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Management of Complex Laryngotracheal Injuries: A Challenging Surgical Emergency

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The High-risk Surgical Patient

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Abstract

Laryngotracheal trauma poses innumerable management challenges to the treating physician as it causes life-threatening morbidity or even mortality to the patient. Injury to the larynx can be direct or indirect mode. Laryngeal injuries frequently occur with other intracranial or cervical injuries. Suspected laryngeal injury be managed by a multidisciplinary trauma team. Penetrating injuries include suicidal or homicidal cutthroat, ballistic injuries, etc., which cause tissue loss. Blunt trauma includes clothesline or vehicle handlebar injuries causing disruption of tissue. Penetrating trauma may be associated with esophageal injury and vascular injury which must be addressed promptly to avoid complications like mediastinitis and mediastinal abscess. Complex laryngotracheal injury includes when there is rupture or damage in more than one site or when associated with esophageal and vascular injury. Fiberoptic transnasal laryngoscopy must be done in all stable patients to directly assess endolaryngeal structures. Imaging studies help in categorizing the patients who can be managed conservatively versus surgical exploration. Direct laryngoscopy and rigid esophagoscopy are done before inspecting the laryngeal cartilage and soft tissues and to examine the pharynx and esophagus. Minor endolaryngeal injuries are managed conservatively. Major laryngotracheal injuries require open surgery and primary closure. Laryngeal framework fractures should be reduced and fixated. Endolaryngeal stents are reserved for comminuted fractures and massive anterior commissure disruption. This chapter is intended to highlight the important aspects of laryngotracheal injury and its management during an emergency.

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Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India

    Raja Kalaiarasi & Kushwaha Akshat

  2. Department of ENT, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Karaikal, India

    Ramasamy Karthikeyan

Authors
  1. Raja Kalaiarasi
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  2. Kushwaha Akshat
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  3. Ramasamy Karthikeyan
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Editor information

Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Aseni

  2. Divisione di Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia, Pavia, Italy

    Antonino Massimiliano Grande

  3. Div. of Emerg. Surg., Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland

    Ari Leppäniemi

  4. Department of Pathophysiology and Transplantation, General Surgery and Trauma Team, University of Milano, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Osvaldo Chiara

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Kalaiarasi, R., Akshat, K., Karthikeyan, R. (2023). Management of Complex Laryngotracheal Injuries: A Challenging Surgical Emergency. In: Aseni, P., Grande, A.M., Leppäniemi, A., Chiara, O. (eds) The High-risk Surgical Patient. Springer, Cham. https://doi.org/10.1007/978-3-031-17273-1_71

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  • DOI: https://doi.org/10.1007/978-3-031-17273-1_71

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  • Online ISBN: 978-3-031-17273-1

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