Injury of the larynx is a violation of the integrity of the tissues of the body under the influence of one or another traumatic agent.
The larynx is a part of the upper respiratory tract, so the trauma can be fraught for the normal act of breathing.
In addition, trauma to the larynx may lead to violation of the formation of the voice, and such a state of things is disastrous for members of certain professions whose voice is the main working tool of actors, singers, masters of ceremonies, leading the festivities.
The larynx is part of upper respiratory tract. Its upper section is bordered by the throat, and the lower with the trachea. Space all three bodies into each other, forming the airway.
The second important function of the larynx – voice required for verbal (verbal) communication.
The layout area of the larynx is an important strategic locations of the body, as it is a number of vital organs. So, in the neighbourhood of the larynx, also pharynx and trachea, are such structures as:
- the esophagus;
- thyroid gland;
- cervical spine;
- large vessels of the neck;
- recurrent nerves;
- parasympathetic nerve trunks.
Therefore, when trauma to the larynx, there is a risk of injury to these structures with consequent impairment of their vital functions. Most often, injuries of the larynx combined with injuries of the pharynx and trachea.
Such combined defects lead to severe and dangerous States is:
- heavy breathing;
- profuse (expressed) bleeding, which leads to massive blood loss, and she, in turn, may trigger the development of hemorrhagic shock – shock (critical) violation of microcirculation;
- the violation of innervation (nerve support) vital structures.
These violations were often observed simultaneously and the end result can only lead to one consequence – death.
Trauma of the larynx is observed in almost all cases, as the trauma of the pharynx, the larynx consists of cartilage, and therefore, it is in some way more durable than SIP.
Injuries of the larynx, depending on the traumatic agent are:
The first category is observed more often in the other two, so in this article, we will discuss the mechanical injury of the larynx – its wounds.
Injuries of the larynx can occur when:
- the medical intervention;
- as a result of trauma, not related to medical actions.
A separate case – injuries of the larynx, which are observed with a sharp increase in endolaryngeal pressure. This can occur during:
- hoarse cough;
- strong Creek.
The circumstances of such injuries are:
To injure the larynx during medical procedures:
Most often injure the larynx when performing such diagnostic procedures, such as:
- laryngoscopy is examination of the larynx using the laryngoscope (variety of endoscopic equipment);
- intubation – the introduction of a special hook to connect to the Ambu bag used for ventilation, or a ventilator. In itself, the introduction tube is not a traumatic procedure, but during the intubation using a laryngoscope, which can damage the larynx;
- a biopsy of the larynx – fence part of its soft tissue for subsequent examination under a microscope;
- bronchoscopy is the study of the bronchi using bronchoscope (a kind of endoscope) that is inserted through the larynx.
Therapeutic interventions, during which there is a risk of damage to the larynx, the most common are:
- incorrect probing of the esophagus – an introduction to his extending metal rods, while the bougie can be erroneously introduced into the cavity of the larynx and injure its wall.
- extraction of foreign body of larynx, trachea or esophagus;
- conicotomy – forming an artificial opening in the wall of the larynx with symptoms of asphyxia;
- any operations on the throat, trachea, esophagus, and other neck structures.
Injuries of the larynx not related to medical manipulations on it can occur as a result of the action:
In the first case is often:
- road traffic accidents;
- man-made disaster – the formation of landslides as a result of explosions in the workplace;
- natural disasters – the formation of the same collapses as a result of earthquakes.
Injuries of the larynx due to intentional trauma occur most frequently. This:
- closed blunt trauma when hit with a fist in the neck;
- fractures of the cartilages of the larynx when attempting strangulation or hanging;
- wounds caused by sharp objects – knives, stilettos;
- rarely a gunshot wound (more often in time of war). However, about 80% of gunshot wounds of the larynx are through.
Cases of injury of the larynx is also not uncommon in sports trauma is associated with such strenuous activities as:
- different types of wrestling;
and several others.
The development of the disease
On the mechanism of the origin of the injuries of the larynx are divided into:
- internal – arise from the impact of traumatic agent on the inside if it got into the larynx;
- external – occur when soft tissue injuries of the neck, when a traumatic factor, after passing through the tissue arrays, reaches the walls of the larynx and violates its integrity.
Internal injuries of the larynx are often isolated – that is, suffering only the larynx. The explanation is simple: in the lumen of the larynx can enter the traumatic agent is small, not able to cause massive tissue damage, moreover, it is literally no place to “turn around”.
External trauma of the larynx in the majority of cases are associated with injury, in addition to the larynx, other anatomical structures.
Depending on the nature of the injuring factor injuries of the larynx are:
- hurt (stupid, they are still in severe injury called concussions);
- gunshot (bullet).
