1
|
Moroco AE, Patel VA, Saadi RA, Gniady JP, Lighthall JG. Systematic Review of Laryngeal Fractures and Trends in Operative Management. Craniomaxillofac Trauma Reconstr 2023; 16:62-69. [PMID: 36824183 PMCID: PMC9941301 DOI: 10.1177/19433875221074847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design Systematic review of the literature. Objective The goal of this study is to review the current literature on the trends in management of laryngeal fractures following trauma. Methods Independent searches of the PubMed and MEDLINE databases were performed. Articles from the period of 1963 to 2020 were collected. All studies which described laryngeal fractures using the Boolean method and relevant search term combinations, including "Laryngeal", "Fracture", "Operative", and "Management" were collected. Results A total of 588 relevant unique articles were identified for analysis. Of these, 24 articles were deemed appropriate for inclusion in the literature review. Due to variability in study design and outcome measures, formal synthesis of data in the form of a meta-analysis was not possible. Conclusions Laryngeal fractures are rare traumatic injuries that require early identification and evaluation with complex management options. This comprehensive review aims to highlight the breadth of the topic with regard to presentation and clinical management. Though there remains no clear best practice for laryngeal fracture management, we review trends in clinical practice throughout the literature.
Collapse
Affiliation(s)
- Annie E. Moroco
- Department of Otolaryngology – Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vijay A. Patel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, UPMC Centers for Cranial Base Surgery & Sinonasal Disorders and Allergy, Pittsburgh, PA, USA
| | - Robert A. Saadi
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - John P. Gniady
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Jessyka G. Lighthall
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| |
Collapse
|
2
|
Petrone P, Velaz-Pardo L, Gendy A, Velcu L, Brathwaite CEM, Joseph DK. Diagnosis, management and treatment of neck trauma. Cir Esp 2019; 97:489-500. [PMID: 31358299 DOI: 10.1016/j.ciresp.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/27/2019] [Accepted: 06/02/2019] [Indexed: 11/15/2022]
Abstract
Trauma injuries to the neck account for 5-10% of all trauma injuries and carry a high rate of morbidity and mortality, as several vital structures can be damaged. Currently, there are several treatment approaches based on initial management by zones, initial management not based on zones and conservative management of selected patients. The objective of this systematic review is to describe the management of neck trauma.
Collapse
Affiliation(s)
- Patrizio Petrone
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU..
| | - Leyre Velaz-Pardo
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Amir Gendy
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Laura Velcu
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Collin E M Brathwaite
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - D'Andrea K Joseph
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| |
Collapse
|
3
|
Abstract
Laryngeal trauma is an uncommon but life threatening injury which is uncommon in British practice. It often occurs as part of a multiple injury. Major laryngeal injury may cause catastrophic airway compromise and death. Minor laryngeal injuries may be missed as more severe injuries supercede the management of the larynx. This may have adverse long-term sequlae. This article presents the initial assess ment and management of the patient with laryngeal trauma. The various controversies are discussed with reference to the literature available. The surgical approaches to the larynx are described.
Collapse
Affiliation(s)
| | - P Pracy
- Queen Elizabeth Hospital, Birmingham, UK
| |
Collapse
|
4
|
Kao CH, Wang HW, Lee JC, Chin SC. Pseudotumor of the hypopharynx-displaced superior cornu of the thyroid cartilage. Otolaryngol Head Neck Surg 2016; 132:167-8. [PMID: 15632937 DOI: 10.1016/j.otohns.2004.03.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Chuan-Hsiang Kao
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan.
