The larynx, due to its topographic-anatomical position, can be considered an organ that is fairly well protected from external mechanical influence. It is protected above and in front by the lower jaw and thyroid gland, below and in front by the manubrium of the sternum, on the sides by strong sternocleidomastoid muscles, and behind by the bodies of the cervical vertebrae. In addition, the larynx is a mobile organ, which, when subjected to mechanical impact (impact, pressure), easily absorbs and moves both en masse and in parts due to its articular apparatus. However, with excessive mechanical force (blunt trauma) or with piercing and cutting gunshot wounds, the degree of damage to the larynx can vary from mild to severe and even incompatible with life.
The most common causes of external laryngeal injuries are:
impacts with the front surface of the neck on protruding hard objects (steering wheel or handlebars of a motorcycle, bicycle, stair railing, back of a chair, edge of a table, stretched cable or wire, etc.); direct blows to the larynx (from a palm, a fist, a leg, a horse’s hoof, a sports equipment, an object thrown or torn off during rotation of the unit, etc.); suicide attempts by hanging; knife piercing-cutting, bullet and shrapnel wounds.
External injuries of the larynx can be classified according to criteria that have a certain practical significance both for making an appropriate morphological and anatomical diagnosis, and for determining the severity of the lesion and making an adequate decision on providing assistance to the victim.
Classification of external injuries of the larynx
Situational criteria
domestic: as a result of an accident; for murder; for suicide. industrial: as a result of an accident; as a result of non-compliance with safety regulations. wartime injuries.
By severity
Light (non-penetrating) - injuries in the form of bruises or tangential wounds without violating the integrity of the walls of the larynx and its anatomical structure, which do not cause immediate disruption of all functions. Moderate severity (penetrating) - damage in the form of fractures of the cartilage of the larynx or penetrating wounds of a tangential nature without significant destruction and separation of individual anatomical structures of the larynx with immediate, non-severe impairment of its functions, not requiring emergency assistance for life-saving reasons. Severe and extremely severe - extensive fractures and crushing of the cartilage of the larynx, cut or gunshot wounds that completely block all respiratory and phonatory functions, incompatible (severe) and combined (extremely severe and incompatible with life) with injuries to the main arteries of the neck.
According to anatomical and topographic-anatomical criteria
Isolated injuries of the larynx.
In case of blunt trauma: rupture of the mucous membrane, internal submucosal hemorrhage without damage to cartilage and dislocations in the joints; fracture of one or more cartilages of the larynx without their dislocation and disruption of the integrity of the joints; fractures and avulsions (separation) of one or more cartilages of the larynx with ruptures of the joint capsules and dislocations of the joints. For gunshot wounds: tangential injury to one or more cartilages of the larynx in the absence of penetration into its cavity or into one of its anatomical sections (vestibule, glottis, subglottic space) without significant impairment of respiratory function; penetrating blind or through wound of the larynx with varying degrees of impairment of respiratory and vocal functions without combined damage to surrounding anatomical formations; penetrating blind or through wound of the larynx with varying degrees of impairment of respiratory and vocal functions with the presence of damage to surrounding anatomical structures (esophagus, neurovascular bundle, spine, etc.).
Internal injuries of the larynx
Internal injuries of the larynx are less traumatic injuries of the larynx compared to external injuries. They may be limited to damage to the mucous membrane only, but can be deeper, damaging the submucosal layer and even the perichondrium, depending on the cause of the damage. An important reason complicating internal injuries of the larynx is secondary infection, which can provoke the occurrence of abscesses, phlegmon and chondroperichondritis, followed by more or less severe cicatricial stenosis of the larynx.
Classification of internal larynx injuries
Acute laryngeal injuries:
iatrogenic: intubation; as a result of invasive interventions (galvanocaustics, diathermocoagulation, endolaryngeal traditional and laser surgical interventions); damage by foreign bodies (stabbing, cutting); burns of the larynx (thermal, chemical).
Chronic laryngeal injuries:
bedsores resulting from prolonged tracheal intubation or the presence of a foreign body; intubation granulomas.
The criteria for the classification of external laryngeal injuries may be applicable to this classification to a certain extent.
Chronic injuries of the larynx most often occur in persons weakened by long-term illnesses or acute infections (typhoid, typhus, etc.), in which general immunity is reduced and saprophytic microbiota is activated. Acute laryngeal injuries can occur during esophagoscopy, and chronic injuries can occur when the probe remains in the esophagus for a long time (during tube feeding of the patient). During intubation anesthesia, swelling of the larynx often occurs, especially often in the subglottic space in children. In some cases, acute internal injuries of the larynx occur during forced screaming, singing, coughing, sneezing, and chronic injuries occur during prolonged professional vocal stress (singers' nodules, laryngeal ventricular prolapse, contact granuloma).