The degree of violation of the integrity of the wall of the larynx, her injuries are divided into:
- penetrating the cartilage of the larynx, ligaments and muscles are damaged, but through holes they are not;
- penetrating – the impact of traumatic agent on the structures of the larynx leads to the formation of these end-to-end defect, through which the cavity of the larynx communicates with the surrounding tissues (if there is an outdoor and nature of injury and external environment).
Even with non-penetrating nature of the injury of the larynx can be substantial. So, when the blunt trauma of the larynx are possible:
- fracture of the cartilages of the larynx;
- fracture of the hyoid bone;
- the separation of the larynx;
- the gap of one (rarely) or both (most) of the vocal cords.
Depending on the circumstances in which it was received injuries to the larynx, they may be:
Symptoms of injury of the larynx
Symptoms of laryngeal injuries depend on characteristics such damages as:
- the vastness;
- embroiled neighboring structures.
The clinical picture traumas of the larynx constitute such symptoms as:
- violation of respiratory function;
- violation of the voice;
- pain syndrome;
- swallowing disorder;
- subcutaneous emphysema.
Violation of respiratory function is the leading symptom of injuries of the larynx and develops in almost all cases of this disease. Such a violation manifests respiratory failure. In some cases it may be absent immediately after injury, but then develops due to:
- amplification of inflammatory infiltration (thickening and hardness);
- swelling of the soft tissues of the neck;
- the formation of hematoma (blood clot).
Violation of voice also occurs in all injuries of the larynx, especially it is expressed in the injury region of the vocal cords. May occur:
- dysphonia is an alteration of the timbre and strength of voice;
- aphonia – complete lack of voice.
The pain intensity depends on the degree of the injuries and can occur from feelings of discomfort to intense pain, often requiring narcotic analgesics.
Cough does not occur in all cases of injuries of the larynx. Maximum in most cases it appears under such conditions as the ingress of a foreign body in the larynx naturally or through the wound.
External bleeding occurs when the external injuries of the larynx. Internal bleeding is not visualized, but it can manifest with hemoptysis. In the presence of a solid foreign object in the wound should fear that he might damage the large vessels of the neck with the occurrence of massive bleeding.
A swallowing disorder occurs when damage affecting the entrance to the larynx.
Subcutaneous emphysema is air getting into the arrays of fabrics with their swelling and shape change of the neck. Its presence indicates the nature of penetrating injuries of the larynx. Emphysema can quickly spread to the mediastinum and then to the subcutaneous tissue in the chest area.
If you suspect an internal injury of the larynx should contact the otolaryngologist, the external – to the traumatologist. In critical cases of injury of the larynx require the intervention of a resuscitator.
The diagnosis is based on complaints of the victim and the anamnesis (matters the fact that the impact of the traumatic agent). Additional diagnostic methods (physical, instrumental, laboratory) necessary to assess the severity of the pathology and possible complications.
The physical examination revealed the following:
- at the General survey – in severe injury associated with respiratory failure, revealed that the victim is breathing heavily, breathing may be shallow and rapid, with skin and visible mucous membranes are pale, in severe respiratory failure – with a bluish tint. During the General survey assesses the patient’s condition;
- during local inspection – in the case of external injuries of the larynx on the anterior surface of the neck renders the surface of the wound, with a significant wound is bleeding, subcutaneous emphysema – swelling of the soft tissues of the neck. During local inspection evaluated the nature of the damage;
- palpation (feeling) – in the case of emphysema in its place is determined by palpation the swelling of soft tissues and crepitus (fine crackle, burst like fine bubbles).
In the diagnosis of injuries of the larynx, the following instrumental methods of examination:
- probing of wounds – medical probe (metal rod) carefully examined the wound, thus determine its depth, the presence of foreign bodies;
- laryngoscopy with the aid of the laryngoscope (a variety of endoscopic equipment) examine the internal surface of the larynx. During the study, is scratched and torn laryngeal mucosa, hemorrhage in the submucosa, foreign body, confirmed or excluded the perforation of the wall of the larynx. If there was a separation of the larynx from the hyoid bone, it is revealed by such features as the elongation of the epiglottis, the increased mobility of its free edge, a lower location of the glottis;
- radiography of the larynx helps to clarify the nature of the damage, the size of the wound;
- multislice computed tomography of the larynx (CT) – with the help of computer sections it is possible to obtain more information than x-ray examination.
Also used a variety of instrumental techniques, which will help to establish if there was any damage to the neighboring structures of the larynx. That these diagnostics, such as:
If the patient’s condition is not critical, methods used, evaluation of the voice:
- fontography – during it with the help of a special computer program analyzes the voice;
- stroboscopy – during this method with a timing light is studied vibrating ability of the vocal cords;
- electroglottography – estimated the mobility of the larynx and vocal cords. This measured electrical resistance of the larynx.
