Damage Control of Laryngotracheal Trauma: The Golden Day

Abstract

Laryngotracheal trauma is rare but potentially life-threatening as it implies a high risk of compromising airway patency. A consensus on damage control management for laryngotracheal trauma is presented in this article. Tracheal injuries require a primary repair. In the setting of massive destruction, the airway patency must be assured, local hemostasis and control measures should be performed, and definitive management must be deferred. On the other hand, management of laryngeal trauma should be conservative, primary repair should be chosen only if minimal disruption, otherwise, management should be delayed. Definitive management must be carried out, if possible, in the first 24 hours by a multidisciplinary team conformed by trauma and emergency surgery, head and neck surgery, otorhinolaryngology, and chest surgery. Conservative management is proposed as the damage control strategy in laryngotracheal trauma.

Thyroid Cartilage Fracture in a Blunt Cervical Trauma a Case Report

“…The absence of obvious signs of laryngeal injury makes it essential to carry out an organized multidisciplinary care to avoid inadequate management and diagnosis, since early treatment of injuries improves the prognosis and reduces the risk of serious complications for the trauma victim 2,7,8 . Therefore, all the cervical traumas require a high level of suspicion of laryngeal fracture due to asymptomatic cases 3,4 . As for the trauma mechanism, it can be blunt or penetrating, the most common cause being a car collision, with extension of the neck resulting in fracture of the thyroid cartilage, rupture of the mucosa, edema and detachment of the arytenoid cartilage 1,3 .…”

“…The main objective of dealing with laryngeal trauma is to maintain airway clearance, it is necessary to ensure airway patency through effective procedures possible at the time and place of the trauma 2,9 . There is divergence in the literature regarding the most appropriate method for obtaining airway patency [1][2][3][4][5] and how laryngeal trauma causes difficulties in performing intubation due to distorted anatomy, poor visualization and suboptimal conditions [2][3][4] there is a risk of increasing new lesions and worsening existing ones. Thus, a tracheostomy with local anesthesia must be preferred,³ which can be performed through the existing cervical wound itself, in the presence of anterior neck laceration 3,10 .…”

“…Regarding the definitive management, it is recommended that it be carried out in the first 24 hours by a multidisciplinary team from trauma services, emergency surgery, head and neck surgery, otorhinolaryngology and thoracic surgery. 4 Conservative treatment of laryngeal lesions can be instituted in patients with no respiratory difficulty, minimal mucosal laceration without cartilage exposure, small edema with or without hematoma, isolated fracture of the thyroid cartilage without displacement of the fragments, vocal folds with preserved movements and without involvement of the arytenoid cartilages. 11,12 Once the care and treatment has been carried out, repair of phonation and other functions of the laryngeal apparatus must be sought.…”

Reconstrução de cartilagem tireoide com enxerto costocondral durante abordagem primária em trauma cervical penetrante - relato de caso

“…Mesmo com sua mobilidade e capacidade de se deslocar quando pressionada ou atingida, devido sua localização mais superficial e ausência de anteparo ósseo, a laringe torna-se vulnerável a traumas externos(Pérez Alcantud et al, 2020).As lesões laríngeas ocorrem mais comumente em decorrência de mecanismos iatrogênicos, principalmente relacionada a longos períodos de intubação orotraqueal, este correspondendo a aproximadamente 90% dos mecanismos de lesão endolaríngea, seguidos de traumas contusos, traumas penetrantes e inalação de substâncias cáusticas(Benjamin, 2018;Farley, et al, 2021; Pérez Alcantud et al, 2020;Reid & Ha, 2019). Em todas estas situações, o prognóstico do paciente está intimamente ligado ao momento do diagnóstico da lesão, quando mais cedo identificada e tratada, menores as chances do paciente evoluir com comprometimento funcional da estrutura, ou mesmo com oclusão de via aérea pelo edema local em decorrência do trauma(Welter, et al, 2020;Farley, et al, 2021;Sachdeva & Upadhyay, 2017) Desta forma, ter ciência do mecanismo de trauma, realizar exame físico criterioso e deter conhecimento anatômico detalhado da região cervical, além de acesso a exames complementares direcionados, é de extrema importância a fim de detectar lesões precocemente(Pérez Alcantud et al, 2020;Herrera, et al 2020, Elias et al, 2021Ford et al, 1995) O trauma de laringe está presente em 18% das lesões penetrantes na região cervical(Jewett et al, 1999;Elias et al, 2021), correspondendo a apenas um em 5.000 a 137.000 atendimentos em emergências(Bent et al, 1993;Jewett et al, 1999;Elias et al, 2021). Destes, um em 445 pacientes com lesões laríngeas graves(Verschueren et al, 2006).…”

“…Lesões penetrantes estão geralmente associadas a trauma balístico, com maior chance de ruptura endolaríngea(Elias et al, 2021). Embora não haja um algoritmo universal a ser seguido, a literatura mais atual utiliza as classificações de Legacy Emanuel e Schaefer-Fuhrman como base para determinar a gravidade da lesão laríngea e qual tratamento a ser proposto ao paciente(Madsen et al, 2016;Tabarcea, et al 2020;Herrera, et al 2020;Jewett et al, 1999;Elias et al, 2021, Ford et al, 1995…”