Symptoms of laryngeal injuries
Symptoms of laryngeal injuries depend on many factors: the type of injury (bruise, compression, wound) and its severity. The main and first symptoms of external mechanical injury are shock, respiratory obstruction and asphyxia, as well as bleeding - external or internal, depending on the damaged vessels. In case of internal bleeding, mechanical obstruction of the respiratory tract is accompanied by the phenomena of aspiration asphyxia.
Laryngeal contusions
With contusions of the larynx, even if external signs of damage are not detected, a pronounced state of shock occurs, which can lead to a rapid reflex death of the victim from respiratory arrest and cardiac dysfunction. The starting points of this fatal reflex are the sensory nerve endings of the laryngeal nerves, the carotid sinus and the perivascular plexuses of the vagus nerve. A state of shock is usually accompanied by loss of consciousness; upon recovery from this state, the patient feels pain in the larynx, intensifying when trying to swallow and talking, radiating to the ear(s) and the occipital region.
Hanging
A special clinical case is hanging, which is compression of the neck by a noose under the weight of one’s own body, leading to mechanical asphyxia and, as a rule, death. The direct cause of death may be asphyxia itself, impaired cerebral circulation due to compression of the jugular veins and carotid arteries, cardiac arrest as a result of compression of the vagus and upper laryngeal nerves due to their compression, damage to the medulla oblongata by a tooth of the II cervical vertebra when it is dislocated. When hanging, laryngeal injuries of various types and locations may occur, depending on the position of the strangulation instrument. Most often these are fractures of the cartilage of the larynx and dislocations in the joints, the clinical manifestations of which are detected only with timely rescue of the victim, even in cases of clinical death, but without subsequent decortication syndrome.
Laryngeal injuries
Wounds to the larynx, as noted above, are divided into cuts, stabs and gunshots. The most common are incised wounds on the anterior surface of the neck, among which are wounds with damage to the thyrohyoid membrane, thyroid cartilage, wounds localized above and below the cricoid cartilage, transcricoid and laryngeal-tracheal wounds. In addition, wounds in the anterior surface of the neck are divided into wounds without damage to the cartilage of the larynx, with damage to them (penetrating and non-penetrating) and combined injuries of the larynx and pharynx, larynx and neurovascular bundle, larynx and cervical vertebral bodies. According to A.I. Yunina (1972), wounds of the larynx, in accordance with clinical and anatomical feasibility, should be divided:
for wounds of the supra- and sublingual area; areas of the vestibular and vocal folds; subglottic space and trachea with or without damage to the esophagus.
With injuries of the first group, the pharynx and laryngopharynx are inevitably damaged, which significantly aggravates the injury, complicates surgical intervention and greatly lengthens the postoperative period. Injury to the thyroid cartilage invariably leads to injury to the area of the vocal folds, pyriform sinuses, and often the arytenoid cartilages. This type of injury most often leads to laryngeal obstruction and suffocation. The same phenomena occur with injuries to the subglottic space.
Injuries to the larynx due to incised wounds
Damage to the larynx due to incised wounds can vary in severity - from barely penetrating to complete transection of the larynx with damage to the esophagus and even the spine. Injury to the thyroid gland leads to parenchymal bleeding that is difficult to stop, and injury to large vessels, which occur much less frequently for the reasons noted above, often leads to profuse bleeding, which, if it does not immediately end in the death of the victim from blood loss and hypoxia of the brain, is fraught with the danger of death a patient from asphyxia caused by the flow of blood into the respiratory tract and the formation of clots in the trachea and bronchi.
The severity and scale of the wound to the larynx do not always correspond to the size of the external wound, this is especially true for puncture wounds and bullet wounds. Relatively minor skin injuries can hide deeply penetrating wounds of the larynx, combined with wounds of the esophagus, neurovascular bundle, and vertebral bodies.
A penetrating cut, stab or gunshot wound has a characteristic appearance: as you exhale, air bubbling with bloody foam comes out of it, and as you inhale, air is sucked into the wound with a characteristic hissing sound. Aphonia and coughing attacks are noted, which increase “before our eyes” the beginning emphysema of the neck, spreading to the chest and face. Breathing disorders can be caused by either blood flowing into the trachea and bronchi, or destructive phenomena in the larynx itself.
A victim with a laryngeal injury may be in a state of traumatic shock in a twilight state or with a complete loss of consciousness. In this case, the dynamics of the general condition may acquire a tendency to move toward a terminal state with disruption of the rhythm of respiratory cycles and heart contractions. Pathological breathing is manifested by changes in its depth, frequency and rhythm.