| | | | | | | |
Collapse
|
5
|
Randall DR, Rudmik LR, Ball CG, Bosch JD. External laryngotracheal trauma. Laryngoscope 2013; 124:E123-33. [DOI: 10.1002/lary.24432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/07/2013] [Accepted: 08/27/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Derrick R. Randall
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, (D.R.R., L.R.R., J.D.B.); The University of Calgary; Calgary AB Canada
| | - Luke R. Rudmik
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, (D.R.R., L.R.R., J.D.B.); The University of Calgary; Calgary AB Canada
| | - Chad G. Ball
- Divisions of General Surgery and Trauma Surgery Department of Surgery (C.G.B.); The University of Calgary; Calgary AB Canada
| | - J. Douglas Bosch
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, (D.R.R., L.R.R., J.D.B.); The University of Calgary; Calgary AB Canada
| |
Collapse
|
6
|
Tartaglia F, Russo G, Manciati P, Blasi S, Sgueglia M. Iatrogenic Lesion of the Larynx during Total Thyroidectomy: A Rare Complication. Am Surg 2011. [DOI: 10.1177/000313481107700304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Giulia Russo
- Surgical Sciences Department Sapienza University of Rome Rome, Italy
| | - Paola Manciati
- Department of Otorhinolaryngology, Audiology and Phoniatrics Sapienza University of Rome Rome, Italy
| | - Sara Blasi
- Surgical Sciences Department Sapienza University of Rome Rome, Italy
| | - Monica Sgueglia
- Surgical Sciences Department Sapienza University of Rome Rome, Italy
| |
Collapse
|
7
|
Management of laryngeal fractures--a 10-year experience. J Voice 2010; 25:473-9. [PMID: 20236793 DOI: 10.1016/j.jvoice.2009.12.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 12/15/2009] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Laryngeal fracture patients can present with a spectrum of clinical findings ranging from normal to airway collapse and death. We will therefore examine and emphasize clinical presentation, an algorithm for appropriate diagnosis and acute airway management, and radiological or physical examination findings and demonstrate the appropriate surgical approach for optimum clinical outcome in cases of blunt and penetrating laryngeal injury. Herein, we present one of the largest series of management of laryngeal and tracheal fractures from a tertiary care level I trauma center. STUDY DESIGN A retrospective chart review from 1998 to 2008. METHODS A retrospective chart analysis on patients presenting to the head and neck trauma service. Institutional review board approval was obtained before the start of the research. RESULTS Our series consisted of 11 men and one woman with a mean age of 41.8 years presenting with laryngeal fractures caused by blunt (n=10) or penetrating (n=2) trauma. One patient presented with complete laryngotracheal separation, which was successfully managed by immediate tracheotomy and early surgical intervention. The other 11 patients had a combination of conservative (n=6) and surgical (n=5) management. All patients who required a tracheotomy (n=7) were decannulated. CONCLUSIONS Early suspicion and diagnosis of acute laryngeal and tracheal injuries are crucial. The airway must be secured via tracheotomy when possible. Computed tomography scans play a central role in diagnosis. Proper restoration of the laryngeal framework with appropriately timed open reduction and internal fixation is critical for optimal recovery of the airway, voice, and swallowing.
Collapse
|
8
|
|
9
|
Affiliation(s)
- Julie Mullen
- DeWitt Army Community Hospital, Ft. Belvoir, VA 22060, USA
| | | | | |
Collapse
|
10
|
Verschueren DS, Bell RB, Bagheri SC, Dierks EJ, Potter BE. Management of laryngo-tracheal injuries associated with craniomaxillofacial trauma. J Oral Maxillofac Surg 2006; 64:203-14. [PMID: 16413891 DOI: 10.1016/j.joms.2005.10.034] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Indexed: 11/15/2022]
Abstract
PURPOSE Laryngeal fractures can occur in association with maxillofacial injuries and may lead to life-threatening airway obstruction. Because of a low incidence and a paucity of peer-reviewed information, there is no universally accepted treatment protocol and few clinicians have extensive experience with complex laryngo-tracheal trauma. The purpose of this retrospective analysis is to validate a treatment protocol for the management of laryngo-tracheal injuries occurring in severely injured patients by assessing the outcome of a consecutive series of patients who were treated by the same surgeons over a 12-year period. PATIENTS AND METHODS All patients with laryngeal fractures admitted to the trauma service at Legacy Emanuel Hospital and Health Center (LEHHC; Portland, OR) from 1992 to 2004 were managed by the same surgeons, using a standard protocol based on the stability of the airway, and were retrospectively identified using the LEHHC Trauma Registry. Using information from the Trauma Registry and individual physician