ENT Students Larynx Traumatic
5Types of laryngeal trauma
Types of laryngeal trauma:
1-Foreign body inhalation.
2-Acute and chronic laryngeal trauma.
3-Laryngeal stenosis.
101-Laryngeal foreiegn body
-Inhaled foreign body may be vegetable or non-vegetable hard objects.
-It may arrest at the larynx or trachea.
A-Laryngeal clinical picture:
-Cough, chocking, stridor, hemoptysis, pain and suffocation.
-Laryngeal examination will reveal the foreign body.


B-Tracheal clinical picture:
-Initially there may be sudden severe cough, chocking and hemptysis.
-Then there may be a latent period without symptoms.
-Later foreign body may lead to complete obstruction of a bronchus ( mainly Rt) with a resulting lung collapse.


-Or it may lead to partial obstruction of a bronchus with a resulting lung emphysema.



Investigations:
-X-ray or CT scan neck & chest are helpful in diagnosis.
-Diagnostic laryngoscopy & bronchoscopy.
Treatment:
-Foreign body is removed by either laryngoscopy or bronchoscopy under general anesthesia.
-Heimlich maneuver may be used.

202-Acute and chronic laryngeal trauma
-Acute laryngeal trauma may be due to:
Penetrating trauma as gun shot or cut throat, blunt injury as strangulation or car accidents, surgical trauma, chemical as in steam inhalations or irradiation injury.

-Chronic laryngeal trauma may be due to:
Intubation granuloma (at the vocal process of the arytenoids) or prolonged endotracheal intubation.


Clinical picture:
-There may be pain, hoarseness of voice, stridor, hemoptysis or even shock.
-Examination may shows laryngeal tenderness, crepitus of fractured cartilage, edema, deformity or external wound.
-CT scan may be helpful.
Treatment:
-Ensure patent air way be tracheostomy.
-Shock is controlled, antibiotics and steroids are used.
-Fractured laryngeal cartilage may be fixed later on.


303-Laryngeal stenosis
Laryngeal stenosis may be subglottic (commomest), glottic or supraglottic.
Causes of subglottic stenosis:
a-Congenital.
b-Trauma due to prolonged endotracheal intubation, surgical or penetrating trauma.
c-Inflammation as granuloma especially larygoscleroma which is common in Egypt.
d-Tumors.
Clinical picture:
Either no symptoms or biphasic stridor. Examination or endoscopy with reveal the stenosis.
CT neck is important to define the length of the stenosis.
Treatment:
1-No teeatment in asymptomatic lesions.
2-Tracheostomy in subglottic stenosis in severe stridor.
3-Endoscopic dilatation or laser ablation.
4-External procedures.
-Anterior cricoid split +/- augmentation with cartilage.
-Anterior & posterior cricoid split +/- augmentation with cartilage.
-Submucous excision of the stenotic part with skin graft.
-Resection anastomosis.