Surgery for acute laryngotracheal trauma

The larynx is located in the front of the neck, protected by the mandible and sternum in the front, and has a cervical vertebra in the back. The chance of injury is less, accounting for about 1% of the total body trauma. According to the source of the damage, it is divided into: 1 external direct violence damage, such as car accident, machine rolling, rope wound, ball or boxing injury, gun, bullet penetrating injury, knife or sharp cut injury. 2 from the internal endotracheal intubation, laryngotracheal mirror damage, foreign body damage. According to the neck skin with or without wounds, it is divided into open and closed injuries. According to the injury site, it can be divided into glottis, glottis, subglottic and commemorative door injuries (ie, from the sound door to several areas under the glottis are injured). Severe laryngeal trauma often involves important blood vessels, trachea and esophagus, and often combined with important organ damage such as craniocerebral, maxillofacial, chest, abdomen, limbs, etc. Therefore, attention should be paid to the general condition in the treatment of acute laryngeal trauma to avoid delay. Treatment of diseases: children's trachea, bronchial foreign body Indication Surgery for acute laryngeal tracheal trauma applies to: 1, open throat tracheal trauma. 2. Closed laryngotracheal trauma has the following conditions: (1) There is a blockage of the airway after the injury, and the trachea should be cut open. (2) progressive subcutaneous emphysema. (3) Large pieces of mucosal avulsion. (4) Collapse cartilage fracture. (5) Double side vocal cords. Preoperative preparation 1. Learn more about the condition, general and local examination (indirect laryngoscope, direct laryngoscope, fiber bronchoscopy, cervical X-ray or CT scan) to determine the location, extent and extent of the injury in order to select the surgical method. 2, according to the injury to do head, cervical, chest, abdomen, limbs X-ray film, rule out serious combined injuries. 3, there are shock patients first to treat shock. 4. Prepare blood transfusion and infusion. 5. Inject antibiotics to prevent infection. 6, injection of tetanus anti-toxic anti-toxin. 7, to explain to the family the significance of tracheotomy, after wearing a support for a period of time. If the glottic is damaged, the sound recovery is difficult; if an infection occurs, the operation may fail, a scar is formed, and surgery is required. Surgical procedure Surgery for acute supraglottic trauma Acute glottic injuries often involve horizontal fractures of the thyroid cartilage and fractures of the hyoid bone. The epiglottis is disconnected from the shank and displaced backwards and upwards to block the laryngeal and pharyngeal cavity. The thyroid gland and the ligament of the nail are causing pharyngeal fistula, dysphagia, misdiagnosis and subcutaneous emphysema. (1) Incision: The transverse incision from the lower edge of the annular cartilage is about 5 to 6 cm long. Cut the skin, subcutaneous tissue and platysma. (2) Separation of the anterior cervical tissue and tracheotomy: the skin is separated upwards and downwards, up to the hyoid bone, down to the 3rd and 4th tracheal rings, and the anterior cervical band muscle is separated to reveal the laryngeal and tracheal cartilage. In the 3rd and 4th tracheal rings for tracheotomy, drip 1% tetracaine 0.5ml plus 1:1000 adrenaline into the tracheal cavity, insert the anesthesia cannula, inflate the intubated balloon, and then use 1% Dingka Because the gauze is filled around the anesthesia cannula, the other end of the gauze is clamped to the outside of the neck skin. Examination of the wound showed that the thyroid cartilage was horizontally fractured, and the epiglottis broke from the handle and fell to the laryngeal and pharyngeal cavity. (3) Cutting the hyoid bone into the epiglottic anterior space and the epiglottis valley: The upper lingual muscle group is clamped with the vascular clamp from the upper edge of the hyoid bone, and then cut with a knife and ligated to stop bleeding. The hyoid bone was cut from the midline, and the midline incision of the hyoid bone was extended downward to the upper thyroid cartilage, and the periosteum of the thyroid was cut longitudinally. The anterior epiglottis was separated by a vascular clamp, and the anatomical mucosa was entered into the throat and throat from the base of the tongue. (4) cut off the epiglottis and sickle-like epiglottis: use the automatic retractor to pull the mucous membrane to the sides, see the broken epiglottis, use the tissue forceps to get caught up, use scissors to get along the avulsion The fragmented epiglottis is removed from the shank either above the chamber band or together with the chamber band. (5) suture the anterior pharyngeal tissue: suture the posterior wall of the pharynx with a gut to tear the mucosa, the sacral disgusting incision mucosa, the epiglottic stalk wound and the epiglottic incision mucosa, completely stop bleeding. The intestine was sutured from the periosteum of the upper edge of the hyoid bone and the margin of the base of the tongue, and the periosteum of the thyroid was sutured. Stitch the tongue and the tissue on the hyoid bone to prevent pharyngeal fistula. (6) Closing the incision: suture the anterior cervical band muscle with a thin wire, wash the wound with saline, and place a rubber drainage strip. The platysma, subcutaneous tissue and skin are layered. Aseptic dressing is applied. (7) Remove the anesthesia cannula and place the tracheal cannula.