Laryngotracheal separation

Abstract

The popularity of the motorcycle, specifically trail bike riding, in the past several years has produced an increasing incidence of severe "clothesline" injuries to the larynx and trachea. Even at moderately high speed the impact of a horizontal cable with the neck of the rider causes a sudden hyperextension of the neck, and an avulsion of the larynx from the trachea, separating at the relatively rigid fibrous connective tissue between the cricoid cartilage and the first tracheal ring. Interruption of the strap muscles, the recurrent laryngeal nerves, laceration of the esophagus, and compression fracture of the cervical vertebral bodies can occur. The unseated rider requires immediate assistance, airway obstruction being his greatest problem. In the early minutes after the accident he must be transported to an emergency facility where tracheostomy and resuscitation can be provided. Mediastinal infection, tracheoesophageal fistula, subglottic stenosis, and intermittent depression many follow the initial repair. Rehabilitative measures include permanent tracheostomy, the use of neuromuscular pedicle graft, hyoid bone graft, intracordal injection of teflon paste, and carbon dioxide laser excision of webs and cicatricial tissue.

Laryngeal Transection in a Patient after Hanging

“…10 Direct upward pressure from hanging elevates the larynx superiorly resulting in separation of larynx and trachea. 11 Similarly, the extent and location of blunt laryngotracheal trauma is determined by several factors. 12 In one review, majority of the injuries occurred above the fourth tracheal ring (88%).…”

Complete Laryngotracheal Separation Following Attempted Hanging

“…Sudden neck extension, fixation of the larynx, and anteroposterior compression of tracheal rings creates shearing forces tearing the cricotracheal membrane. Direct upward pressure by hanging elevates the larynx superiorly and, as a result, larynx, and trachea are separated [6]. …”

Laryngotracheal Closure and Cricopharyngeal Myotomy for Intractable Aspiration and Dysphagia Secondary to Cerebrovascular Accident

“…Laryngotracheal separation is a therapeutic technique used to treat intractable aspiration [1,[14][15][16][17] . The procedure separates the airway and digestive systems and can eliminate aspiration completely.…”