chart notes, a database was created for the purpose of assessing outcome. The following data were collected: age, gender, mechanism of injury, number of associated injuries and the Injury Severity Score, Glasgow Coma Scale on admission, initial hematocrit, airway management techniques, length of hospital stay, LEHHC laryngeal injury classification, treatment modality, disposition, and any available follow-up. Descriptive statistics were used to describe demographics, treatment, and outcome. Outcome measures were defined as complications, airway patency, speech, and deglutition. RESULTS A total of 16,465 patients were identified from the Trauma Registry as having sustained head, neck, or facial injuries, of which 37 patients were diagnosed with laryngeal fractures. Complete patient records were available for 27 patients (mean age, 35.5 +/- 15.3 years; range, 8 to 80 years; 23 males, 4 females) who were classified according to the LEHHC laryngeal injury classification scheme. Most patients sustained injuries as the result of blunt trauma (n = 23; 85.1%) and almost all of them had concomitant maxillofacial injuries (n = 26; 96.3%). Twenty patients (74.1%) required advanced airway intervention (tracheostomy, 14; endotracheal intubation, 5; emergent cricothyrotomy, 1), of which 13 patients underwent neck exploration. Eight of these patients required open reduction and internal fixation with titanium plates and screws, and 2 patients required the addition of an endolaryngeal stent. There was a general trend toward poorer outcome with increased LEHHC laryngeal injury classification. However, all patients were successfully decannulated, maintained patent airways, and ate a normal diet. Hoarseness was common in patients who underwent surgical exploration; however, long-term perioperative complications were rare and included infection requiring hardware removal (n = 1), unilateral vocal cord paralysis (n = 1), and subjective dysphagia. CONCLUSION Fractures of the larynx are uncommon injuries that are frequently associated with maxillofacial trauma and are potentially associated with significant morbidity. Management of laryngo-tracheal injuries using a protocol based on airway status as described in this report results in airway patency, functional vocal quality, and normal deglutition for almost all patients.
Collapse
Affiliation(s)
- David S Verschueren
- Department of Oral and Maxillofacial Surgery, Oregon Health & Science University, Portland, OR 97209, USA
| | | | | | | | | |
Collapse
|
11
|
Cheng TY, Lee SW, Fang TJ, Li HY, Chen IH. A Thyroarytenoid Muscle Tear Presenting as a Vocal Cord Granuloma. Otolaryngol Head Neck Surg 2006; 134:336-7. [PMID: 16455389 DOI: 10.1016/j.otohns.2005.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Accepted: 07/18/2005] [Indexed: 11/23/2022]
Affiliation(s)
- Tsung-Yueh Cheng
- Department of Otolaryngology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
12
|
|
13
|
Abstract
Traumatic airway injuries fortunately are rare. While sometimes injuries are obvious and initial management straightforward, frequently the diagnosis is difficult. Prompt diagnosis of airway injuries requires a high index of clinical suspicion, complemented by judicious use of endoscopy and radiological imaging. Initial management can be complicated by associated head, neck, and thoracic injuries. Importantly, a patient's airway can be lost because of injudicious use of sedation or failure to be properly cautious during attempts at airway management and endotracheal intubation. Mortality rates and the incidence of late complications remain high and have been related to delays in diagnosis and definitive treatment.
Collapse
Affiliation(s)
- R Peralta
- Department of Surgery, Massachusetts General Hospital, Boston 02114, USA
| | | |
Collapse
|
14
|
Abstract
BACKGROUND Laryngeal fracture is a rare injury with the potential to affect all functions of the larynx. Restoration of the laryngeal framework is critical for the rehabilitation of laryngeal function. OBJECTIVE To ascertain the efficacy of adaptation plate fixation (APF) to repair the laryngeal skeleton. STUDY DESIGN Retrospective review of the clinical data of all patients who underwent APF of laryngeal fractures from January 1989 to September 1999. RESULTS Our series consisted of 16 men and 4 women presenting with laryngeal fractures caused by blunt (n = 16) or penetrating (n = 4) trauma. Most of these patients presented with severe fractures classified as category III (n = 6), IV (n = 10), or V (n = 1), according to the Schaefer-Fuhrman classification. All patients who required a tracheotomy (n = 13) were de-cannulated. Nineteen of the 20 patients recovered a social voice. The exception was a patient with aphasia secondary to head trauma No patient had aspiration problems. We encountered no complication associated with the use of APF. CONCLUSION APF is an effective and well-tolerated method to repair laryngeal fractures.
