Acute External Laryngeal Trauma: Experience with 112 Patients

Butler, Allen P; Wood, Brennan P; O’Rourke, Ashli; Porubsky, Edward S.

doi:10.1177/000348940511400505

Cited by 69 publications

(76 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although features detected on CT may provide some guidance, nonindicated early intubation is a significant issue in patients with ELTIs because it eliminates many of the clinical injury features that assist a surgeon in deciding to proceed with early operative intervention and, as a result, optimize both vocal and aerodigestive outcomes. 19,20 Fig . 6 shows a simplified algorithm applicable to the management of ELTIs in the trauma assessment.…”

Section: Discussionmentioning

confidence: 99%

Airway management changes associated with rising radiologic incidence of external laryngotracheal injury

Randall

Rudmik

Ball³

et al. 2018

cjs

View full text Add to dashboard Cite

Background: Traumatic laryngeal injuries are uncommon life-threatening injuries that require prompt, rational management of a potentially precarious airway. It is unclear whether the current incidence of laryngotracheal injury is due to enhanced injury detection or increased occurrence. The objective of this study was to evaluate the relations between diagnostic imaging with both initial airway management and surgical treatment in patients with external laryngotracheal injuries (ELTIs) in Alberta. Methods:In this large-scale population-based analysis, we used regional health databases containing inpatient admissions, emergency department visits and trauma service activations employing International Classification of Diseases diagnostic codes to identify all ELTIs diagnosed from Apr. 1, 1995, to Dec. 31, 2011, in adults (age ≥ 16 yr). We evaluated health records and diagnostic imaging for injury features, airway management, operative interventions and hospital length of stay (LOS).Results: Eighty-nine patients met the inclusion criteria. The incidence of ELTIs increased over time, paralleling a rise in detection during the period incorporating greater computed tomography (CT) use (p = 0.002). Endotracheal tube intubation was performed in 8/30 cases (27%) in the pre-CT era, compared to 38/59 cases (64%) in the post-CT era (p = 0.001); the use of surgical intervention remained consistent. The largest contributors to increased endotracheal tube placements were the emergency department and emergency medical services. No change in survival was detected, but mean LOS among patients admitted for minor, isolated ELTIs increased by 2.3 (95% confidence interval 0.14-4.8) days (p = 0.06), mostly for patients admitted under critical care for mechanical ventilation. Conclusion:Management of ELTIs shifted from predominantly conservative airway monitoring to endotracheal tube intubation over the study period in spite of no clinically significant change in injury severity or operative intervention frequency. The location of endotracheal tube placement suggests less comfort with ELTI among first-responder and emergency personnel.

show abstract

Section: Discussionmentioning

confidence: 99%

Airway management changes associated with rising radiologic incidence of external laryngotracheal injury

Randall

Rudmik

Ball³

et al. 2018

cjs

View full text Add to dashboard Cite

show abstract

“…4 Laryngeal trauma can be life threatening if not early identified and managed; the mortality rate has been reported to be from 17.9 to 40% with many patients dying before reaching the emergency room because of severe airway's injury or multiple organ's injury. 1 Blunt external trauma to the neck has been reported to be a more common cause of laryngeal fracture, which results from motor vehicle accidents, sports-related trauma, assault, and strangulation.…”

Section: Discussionmentioning

confidence: 99%

“…8 Because of the importance of identifying and fully understanding the types of laryngeal trauma as a precondition for establishing successful diagnostic procedures and therapy, several authors have proposed categories of laryngeal trauma. 4 Like other recent publications, we used the classification of Schaefer-Fuhrman (Table 1), the laryngeal injury was graded as Grade IV.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and management of laryngeal fracture: a case report

Attifi

Elfarouki

Nadour

et al. 2017

Int J Otorhinolaryngol Head Neck Surg

View full text Add to dashboard Cite

<p class="abstract">Laryngeal fracture is a rare and potentially fatal traumatic injury. Because of the rarity of this type of injury, many laryngeal fractures are often undiagnosed or poorly managed, leading to significant problems with airway patency, voice production, and swallowing. We report a case of a 49 year old man admitted to the emergency room after a motor cycle accident with cervical trauma. The patient presented with hoarseness, anterior neck pain, cervical subcutaneous emphysema, and increasing respiratory distress that led to the tracheostomy of the patient. The computed tomography (CT) of the neck revealed a comminuted fracture of the thyroid cartilage, a hematoma of the left piriform sinus and cervical subcutaneous emphysema. The three-dimensional CT showed a double fracture of thyroid cartilage with displaced intermediate fragment. The patient underwent an open reduction and internal fixation of the thyroid cartilage with miniplates along with laryngeal stenting. He has no significant swallowing or breathing problem and reasonably good voice 6 months after surgery. We conclude that early diagnosis and appropriate therapy favorably alters the prognosis in terms of long-term voice and airway outcome.</p>

show abstract

“…En caso contrario es preferible la realización de traqueotomía bajo anestesia local [8,9]. El retraso en la reparación quirúr-gica incrementa la posibilidad de estenosis en la vía aérea, existiendo mayor incidencia de complicaciones en las actuaciones posteriores a las 24 horas de la lesión [10,11]. En el caso presentado, la intubación orotraqueal no fue posible y se practicó traqueotomía bajo anestesia local con posterior reconstrucción de la fractura y colocación de estent endolaríngeo.…”

Section: Discussionunclassified