© Borgis - New Medicine 3/2005, s. 34-36
Lidia Zawadzka-Głos, Mieczysław Chmielik, Dorota Kowalczys
Acute laryngeal trauma in children
Department of Paediatric Otorhinolaryngology, Medical University of Warsaw, Poland
Head: Prof. Mieczysław Chmielik MD, PhD
Laryngeal trauma may be life-threatening when airways are compromised. Early diagnosis of laryngeal trauma and appropriate management are necessary to save lives and to prevent delayed airway complications. The present paper is a clinical analysis of seven patients treated for laryngeal trauma.
External laryngeal trauma occurs rarely compared to overall trauma incidence. It accounts for less than 1% of the trauma cases seen at major trauma centres. Laryngeal trauma may be life-threatening when airways are compromised.
The larynx is protected against external injury by the mandible from the top, the sternocleidomastoideus muscle from the sides and by the clavicle from the bottom. Several unique anatomical features characterize the paediatric larynx. The larynx of a child differs from that of an adult in terms of its size, shape, position, and consistency. Because of these anatomical differences, the effect of trauma on the paediatric larynx is also different.
In addition to being smaller in actual size, the larynx of a child has also relatively smaller dimensions. In this regard, a similar injury will cause significantly greater functional problems in children than in adults. The consistency of tissues forming the lining of the paediatric larynx predisposes this structure to unfavourable outcomes from blunt trauma. Blunt laryngeal trauma in children is not an uncommon injury but it often remains unrecognized (3, 7). Traumatic injuries of the larynx may be classified according to three criteria:
1. a type of wound – blunt or closed versus penetrating or open
2. a point of application of the wounding force - external or internal
3. an anatomic site of the injury - supraglottic, glottic, subglottic or combined.
Penetrating wounds of the airways are obvious and surgical exploration is usually performed immediately. Blunt trauma creates a different situation, because the extent of injury may not be appropriately assessed so that the patient fails to receive prompt treatment. Internal airway injuries may be the result of endotracheal intubation, laryngoscopy, bronchoscopy or presence of a foreign body. External injuries usually occur as the result of accidents, in which an impact on the anterior neck compresses the larynx against the rigid vertebral column, thereby fracturing the cartilages and contouring or lacerating the mucosal lining.
In every injury involving trauma of the extended anterior neck, laryngeal fracture must be suspected and ruled out. The relatively lower observed incidence of laryngeal fractures in children may reflect the resilience of the young cartilages.
The signs and symptoms of acute laryngeal trauma are airway obstruction, subcutaneous emphysema, hoarseness or aphonia, hemoptysis, odynophagia and loss of the normal external contour of the larynx, arytenoids dislocation, anteroposterior collapse of the larynx and vocal cord paralysis (2, 7).
Material and method
Seven patients treated for acute laryngeal trauma at the ENT Department of the Medical University of Warsaw, were evaluated between 2004 and 2005. These cases were primarily treated by otolaryngologists. All diagnoses of laryngeal trauma were confirmed by radiography and by laryngoscopic examination. The study group consisted of 4 boys and 3 girls with ages ranging from 5 to 9.
Symptoms ranged from mild neck pain to hoarseness and dyspnoea. The presenting signs and symptoms in this group were: hoarseness (5 cases), neck subcutaneous emphysema (2 cases), haemoptysis (4 cases), dyspnoea (3 cases), and mediastinal air (1 case).
Indirect or direct laryngoscopy and plain neck and chest X-rays were routinely performed.
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