Collapse
Affiliation(s)
- F V de Mello-Filho
- University of São Paolo, Ribeimo Preto Department of Head and Neck Surgery, Brazil
| | | |
Collapse
|
15
|
Dray TG, Coltrera MD, Pinczower EF. Thyroid cartilage fracture repair in rabbits: comparing healing with wire and miniplate fixation. Laryngoscope 1999; 109:118-22. [PMID: 9917052 DOI: 10.1097/00005537-199901000-00023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Evaluate cartilaginous healing in rabbits in response to surgically created thyroid cartilage fractures. Compare healing between laryngeal fracture repair techniques. STUDY DESIGN Animal model. MATERIALS AND METHODS Laryngectomy specimens were analyzed at 10 weeks, following paired wire fixation (n = 7) and miniplate fixation (n = 7) of thyroid cartilage fractures. RESULTS Cartilaginous unions were present in all seven of the miniplated repairs, while fibrous unions were present in six of the wired repairs. The measure of distraction at the fracture site was significantly greater in the wired repairs compared with the plated repairs (P = .005). Furthermore, in five of seven miniplated repairs no distraction at the healed fracture site was present. CONCLUSIONS The results demonstrate the ease, tolerability, and superiority of the miniplate fixation technique for the thyroid cartilage fractures, based on a rabbit model.
Collapse
Affiliation(s)
- T G Dray
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, USA
| | | | | |
Collapse
|
16
|
Brosch S, Johannsen HS. Clinical course of acute laryngeal trauma and associated effects on phonation. J Laryngol Otol 1999; 113:58-61. [PMID: 10341922 DOI: 10.1017/s0022215100143154] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report the clinical course of blunt laryngeal trauma in three young patients. All three patients underwent several phoniatric examinations as well as indirect microlaryngoscopy and microstroboscopy. The follow-up period ranged from three to eight months. In the first case, there was isolated haemorrhage of the left vocal fold; in the second, dislocation of the arytenoid cartilage with formation of an adhesion in the area of the anterior commissure; and, in the third, non-dislocated fracture of the thyroid cartilage with development of haematoma in the right hemilarynx and transient vocal fold paralysis. One patient required surgical treatment; however, repositioning of the arytenoid cartilage, attempted seven weeks following the injury, proved unsuccessful. In conclusion, all three patients showed significant limitation of vocal fold vibration many months after trauma which was unrelated to the extent of resulting tissue damage. In all three cases, patients developed secondary posttraumatic functional dysphonia requiring treatment.
Collapse
Affiliation(s)
- S Brosch
- Section for Phoniatrics and Pediatric Audiology, University Otorhinolaryngological Clinic, Ulm, Germany.
| | | |
Collapse
|
17
|
Abstract
BACKGROUND There is a need to evaluate the effectiveness of laryngeal fracture repair using rigid adaptation plates. METHODS A retrospective chart review of patients undergoing open repair of laryngeal fractures using metal alloy plates, from 1987 to 1995, was performed. Postoperative airway, deglutition, and voice were assessed. Postoperative follow-up ranged from 1 to 58 months (median, 27 months). All 10 patients sustained blunt or penetrating laryngeal trauma. After patients were resuscitated according to the ABC principles recommended by the American College of Surgeons, each underwent open repair of laryngeal fractures using rigid adaptation plates. RESULTS Outcome was measured by perceptual analysis of the postoperative airway, swallowing, and voice, as well as biocompatibility. Ten patients underwent repair and stabilization of the larynx using adaptation plates. Nine patients sustained blunt trauma, and one patient sustained penetrating trauma. Voice was subjectively graded as good if it resembled the preinjury status, fair if it differed, and poor if it represented aphonia, whisper, or unintelligible speech. Airway was graded as good if it resembled preinjury status, fair if mild exercise intolerance or aspiration existed, and poor if the patient could not be decannulated. Nine patients had a good airway following repair, and six of seven patients requiring tracheotomy were decannulated. All patients tolerated the plates well and suffered no surgical complications. CONCLUSION Repair of the laryngeal framework using adaptation plates provides adequate, immediate stabilization with restoration of function and is an alternative to traditional methods of repair.