Respiratory failure
An increase in the breathing rhythm (tachypnea) and a decrease in breathing rate (bradypnea) occur when the excitability of the respiratory center is impaired. After forced breathing, due to weakening of the excitation of the respiratory center caused by a decrease in the carbon dioxide content in the alveolar air and blood, apnea, or a prolonged absence of respiratory movements, may occur. With a sharp depression of the respiratory center, with severe obstructive or restrictive respiratory failure, oligopnea is observed - rare shallow breathing. Periodic types of pathological breathing that arise as a result of an imbalance between excitation and inhibition in the central nervous system include periodic Cheyne-Stokes breathing, Biot and Kussmaul breathing. With shallow Cheyne-Stokes breathing, shallow and rare respiratory movements become more frequent and deeper and, after reaching a certain maximum, they weaken and slow down again, then there is a pause for 10-30 s, and breathing resumes in the same sequence. Such breathing is observed in severe pathological processes: impaired cerebral circulation, head injury, various diseases of the brain with damage to the respiratory center, various intoxications, etc. Breathing Biota occurs when the sensitivity of the respiratory center decreases - alternating deep breaths with deep pauses of up to 2 minutes. It is characteristic of terminal conditions and often precedes respiratory and cardiac arrest. Occurs with meningitis, brain tumors and brain hemorrhages, as well as with uremia and diabetic coma. Big Kussmaul breathing (Kussmaul symptom) - gusts of convulsive, deep breaths, audible at a distance - occurs in comatose states, in particular in diabetic coma, renal failure.
Shock
Shock is a severe generalized syndrome that develops acutely as a result of the action of extremely strong pathogenic factors on the body (severe mechanical trauma, extensive burns, anaphylaxis, etc.).
The main pathogenetic mechanism is a severe circulatory disorder and hypoxia of organs and tissues of the body, primarily the central nervous system, as well as secondary metabolic disorders resulting from a disorder of the nervous and humoral regulation of vital centers. Among the many types of shock caused by various pathogenic factors (burn, myocardial infarction, transfusion of incompatible blood, infection, poisoning, etc.), the most common is traumatic shock, which occurs with extensive wounds, fractures with damage to nerves and brain tissue. The most typical shock state in its clinical picture occurs with a laryngeal injury, in which four main shockogenic factors can be combined: pain due to injury to the sensory laryngeal nerves, incoordination of autonomic regulation due to damage to the vagus nerve and its branches, airway obstruction and blood loss. The combination of these factors greatly increases the risk of severe traumatic shock, often leading to death at the scene.
The main patterns and manifestations of traumatic shock are the initial generalized excitation of the nervous system, caused by the release of catecholamines and corticosteroids into the blood as a result of the stress reaction, which leads to a slight increase in cardiac output, vasospasm, tissue hypoxia and the emergence of the so-called oxygen debt. This period is called the erectile phase. It is short-term and cannot always be traced to the victim. It is characterized by agitation, sometimes screaming, restlessness, increased blood pressure, increased heart rate and breathing. The erectile phase is followed by a torpid phase, caused by worsening hypoxia and the emergence of foci of inhibition in the central nervous system, especially in the subcortical regions of the brain. Circulatory disorders and metabolic disorders are observed; part of the blood is deposited in the venous vessels, the blood supply to most organs and tissues decreases, characteristic changes in microcirculation develop, the oxygen capacity of the blood decreases, acidosis and other changes in the body develop. Clinical signs of the torpid phase are manifested by the victim’s lethargy, limited mobility, weakened response to external and internal stimuli or the absence of these reactions, a significant decrease in blood pressure, rapid pulse and shallow breathing of the Cheyne-Stokes type, pallor or cyanosis of the skin and mucous membrane, oliguria, hypothermia. These disorders, as shock develops, especially in the absence of therapeutic measures, gradually, and in severe shock quite quickly, worsen and lead to the death of the body.
There are three degrees of traumatic shock: degree I (mild shock), degree II (moderate shock) and degree III (severe shock). In stage I (in the torpid stage), consciousness is preserved, but clouded, the victim answers questions in monosyllables in a muffled voice (with a laryngeal injury that even leads to a mild form of shock, vocal communication with the patient is excluded), pulse 90-100 beats/min, blood pressure (100-90)/60 mm Hg. Art. In case of second degree shock, consciousness is confused, lethargic, the skin is cold, pale, pulse is 130 beats/min, blood pressure is (85-75)/50 mm Hg. Art., breathing is frequent, there is a decrease in urination, the pupils are moderately dilated and react sluggishly to light. In case of third degree shock - blackout, lack of response to stimuli, pupils are dilated and do not respond to light, pale and cyanotic skin covered with cold sticky sweat, frequent shallow irregular breathing, threadlike pulse 120-150 beats/min, blood pressure 70/30 mmHg Art. and below, a sharp decrease in urination, up to anuria.
In case of mild shock, under the influence of adaptive reactions of the body, and in case of moderate shock, additionally and under the influence of therapeutic measures, there is a gradual normalization of functions and subsequent recovery from shock. Severe shock often, even with the most intensive treatment, becomes irreversible and ends in death.
A) Initial examination and diagnosis of injury. During the initial examination of a patient with a neck injury, it is first necessary to ensure patency of the airway. This is not always easy to do, and in some cases it is necessary to perform an emergency tracheotomy or conicotomy. The position of the neck cannot be changed. Until a cervical spine injury has been ruled out, the patient's neck should not be extended during either orotracheal intubation or tracheotomy.