Laboratory research methods used in the diagnosis of injuries of the larynx, the following:
- General analysis of blood – decrease in the number of red blood cells and haemoglobin which helps to assess the degree of bleeding;
- analysis of blood gas composition – determine the amount of oxygen and carbon dioxide, these indicators evaluate the degree of development of respiratory insufficiency;
- definition of acid-base balance of blood – helps to judge the degree of impairment of gas exchange in the body;
- bacterioscopic study under the microscope studying a swab from the wound, determine the pathogen causing an infectious process in the wound;
- bacteriological examination – make a sowing smear from the wound in a nutrient medium, determine the causative agent.
Differential diagnosis of
Differential diagnosis should be carried out between isolated and combined injuries of the larynx.
Most often, injuries of the larynx, regardless of their characteristics, developing the following complications:
- traumatic shock – the disruption of the microcirculation of the tissues as a result of the expressed pain which not only causes human suffering, but also trigger a series of pathological mechanisms (vascular constriction, impaired blood flow through it and so on);
- chondrophora of the larynx – inflammation of the larynx pericentre – thin connective tissue film, which covers the cartilage of the larynx;
- phlegmon of neck – it is diffuse purulent defeat. The pus may very actively spread in the soft tissues of the neck;
- purulent mediastinitis is a purulent-inflammatory lesions of the mediastinum (mediastinum) is a complex organs located between the lungs;
- contact edema foreign body – it can be part of the wounding weapon (shell fragments, a bullet, cutting part of a knife), scraps of clothing, soil, sand and so on;
- post-traumatic swelling neck swelling her soft tissues;
- aspiration pneumonia – pneumonia that develops due to the ingress of blood into the lungs in the presence of severe bleeding;
- formation of hematoma – because it can decrease the lumen of the larynx;
- acute stenosis of the larynx. Develops as a result of reflex spasm – it is a reaction of the soft tissues of the larynx to the fact of damage;
- respiratory failure – disruption of flow of air through the larynx from the outside environment to the lungs;
- asphyxia (or asphyxiation) – complete cessation of airflow into the lungs due to violations of the patency of the larynx, resulting from the injury. May occur as in acute stenosis of the larynx, and the presence of a foreign body in its lumen.
Most of the complications of injuries of the larynx is able sooner or later to lead to the death of the victim.
Treatment of injuries of the larynx
The most important event of injuries of the larynx is first aid. Its tasks are:
- stop bleeding;
- restoration of patency of the airway and resume normal breathing.
- anti-shock activity.
In the appointments of:
- external trauma or penetrating wound – treatment, applying sterile dressings
- laying the victim on the bed in such a position that his head was raised;
- immobilization (immobilization) of the neck;
- mask ventilation and oxygen therapy;
- full motor and voice alone;
- nutrition through a nasogastric tube;
The basis of drug therapy – the following nominations:
- antibacterial drugs;
- anti-inflammatory drugs;
- decongestant drugs;
- infusion therapy is to restore blood volume when bleeding and detoxification purpose. Introduced intravenously saline solutions, electrolytes, protein solutions, glucose, blood serum, fresh frozen plasma;
- components of the blood in severe bleeding. Intravenously administered red blood cell mass, platelets, serum and others.
In severe injuries of the larynx carry out surgery.
Indications for operation are the following:
- a fracture of the cartilage of the larynx with an offset;
- increasing emphysema of the neck;
- significant bleeding;
- violation of the skeleton (skeleton) of the larynx;
- a massive wound surface;
- the presence in the tissues of a foreign body that cannot be extracted by non-surgical with no risk of damage to neighboring structures.
Depending on the type of violation during the operations are performed such manipulations as:
- primary surgical processing of wounds;
- extraction of foreign body;
- removal of hematoma;
- tracheostomy – forming an artificial opening in the anterior wall of the trachea to the normal flow of air into the respiratory tract;
- ligation of the external carotid artery – when neustanovivshiesya bleeding, if there is a threat of massive blood loss;
- cordectomy – removal of the vocal folds;
- laryngopathy – suturing of the larynx to the hyoid bone;
- reconstructive manipulation to restore the normal form of the larynx of her as damaged but viable tissue;
- prosthetic and plastic of the larynx (including artificial implants);
- resection of the larynx (if severe damage, when reconstructive actions do not make sense).
In the postoperative recovery of these patients attend special classes held by phoniatr (doctor who problems).
To prevent trauma to the larynx must avoid all situations and circumstances associated with the risk of such injuries. If necessary, to be in such situations, it is necessary to apply individual means of protection.
The prognosis of injuries of the larynx, as it depends on the extent of damage, aggravating circumstances and complications. In General, when the rapid first aid, stop bleeding and resumption of the airway, the prognosis is favorable. Beware of associated injuries, in which damage to neighbouring structures of the larynx are even more dangerous than damage to the larynx.