Laryngotracheal injury can range from soft tissue edema and ecchymosis to mucosal lacerations, vocal cord avulsion, fractures of the thyroid and cricoid cartilage, recurrent laryngeal nerve laceration, or complete laryngotracheal disruption. Classic symptoms include dysphonia, hoarseness, dysphagia, odynophagia, dyspnea, pain, hemoptysis, and stridor. Signs of injury include tenderness, subcutaneous emphysema, deformities, contusions, and tracheal deviation. Unfortunately, in contrast to penetrating tracheal trauma, which is frequently associated with signs and symptoms, blunt injury may present with few or no signs. Diagnosis requires a high index of suspicion.
Establishing an airway is the initial focus in management. Opinions vary as to the optimal method of achieving airway control. Some advocate endotracheal intubation by the most experienced personnel. Others recommend immediate tracheostomy. Those advocating tracheostomy believe that attempts at intubation may result in a false passage, adding further injury to an already compromised airway. Cricothyroidotomy should be avoided as this may worsen laryngeal injury. Any patient with suspected laryngotracheal injury should undergo chest, cervical spine, and soft tissue lateral neck radiographs. Subcutaneous emphysema, narrowing of the subglottic airway, and hyoid bone fractures may be seen on radiographs. Diagnostic work-up will then focus on identification of specific injuries. Laryngoscopy and bronchoscopy will evaluate vocal cord function, luminal integrity, and level of injury. CT is indicated in hemodynamically stable patients with secure airways. Ct delineates the type and degree of injury, and is helpful in deciding which injuries can be managed conservatively and which require immediate operative intervention.
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