After recovery respiratory function must be provided with access to two large veins. If it is necessary to correct circulatory function, intravenous administration of isotonic fluids begins. The patient can then be undressed and examined for other injuries. If the patient's condition is still unstable, emergency surgery is indicated. With relative stability, after carrying out these procedures, you can proceed to diagnostic measures. In all cases, radiographs of the cervical spine and chest are required.
Then, after a detailed assessment of all existing damage, specialists determine the course of action.
b) Secondary examination and diagnosis of laryngeal injury. External laryngeal trauma can range from an open fracture to minor impairment of laryngeal function.
1. Anamnesis. Understanding the mechanism of injury is important in order to make decisions about emergency treatment and to predict the nature and severity of existing injuries. A patient brought to the emergency room after a traffic accident with his neck striking a steering wheel may appear stable at first glance. Within a few hours, the picture of normal airways (including laryngoscopic) can change to the sharply opposite: swelling of the airways increases, and a hematoma forms.
In such cases, if there is a history of an extremely severe blow to the neck, the doctor should always expect the worst case scenario. On the contrary, with injuries of lesser force (for example, a fist to the neck), a fracture of the thyroid cartilage may occur with displacement of the fragments. In case of penetrating wounds, it is necessary to clarify the type of weapon and ammunition, the firing distance and the location of the wound openings. Based on our experience, until confirmation to the contrary, we recommend that all patients with anterior neck injury also have an airway injury.
2. Inspection. In our experience, the severity of blunt trauma can only be judged by the severity of respiratory failure. Sometimes, when examining the neck, an open fracture of the cartilage of the larynx or a laryngeal-cutaneous fistula is determined. But most often with a blunt neck injury, the external examination is uninformative. The larynx is palpated and crepitus is assessed. Pain on palpation, although not a specific symptom, often indicates severe injury. On the skin of the neck you can sometimes see bruises or abrasions (after blunt trauma), or a strangulation groove (after attempts at strangulation, hanging).
At penetrating wounds you need to examine the entrance and exit openings, try to predict the course of the wound channel. Open wounds should not be probed or manipulated with instruments because this may displace the existing hematoma and cause bleeding to resume. Next, the cervical spine is palpated, the presence of uneven bone contours, bone displacement, and pain is assessed. Hemoptysis may indicate injury to the upper respiratory or digestive tracts, but it is often difficult to differentiate it from bleeding due to concomitant facial trauma.
At external injuries of the larynx The voice often changes, and after severe trauma it may be absent. Most often, dysphonia is a consequence of anatomical changes in the larynx, or a consequence of damage to the supraglottic part of the larynx and the upper respiratory tract. A hematoma on the vocal fold leads to an increase in its mass and a decrease in vibration frequency. A weak, hoarse voice may be a consequence of injury to the recurrent laryngeal nerve with the development of paresis of the vocal fold, as well as mechanical subluxation of the cricoarytenoid joint. Finally, any injury to the larynx that is accompanied by a change in air flow through the airways may be accompanied by changes in voice.
One of the most difficult laryngeal dysfunction is a violation of the normal passage of air through the respiratory tract. When the cricoid cartilage is torn from the trachea, when the airways are partially crossed, their integrity is maintained only by maintaining a thin mucous membrane between the cricoid cartilage and the trachea. In gunshot wounds, the wound channel can serve as a laryngeal-cutaneous fistula, allowing breathing even with obstruction at or above the glottis. In such cases, the passage of air through the wound will be obvious, and until the surgeon is prepared to ensure an adequate airway, the wound should not be closed, compressed, or manipulated in any way. Stridor can be a consequence of bilateral paresis of the vocal folds, their rupture, or a combination of unilateral paresis with edema or hematoma of any of the three parts of the larynx.
Expressed edema may itself lead to airway stenosis, even with preserved vocal fold mobility. As discussed above, in some patients swelling and hematoma may develop within a few hours, in these cases there is time to assess which part of the airway is compromised. If the obstruction increases rapidly, it becomes impossible to clarify the nature of stridor (inspiratory, expiratory, mixed). The third, most hidden dysfunction of the larynx is the development of aspiration, which is most often caused by the immobility of one or two vocal folds. And although it is almost impossible to diagnose in the first time after an injury, it can later manifest itself as pneumonia.
After initial examination and ensuring airway patency, you should try to examine the internal structures of the larynx. Since the 1980s, the advent of flexible fiber laryngoscopes has made it possible to examine the injured larynx outside the operating room. After carefully inserting the endoscope into one half of the nose, the oropharynx and hypopharynx are inspected for damage. The larynx is examined, the presence of hematomas or ruptures in the mucous membrane is determined, their size and location are assessed. The range of movements of the arytenoid cartilages during phonation and breathing is assessed.
Partial loss of mobility indicates about structural deformation or displacement of cartilage, while complete immobility is more typical for injury to the recurrent laryngeal nerve. If the vocal folds do not close because they are no longer in the same horizontal plane, this may indicate either trauma to the laryngeal skeleton or damage to the superior laryngeal nerve. For minor injuries, when video stroboscopy can be performed, this research method allows you to assess how damage to the muscles or mucosa affects the mobility of the vocal folds. Finally, the integrity of the cartilage and laryngeal membranes is assessed.
