Introduction:
When the larynx and the windpipe (trachea) get injured in an accident, or any injury to the larynx or the trachea occurs, it is known as laryngotracheal trauma. Trauma is a physical injury or an extremely distressing situation. Laryngotracheal trauma is a type of airway trauma. It also comes under the category of head and neck trauma. This type of trauma is very rare and is not commonly seen. It is one of the leading causes of fatal accidents all around the world. Presenting symptoms include dysphonia (difficulty speaking due to physical disorder), dyspnea (shortness of breath), hoarseness (difficulty making sounds during speaking), stridor (grating harsh sound), neck pain, dysphagia (difficulty swallowing), and hemoptysis (blood while coughing). Physical exam findings may contain tenderness (discomfort or pain) over the larynx, subcutaneous emphysema (a condition that causes shortness of breath), air escaping from a neck wound, cyanosis (bluish discoloration of the skin due to shortage of oxygen), large air leak after chest tube placement, or persistent pneumothorax (a collapse of lungs) despite chest tube placement. It is necessary to remember that the severity of symptoms does not always coordinate with the extent of the injury.
What Is a Laryngopharyngeal Trauma?
An injury to the larynx and trachea is called laryngotracheal trauma. The trauma could be from an accident or any penetrating injury from bullets, knives, etc. Laryngotracheal trauma is a damaging injury that requires a very prompt intervention and an alert mind to diagnose it to improve the chance of survival and maintain functions. Various studies aimed to observe the incidence, airway intervention, and aerodigestive outcome among patients with laryngotracheal trauma, and factors affecting these outcomes should be statistically studied, and results should be derived. Laryngotracheal wounds are uncommon. However, they have a noteworthy mortality rate. These wounds can be penetrating or blunt. Usually, the larynx is shielded by the sternum and jaw from blunt trauma. A clothesline injury (who strikes a stationary, small object such as a tree branch or a fence wire that affects the anterior neck below the helmet line.) occurs when the exposed neck is smashed by a hard object, such as a tree branch or a wire, or when an attack is planned to hurt the larynx. Further, injuries can occur when the neck is stressed due to damage, such as in a rear-end accident that causes a whiplash-like injury or when the larynx is purposefully targeted for harm. Penetrating neck trauma results in damage to the larynx.
What Are the Types of Laryngotracheal Trauma?
The laryngotracheal trauma is classified as follows:
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Penetrating Injury: The degree of severity is frequently proportional to the force used and the area across which it is applied. The larynx and trachea can develop structural malformations due to high-velocity traumas that fracture the cartilages that line the larynx and trachea. The "clothesline" injury, the most severe occurrence, occurs when a motorcyclist collides with a small, static item, like a fencing net or branch of a tree. It strikes the front of the neck below the line of the helmet. It exerts a powerful impact across constrained space, which may cause serious crumbling and disintegrating injuries to the cartilage of the larynx and trachea and restrict the airway. Due to the shearing pressures, this might potentially result in laryngotracheal separation. In sports or fights, minor blunt laryngeal injuries can occur. They can cause shearing pressures that may not always appear on inspection, such as hyoid fractures or submucosal endolaryngeal injuries. Due to anatomical defects, airway blockage may develop immediately, or it may take time for patients to experience symptoms resulting from delayed airway obstruction.
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Blunt Injury: The mechanism of the injury will decide the seriousness of the injury. For delivery update, knife wounds can at first present with minor symptoms of a lower-velocity penetrating injury, but after the injury, edema (tissue filled with excess fluid) or hematoma (blood or fluid leaked and collected in a mass) may block the airway. High-velocity injuries yielded by weapons, such as military rifles, commonly fracture the target area and are devastating and obliterate laryngeal tissues and supporting systems. In addition to any acute airway complications brought on by tissue disturbance or post-injury edema, relative devascularization (loss of the blood supply to a part of the body due to obstruction or destruction of blood vessels) and scarring of these tissues can result in severe long-term constriction.
There is another classification of laryngotracheal trauma based on the site of injury given in the following: (Glottis- the part of the larynx comprising the vocal cords and the opening between them. It impacts voice modulation through contraction or expansion).
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Supraglottic.
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Glottic.
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Subglottic.
Classification based on tissue injury:
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Cartilage.
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Mucosa.
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Ligaments.
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Nerves.
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Joints.
How Is Laryngotracheal Trauma Evaluated?
After the airway is stabilized, a complete trauma assessment has to be conducted to evaluate the extent of injury to the airway and assess for other organ injuries due to the high possibility of accompanying injuries associated with laryngeal trauma. This evaluation usually starts with a chest X-ray in the trauma evaluation area that can show a pneumothorax (a collapsed lung), pneumomediastinum (a condition where the air is present in the mediastinum), subcutaneous emphysema (one of the diseases that comprise COPD (chronic obstructive pulmonary disease)), or tracheal deviation (deviation in the windpipe). A CT (computed tomography) scan of the chest and neck is shown in stable patients and can diagnose most laryngeal fractures and dislocations, as well as determine associated injuries. The esophagus is the most common site of associated injury in tracheobronchial trauma. There is also an increased chance of associated recurrent laryngeal nerve injury in patients with fractures of the cricoid cartilage because the nerve is proximal to it. Injury to the thyroid gland and the major vessels are also generally seen. CT angiogram may also be indicated if there is suspicion of concomitant vascular injury. One series that investigated major vascular injuries associated with tracheobronchial injuries found that the carotid artery is the most commonly injured vessel.
What Is the Treatment and Management of Laryngotracheal Trauma?
The most important and initial step is to stabilize the airway. Tracheostomy (it is an opening surgically made via the neck into the trachea (windpipe) to permit air to fill the lungs) or cricothyrotomy (it is an incision made via the skin and cricothyroid membrane to establish an airway) should be done immediately in a patient with an evident larynx fracture, stridor with elevated breathing labor (difficulty breathing), or an airway blockage. Medical management and observation are crucial for the first 24 hours. Surgery is essential for all other situations, and detailed anesthetic examinations of the esophagus and larynx with direct laryngoscopy (an exam of the back of your throat, including your voice box (larynx)) and endoscopy (a test to look inside the body), respectively. To cover all cartilage and muscle and prevent scarring, an endoscopic repair can be tried if mucosal lacerations are somewhat mild to moderate. Marked mucosal lacerations, displaced fractures, or unstable fractures will need an open neck examination and probably a thyrotomy (surgical incision or division of the thyroid cartilage) for treatment. The mucosa should be repaired first to fill a surface and prevent scarring or webbing. Any esophageal injuries should be managed, and finally, any laryngeal fractures should be decreased and corrected. Repairing soft tissue and skin has to come last.
Conclusion:
Laryngotracheal injuries can be fatal, so it is important to manage the airway instantly. Missing a severe laryngeal injury can cause airway blockage, which can result in death. Patients with laryngeal or tracheal abrasions or minor tears are treated conservatively with constant monitoring, frequent scopes, and steroids. Early airway treatment helps laryngeal fracture patients since it advances healing times. Early identification and therapy improve the voice and airway results of patients.