Collapse
Affiliation(s)
- A M Pou
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, USA
| | | | | | | | | |
Collapse
|
18
|
Abstract
PURPOSE To assess the fixation strength provided by miniplate fixation, wire-tube batten fixation, and wire fixation alone in repair of thyroid cartilage. MATERIALS AND METHODS Segments 2.5-cm wide x 1-cm long were cut from three fresh, frozen, human cadaveric larynges from an 83-year-old man, a 58-year-old woman, and an unknown cadaver. A vertical fracture was induced and repaired with one of three randomly assigned fixation techniques (n=10 in each fixation group). The repaired cartilage was placed in an Instron Universal Testing Device (Boston, MA) and subjected to a three-point bending test. Load to failure was recorded on an analogue graph. RESULTS All reconstruction techniques significantly differed from each other, with miniplate fixation providing a stronger repair than wire tube batten (P < .05), wire tube batten providing a stronger repair than wire alone (P < .01), and miniplate providing a stronger repair than wire alone (P < .001). CONCLUSION In experimentally induced fractures of the human larynx, miniplate fixation consistently yielded the strongest repair. Although both miniplate and wire batten produced excellent anatomic reaction, we feel that miniplate fixation was easier to perform.
Collapse
Affiliation(s)
- C L Lykins
- Department of Otolaryngology--Head and Neck Surgery, University of Washington Medical Center, Seattle 98195, USA
| | | |
Collapse
|
19
|
Abstract
We reviewed the evaluation and management of pediatric laryngeal trauma, focusing on the unique characteristics of the immature airway as they affect functional results. The study was based on 91 cases of acute laryngeal trauma managed by the senior author (E.S.P.) from 1973 to 1996. Patients over 15 years old were considered physically mature and excluded. The remaining 10 cases (mean age 9.7) were reviewed in detail and compared to the adult series. Intervention ranged from level I (observation) to level III (open repair with stent placement). Outcome measure was by functional evaluation of swallowing, voice, and airway. Injuries were rated from group 1 (minor trauma) to group 4 (massive laryngeal injury with multiple fractures). Sixty percent fell into group 1 or 2. Conservative management in these patients produced excellent results as measured by decannulation (100%), functional speech (100%), and normal deglutition (100%). Conversely, 2 of the 4 patients with group 3 or 4 injuries had persistent airway and/or voice complications despite more aggressive intervention. As the pediatric larynx is protected by pliable cartilage and a more craniad location in the neck, traumatic laryngeal injuries in children tend to be less severe than those in the adult population. Group 1 or 2 injuries respond well to conservative treatment. However, children with extensive laryngeal injuries may have more long-term sequelae.
Collapse
Affiliation(s)
- R M Merritt
- Division of Otolaryngology, Medical College of Georgia, Augusta 30912, USA
| | | | | |
Collapse
|
20
|
Mathieson L. Voice disorders following road traffic accidents. J Laryngol Otol 1997; 111:903-6. [PMID: 9425474 DOI: 10.1017/s0022215100138940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
21
|
Abstract
This article discusses the problems and controversies in the assessment of penetrating injuries of the neck. The role of physical examination and color-flow Doppler imaging in the initial assessment is highlighted. Complex injuries of major vessels, the aerodigestive tract, and the parotid are discussed and therapeutic options are presented.
Collapse
Affiliation(s)
- D Demetriades
- Division of Trauma and Critical Care, Los Angeles County/University of Southern California Medical Center 90033, USA
| | | | | | | |
Collapse
|