Protocol for providing care to patients with acute laryngeal trauma. CT, computed tomography.
3. Radiation diagnosis of laryngeal trauma. Severe fractures can be seen on plain radiographs, but the information content of plain radiography is limited by the two-dimensionality of the image. Magnetic resonance imaging (MRI) allows a more accurate assessment of the soft tissue structures of the larynx, but it cannot assess denser areas. In contrast, computed tomography (CT) allows non-invasive examination of both the laryngeal skeleton and its soft tissues. We recommend it be performed when laryngeal injury is suspected based on history without clinical manifestations during physical examination.
Such patients Only one symptom or sign of laryngeal injury (eg, hoarseness) may be present, and physical examination findings are inconsistent. In such cases, CT makes it possible to exclude trauma to the larynx, while avoiding direct laryngoscopy with its accompanying anesthesia. CT is also useful in diagnosing small fractures of the thyroid cartilage with minimal displacement along the midline or lateral surface; Often, upon initial examination, such patients do not have significant symptoms. If left untreated, such lateral displacements can lead to dysphonia because the vocal folds will not be able to close completely and the valvular function of the larynx will be impaired.
A small number patients with severe edema or hematoma without ruptures of the mucous membranes, it may be impossible to assess the condition of the laryngeal skeleton using direct laryngoscopy. In such cases, CT is used to detect cartilage fractures. If no fractures are detected on CT, then a tracheotomy is simply performed to ensure airway patency, and open revision of the laryngeal skeleton can be avoided.
Treatment tactics for laryngeal injury depends on the mechanism and severity of the injury, which must be assessed during the initial examination. First of all, you should think about ensuring airway patency. The long-term goal is to restore normal laryngeal function. Therefore, during the initial examination you should always answer several questions. First, is there anything threatening the airway? Considering that injuries to the anterior neck often involve injuries to the laryngeal skeleton, the answer must be carefully considered. Second, what research methods are optimal for assessing injury severity? These include flexible laryngoscopy, CT and direct laryngoscopy.
Due to its location, the human larynx is protected from various external influences. The articular apparatus controls the larynx, allowing it to cushion the organ from pressure or bruise. With injuries to the larynx, especially penetrating wounds, the person’s condition is aggravated if large vessels are damaged. We are talking about dangerous lesions that lead to the death of the victim or entail a deterioration in the victim’s health, and sometimes disability. The danger of laryngeal injuries is that the consequences tend to appear months and even years later: a person’s breathing is constantly impaired, his voice changes, and he has difficulty swallowing food. In such cases, specialists perform surgical operations that help restore the functions of the organ.
Definition
Laryngeal injuries are various injuries caused by the influence of one or another factor. This influence can be external and internal. Trauma to the larynx can be internal or external.
Internal injuries include burns with chemicals, internal injuries with cutting objects, as well as penetration of a foreign body, which leads to bedsores, re-infection, and necrosis. These also include forced and accidental injuries (consequences of unsuccessful surgery), the consequences of intubation that occurs with the trachea (the presence of cysts or bedsores).
External injuries are considered to be wounds and blunt injuries. They are often combined with lesions of nearby structures that can affect the trachea and pharynx.
External injuries: classification
- Non-penetrating - superficial wounds that do not damage the walls of the organ, its structure and do not cause disruption of its functions.
- Penetrating – cartilage fracture, wounds. They cause immediate but minor dysfunction.
- Severe - crushing, fractures of one or more cartilages, various deep wounds. They block organ functions.
A person can get a laryngeal injury in several ways. Experts classify such injuries according to a number of criteria that help make a diagnosis, determine the severity of laryngeal injuries, and provide competent first aid to the victim.
Internal injuries: classification
Acute internal trauma of the larynx is understood as an isolated lesion that occurs during various interventions (for example, diathermocoagulation), when the organ comes into contact with foreign bodies, chemicals (burns). In addition, there are chronic injuries: bedsores that appear when long-term tracheal intubation occurs, penetration of foreign objects, intubation granulomas. As a rule, they occur if the human body is weakened by diseases or infections (for example, typhus). In some cases, acute lesions occur due to overstrain of the vocal cords (singing, strong screaming), while chronic lesions occur due to regular stress on the cords.
Etiology
Damage is possible from blows, attempted hangings, knife and bullet wounds, foreign bodies, surgical and other interventions, and chemical burns.
A person can get a concussion due to forceful impact on the larynx. A minor blow that does not damage the integument can provoke a contusion, and strong compression of the larynx can lead to dislocation.
This action can also cause a fracture.
