The hematoma can be confined to one side of the vocal cord or the submucosa, but the hematoma can also occur widely in the larynx. Department, and extended to the trachea, throat and esophageal wall, light contusion only scratch or slightly tear the mucosa and soft tissue of the throat, laryngeal edema, hematoma and small mucosal tear are generally reversible lesions.
After severe contusion and crush injury in the larynx, thyroid cartilage and ring cartilage fractures occur. The sacral cartilage displaces the laryngeal soft tissue and tears or extensively. The fracture piece and soft tissue can block the airway, tear tissue, edema, granulation. Hyperplasia, and finally fibrosis, can occur in the ankle joint fixation, or the vocal cord and ventricular band stiffness, or the formation of a throat, ring cartilage fracture or tracheal and annular cartilage separation often combined with recurrent laryngeal nerve injury, severe recurrent laryngeal nerve can be complete Tear, laryngeal cartilage fracture, laryngeal soft tissue defect and recurrent laryngeal nerve injury are all irreversible lesions, leaving permanent dysfunction.
Prevention
Laryngeal contusion prevention
The prognosis of acute closed laryngeal trauma is generally worse than that of acute open laryngeal trauma. Because of the concealed condition, it is easy to be ignored and prone to delay. Contusion tissue edema, granulation hyperplasia, scar contraction, easy to form chronic laryngeal stenosis, severely impair the respiratory function and vocal function of the larynx, and the treatment of traumatic laryngeal stenosis is also more complicated and difficult.
The laryngeal contusion is properly treated in the acute phase, and most of the respiratory function can be restored, but the vocal function is often not ideal.
Complication
Laryngeal contusion complications Complications, mediastinal emphysema, pneumothorax, recurrent nerve injury, fracture
1. In the lower respiratory tract infection, when the supraglottic region is torn and fractured, the glottic sphincter disappears, and the oral and pharyngeal secretions easily flow into the trachea, so it is prone to lower respiratory tract infection and wound infection in the upper glottic region.
2. Subcutaneous emphysema and recurrent laryngeal nerve injury When the trachea and the annular cartilage are separated, the neck and facial subcutaneous emphysema, often with recurrent laryngeal nerve injury, breathing difficulties are very serious, if the trachea and annular cartilage are completely separated and contracted downward, can immediately suffocate death.
3. Mediastinal emphysema and pneumothorax emphysema are often extensive, extending from the supraclavicular region to the facial and scalp hairline, severe cases often associated with mediastinal emphysema and pneumothorax, and even pericardial air filling.
Symptom
Symptoms of blunt laryngeal symptoms Common symptoms Difficulty breathing Dysphagia Difficult hematoma Formation suffocation hemoptysis Hemorrhage Pneumothorax subcutaneous emphysema
Laryngeal contusion, early symptoms concealed, all patients with a history of neck contusion should pay attention to observation, and its symptoms will gradually appear.
1. Laryngeal pain has varying degrees of pain, pain is aggravated during swallowing movements and head rotation, and even dysphagia. Sharp tingling when coughing is a prominent symptom of a laryngeal fracture. Sore throat and obvious swallowing pain when the tongue is extended is a combined tongue. Characteristics of bone fractures.
2. Sonic and vocal edema, laryngeal hematoma and vocal cord sputum have hoarseness, the following conditions can cause complete loss of sound: thyroid cartilage median fracture, cartilage piece overlaps at the front, vocal cords are displaced outward, sacral cartilage dislocation The annular cartilage fracture collapsed, the airway in the subglottic area disappeared and the hemorrhage in the subglottic area. Although the sound was normal, it did not indicate that the injury was slight.
3. Cough and hemoptysis often have irritating cough, cough aggravation of emphysema, internal hemorrhage aggravates cough, hemoptysis is also a common symptom.
4. Laryngeal wheezing and dyspnea are a serious symptom, laryngeal edema, hematoma formation, laryngeal mucosal septum separation, laryngeal cartilage fracture piece misalignment, sacral cartilage displacement torsion and bilateral recurrent laryngeal nerve damage can occur Throat wheezing, severe cases, throat wheezing often accompanied by difficulty breathing and cyanosis.
5. The shape of the anatomical shape of the throat is unclear. The skin in front of the neck is swollen and tender. When there is a laryngeal cartilage fracture, the larynx is flattened and the thyroid cartilage or ring cartilage is unclear.
6. Subcutaneous emphysema laryngeal mucosal tear or cartilage fractures extend into the larynx, air from the wound in the throat into the soft tissue, subcutaneous emphysema in the neck, intra-abdominal hemorrhage and stimulation of cough and aggravation of emphysema, emphysema is often more extensive, The supraclavicular region extends to the face and scalp hairline. In severe cases, mediastinal emphysema and pneumothorax are often combined, and even the pericardial air is packed. The patient can die immediately.
Examine
Examination of blunt laryngeal contusion
1. Indirect laryngoscopy is only suitable for patients who are conscious, not painful, and have difficulty breathing. The extent of laryngeal lesions, including vocal cord movement, can be examined.
2. X-ray film
(1) Positive lateral radiography: If there are multiple traumas of head, face, neck and chest, it should be used for the skull, maxilla, mandible, chest and cervical vertebrae.
(2) laryngeal angiography: laryngeal tracheal body slices, especially laryngeal contrast media can accurately diagnose the point or linear fracture of the ring cartilage and thyroid cartilage, to understand the laryngeal soft tissue swelling, laryngeal obstruction and lesion range Large diagnostic value.
(3) Esophageal angiography: Esophageal contrast imaging is also required to exclude the presence of laryngeal and esophageal injury or tracheal esophageal fistula.
3. CT scan can clearly show the damage of laryngeal cartilage.
4. Endoscopy if the condition requires, and no endoscopic contraindications, can be directly laryngoscopy, bronchoscopy and esophagoscopy, cervical spine injury, only fiberoptic endoscopy, endoscopy indications: indirect Those who can't see the injury site under the laryngoscope; those who have severe laryngeal contusion, have undergone tracheotomy; patients who are unconscious or otherwise unable to perform indirect laryngoscopy; X-ray examination can not determine the injury site; decided to open Reset and surgical repair.
Diagnosis
Diagnosis and diagnosis of blunt laryngeal contusion
Severe laryngeal contusion can delay the occurrence of laryngeal edema and dyspnea, sudden suffocation, death, medical personnel must be highly vigilant, early diagnosis of the location, extent and extent of injury, in order to take effective measures.
1. The medical history details the contusion process and understand the damage mechanism.
2. Physical examination to observe the patient's vocal and respiratory conditions, neck soft tissue changes, palpation with or without tenderness and subcutaneous emphysema, sputum touch the shape of the laryngeal cartilage, paying special attention to the thyroid cartilage upper notch and the annular cartilage arch for deformation and displacement .
3. Auxiliary examination and diagnosis.