Pathogenesis
After an injury. External injuries often lead to contusion, tissue rupture, cartilage fragmentation, and fractures. A bruise provokes a state of shock, and a dislocation, contusion, or fracture disrupts the structure of the organ. They diagnose ruptures of joint capsules, dislocations, hemorrhages, impaired mobility of cartilage, which affects the functions of the organ (respiratory, vocal). Bleeding provokes aspiration of blood and some complications (aspiration pneumonia, asphyxia). The recurrent nerve may be affected and paralyzed, making breathing difficult.
Burns cause external injuries to the mucous membrane and oral cavity. On the first day, the mucous membranes swell; after another day, ulceration occurs. The inflammation continues for several more days and is accompanied by thrombosis. Necrotic masses are rejected approximately on the fifth day. Fibrosis of the laryngeal mucosa and scarring begins after two to four weeks. With inflammation, pneumonia, mediastinitis develops, and a tracheoesophageal fistula appears.
Symptoms
Also one of the symptoms is impaired vocal function. Tissue damage makes swallowing more difficult. Pain is felt in different ways: the victim can feel both discomfort and severe pain. Such laryngeal injuries are rarely accompanied by a cough. This symptom is most likely when foreign objects penetrate, which is accompanied by bleeding or the development of inflammation.
External injuries are also accompanied by bleeding. Significant blood loss occurs if large blood vessels are affected. In this case, bleeding arising from internal lesions is often accompanied by hemoptysis. In addition to hidden blood loss, such a symptom sometimes entails aspiration pneumonia and the occurrence of hematomas.
Symptoms for concussion, hanging, wounds, incised wounds and burns
During a concussion, it is painful for the victim to swallow food, as his swallowing function is impaired. Shortness of breath, swelling, bruising, and fainting are possible.
When hanging, the neck is compressed by a noose, which causes asphyxia and, most often, death. In addition to asphyxia, cardiac arrest and impaired blood circulation in the brain cause death, as veins and arteries are compressed. Hanging causes various injuries to the larynx, depending on the position of the rope.
The following symptoms are characteristic of a wound to the larynx: visual wounds, asphyxia, problems with swallowing, cough, stenosis, difficulties with sound production. A penetrating wound is fraught with the development of infection.
With cut wounds, heavy bleeding (external and/or internal), shock, and breathing problems occur, often leading to suffocation.
The appearance causes tissue necrosis, redness of the mucous membranes, and swelling. In addition, a grayish coating and liquid-filled blisters form. In some cases, after burns, scars appear that narrow the lumen of the larynx. It must be taken into account that against the background of chemical burns, intoxication of the entire body occurs, which is also one of the signs characteristic of this condition.
Clinic
The condition of the victim and the extent to which the trachea and the structure of the neck as a whole are damaged affect the severity of the symptoms. The main sign of damage is impaired respiratory function. This symptom manifests itself in different ways. Dysphonia occurs in all types of damage to the larynx. Patients' voice changes both gradually and suddenly. If the trachea is damaged, the vocal cords suffer less noticeably. Characteristic manifestations include pain during swallowing in the larynx and trachea.
Diagnostics
Physical examination
Medical examination of the patient, assessment of general health. During the examination, the specialist determines the nature of the larynx injury, checks the surface of the larynx for the presence of hematomas, and palpates the neck. In this way, the doctor determines how preserved the structure of the organ is and identifies compactions. Penetrating injuries of the larynx in some cases allow probing.
Laboratory research
In addition to a general examination that helps determine what the patient's health is, it is also important to test the blood. There is a need for microbiological examination of the larynx.
Instrumental studies
Doctors prescribe laryngoscopy, computed tomography, microlaryngoscopy, endofibroscopy, radiography, microlaryngostroboscopic examination, and surgical revision of wounds.
Causes. Mechanical injuries of the pharynx can be internal, external, closed, open (wounds), isolated, penetrating, non-penetrating, blind, through.
Internal wounds of the pharynx are often isolated and occur when damaged by a foreign body (pencil, stick) inserted into the oral cavity. External wounds of the pharynx are predominantly combined with damage to the neck, head, esophagus, and can be cut, stabbed, bruised, or gunshot.
Symptoms Injuries to the oropharynx are often combined with damage to the facial skeleton, soft palate, tongue, cervical vertebrae, retropharyngeal and peripharyngeal space. The main manifestations are the presence of a wound, pain, dysphagia, salivation, speech disorder, bleeding, swelling, emphysema of the lateral pharyngeal wall.
Injuries to the laryngopharynx are often combined with damage to the larynx and esophagus and are characterized by severe general condition, external or intrapharyngeal bleeding, dysphagia, aphagia, respiratory failure including asphyxia, subcutaneous emphysema in the neck. The flow of saliva or food from the wound indicates the penetrating nature of the wound to the pharynx or esophagus.
Complications. Blood loss, aspiration asphyxia, pneumonia, retropharyngeal abscess, purulent mediastinitis.
First medical aid. In case of superficial damage to the mucous membrane of the oropharynx, the wound is treated with a 3% solution of silver nitrate; in case of deep damage, tetanus toxoid, analgesics, and antibiotics are also administered. In case of severe arterial bleeding, it is temporarily stopped by digitally pressing the common carotid artery to the C-VI vertebra. They are urgently evacuated to the ENT department of the hospital.
Specialized assistance provides for the final stop of bleeding and primary surgical treatment of the wound. Some victims, after preliminary tracheostomy, undergo pharyngeal tamponade. If tamponade is ineffective, the bleeding is stopped by ligating the main vessels along their length.
During primary surgical treatment, non-viable tissues, foreign bodies, bone fragments are removed, and hematomas are opened. A large tissue defect and severe inflammation require open treatment of pharyngeal wounds. Tracheostomy is also performed if there is a threat of decompressed laryngeal stenosis. Feeding is provided through a tube inserted through the nose (or mouth). Adequate antibacterial and infusion therapy is prescribed.
Mechanical injuries of the larynx
Causes. Due to its close proximity to other anatomical structures of the neck, the larynx is often damaged by a blow to the front surface of the neck with a blunt object, a collision with and fall on a hard object, an attempt at suffocation, or injury. There are closed and open or wounds, isolated and combined, penetrating (puncture, cut, gunshot) injuries of the larynx.
Symptoms Most often, bruises of the larynx and trachea occur, but cartilage fractures, separation of the larynx from the trachea, damage to the thyroid gland, esophagus, great vessels and nerve trunks are possible. The external wound in a penetrating wound does not always correspond to the damaged hollow organ due to its displacement when turning and tilting the head.
Penetrating wounds are characterized by a severe general condition and signs of traumatic shock. The most constant symptom of wounds of the larynx is difficulty breathing, inspiratory dyspnea of varying severity, caused mainly by the flow of blood into the airways, the formation of blood clots or a mechanical obstacle to the displacement of organ tissue, a foreign body, and later by the addition of edema.
Convincing signs of damage to the larynx are coughing, hemoptysis, and air escaping from the wound. Blockage of the wound channel by blood clots and tissues leads to the development of emphysema. Voice and speech disorders are mandatory symptoms of damage to the larynx. Injury to the epiglottis and arytenoid cartilages is always accompanied by severe pain in the throat, aggravated by swallowing, and a swallowing disorder.
An incised wound of the neck gapes, bleeds, the level of the incision is often below the hyoid bone, while the epiglottis can be cut off from the larynx, less often it corresponds to the conical ligament (between the lower edge of the thyroid and the arch of the cricoid cartilages). The appearance of mucus, saliva during swallowing, or food in the wound indicates damage to the esophagus. With gunshot wounds of the larynx, combined damage to the jaws, great vessels and nerves of the neck, thyroid gland, esophagus, spine, and spinal cord is often observed.
Complications. Traumatic shock, aspiration asphyxia and pneumonia, laryngeal stenosis, purulent mediastinitis.
First aid involves external examination, palpation, careful probing of the wound, indirect (or direct) laryngoscopy to assess the location and extent of the injury to the larynx. Emergency measures are related to ensuring breathing through the larynx, stopping bleeding and anti-shock measures.
In the decompressed stage of laryngeal stenosis, a tracheostomy is performed. In the terminal stage of laryngeal stenosis, crico- or cricoconicotomy is performed. In some cases, to eliminate laryngeal stenosis, a tracheostomy tube may be inserted into the larynx or trachea through a wound.
Minor bleeding is stopped by applying a pressure bandage to the wound and hemostatic agents. Prevent the development of wound infection by administering antibiotics and tetanus toxoid. The wounded person is immediately hospitalized in the surgical department, intensive care unit, or ENT department - depending on the severity of the condition and the extent of the damage.
Specialized assistance involves performing indirect (direct) laryngoscopy, fibrolaryngoscopy, and x-ray examination. An otolaryngologist, surgeon, vascular surgeon, maxillofacial surgeon, neurosurgeon, endoscopist, anesthesiologist, resuscitator, and radiologist take part in the examination and treatment of victims.
If bleeding continues, ligatures are applied to the bleeding vessel. If it is impossible to determine the source of bleeding, the afferent vessels (superior thyroid, inferior thyroid, external carotid artery) are ligated.
Primary surgical treatment of laryngeal wounds is performed early and sparingly. Easily accessible foreign bodies and non-viable tissues are removed. The damaged cartilage is installed as much as possible in its original anatomical position and fixed with sutures placed behind the subchondral cartilage. The use of antibiotics allows for more frequent use of the primary suture. For penetrating wounds of the larynx, laryngotracheostomy is performed for surgical treatment of the intralarynx wound and plastic surgery of the laryngeal mucosa. The final stage of laryngoplasty is the closure of the laryngo-tracheostomy.
Those wounded in the larynx need antibiotics, narcotics, the administration of drugs that reduce salivation (atropine, platyphylline), cough, as well as oral care. Nutrition is provided through a nasoesophageal (gastric) tube until acute reactive phenomena are eliminated.
Are scratches on the throat common? Every person is bound to encounter them. This often happens in childhood. But even a fully grown person can receive them. Often patients indicate that the simplest fish bone scratched their throat.
Article outline
What causes it?
The most common cause is food. But you shouldn’t forget about physical damage from all kinds of foreign bodies. For example, the same child can scratch his throat with almost anything that can fit in his mouth. Children tend to swallow the most unexpected things:
- shell;
- branches;
- grass;
- feathers;
- needles or pins.
The list can be continued endlessly, because little explorers try to taste everything, sometimes swallowing a wide variety of shiny and bright objects. While an adult is able to take care of himself, a small child cannot do this. Very often the cause of a sore throat is not immediately recognized. After all, only a doctor can do this after an examination. Only in some cases are scratches obvious even to the untrained eye.
Symptoms
Scratches have a clearly defined area. They belong to the locals. It hurts exactly at the site of the injury. In this case, the following symptoms may occur.
- Pain with all kinds of tension in the neck.
- Sharp pain when talking, coughing or sneezing.
- Most often, light bleeding occurs in the first minutes after injury. Constant bleeding from a deep cut.
All this can be observed at first. As a rule, symptoms disappear after 3-5 days. However, do not forget about the serious danger of infection. A large number of pathogenic bacteria and viruses accumulate in the oral cavity and on the tonsils. Even the slightest tissue damage will help them get into the blood or lymphatic system. What's next? Distribution throughout the body. Sepsis.
In addition, the penetration of infection into tissues can cause suppuration and cause a number of serious diseases. From tonsillitis to mononucleosis.
What should be done in case of mechanical damage to the throat?
The very first and most important point is to immediately consult a doctor for an examination. In addition to the scratches and cuts themselves, food debris that can get there poses a huge danger. It's even worse if the scratching object remains in the throat. For example, the same bone that scratched the throat continues to be there. What are the symptoms of a stuck object?
- Swelling.
- Swelling of veins and...
- Blueness of the lips and under the eyes.
- Labored breathing.
- Profuse salivation.
- Loss of consciousness.
- Pain when turning or moving the neck.
- Bleeding.
In addition to difficulty breathing, the process of mechanical damage to the throat continues. If the cause is not eliminated in time, the throat becomes inflamed and swelling begins. How all this can end is clear. Therefore, if symptoms occur, you should urgently go to the hospital or call an ambulance.
Serious wounds are treated exclusively in hospital, under the supervision of specialists. This requires special means, including antibiotics.
Medium and small scratches
As already mentioned, you need to start with an examination by a doctor. The healing itself occurs very quickly. Literally the next day you already feel significant relief. Why do you need to see a doctor? To completely prevent small pieces of the same bone from getting stuck.
For a speedy recovery of your throat, you can use several simple recipes. What do we need to achieve? Just two things, the body will do the rest. This:
- disinfection;
- softening fabrics.
It is important to remember that during the recovery period, solid and tough foods are completely excluded from the diet. Hot and cold food should also not be consumed - this can contribute to bleeding, inflammation and suppuration. Exclusively soup, broths and purees without bread.
Which disinfectant should I choose?
One of the best options is a solution of furatsilin. Light rinses will do a great job with almost all types of infections. After rinsing, do not drink, eat or perform any other procedures with the throat for at least 10 minutes. Rinse after bleeding has stopped.
A harsher solution is a solution of table or iodized salt. It cleans no worse, but the sensations are not the most pleasant. In addition, frequent use dries out the tissue, and this negatively affects healing.
Mitigation
The softness of the tissue will reduce pain and speed up recovery. A variety of oils can be used for healing, including those that are in the kitchen of any housewife. The more often they get into the throat, the better.
Vegetable oil and butter perfectly soften the throat. The beneficial vitamins in the composition and the absence of contraindications make them the best candidates. Any oil or fat coats the throat well, creating a kind of protective layer. A lubricated throat hurts less, swallowing and eating are no longer so painful.
This excellent healing agent has been known for its healing properties for centuries. It is enough to dissolve a teaspoon of honey every hour and the result will not take long to arrive.
Scratches on the throat in children
Why do children more often suffer various mechanical injuries? Because their throat tissue is much softer. Even the most ordinary bread can cause a cut if it has not been thoroughly chewed. High risks of injury when eating fish or meat, especially poultry.
But what if the reason is unknown? See a doctor; you may need an x-ray or probing. In this case, scratches may indicate a much greater danger.
Complications
If symptoms do not go away after three days, then this is a cause for concern. The presence of inflammatory processes in the body can be indicated by an increased body temperature already in the first day after the injury. You should pay attention to both a slight rise, up to 37-37.3, and severe heat and fever. In these cases, self-medication is very dangerous.
Inflamed lymph nodes also indicate the need for medical attention.
You cannot hope that these symptoms will go away on their own. It will not happen. But refusal of professional medical care can have serious consequences, including suffocation and sepsis.
Video
The video talks about how to quickly cure a cold, flu or acute respiratory viral infection. Opinion of an experienced doctor.
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