Laryngeal and Esophageal Trauma

8.3.1 Describe the zones of the neck and zones of the face. How does this impact workup of the patient?

8.3.2 Give us a grading system of laryngeal fractures. How does the grade affect acute and long term management? What grade injury is represented in the picture?

8.3.3 Discuss the role of CT scan in decision making for the care of laryngeal trauma.

8.3.4 Discuss the role of stents and keels in operative management of laryngeal fractures.

8.3.5 How do you assess and manage inhalation injury to the larynx? Is there a difference in steam vs. fire inhalations?

8.3.6 An 18-year old female presents to the Trauma Unit after a clothes line injury to the neck (she and her girlfriend were joy riding on a moped at 2AM and ran into a metal chain). She is stable, but appears to be having increasing respiratory distress. What do you look for on physical exam and how will you work this up? Does she need to go to the OR stat?

Goudy SL, Miller FB, Bumpous JM. Neck crepitance: evaluation and management of suspected upper aerodigestive tract injury. Laryngoscope. 2002 May;112(5):791-5. PMID:12150608

8.3.7 What is the best way to manage the airway in laryngotracheal trauma? What role does intubation play in that management?

8.3.8 What is the role of steroids in acute management of laryngeal fractures?

8.3.9 Tell us about penetrating injuries to the larynx and esophagus. Does stab penetrations differ from gunshot injuries in regards to the nature of the injury? How?

8.3.10 Do pediatric patients differ from adults in the incidence and extent of laryngeal trauma? Why? How is the management of pediatric laryngeal trauma similar and different from adults?

Merritt RM, Bent JP, Porubsky ES. Acute laryngeal trauma in the pediatric patient. Ann Otol Rhinol Laryngol. 1998 Feb;107(2):104-6. PMID:9486903

Shires CB, Preston T, Thompson J. Pediatric laryngeal trauma: a case series at a tertiary children's hospital. Int J Pediatr Otorhinolaryngol. 2011 Mar;75(3):401-Epub 2011 Jan 16. PMID:21242005

8.3.11 An adult male presents to the Trauma Unit with a knife lodged in zone II of neck. Discuss selective vs. mandatory exploration.

8.3.12 Would you use plates to fixate a laryngeal fracture?

de Mello-Filho FV, Carrau RL. The management of laryngeal fractures using internal fixation. Laryngoscope. 2000 Dec;110(12):2143-6. PMID:11129037

Dray TG, Coltrera MD, Pinczower EF. Thyroid cartilage fracture repair in rabbits: comparing healing with wire and miniplate fixation. Laryngoscope. 1999 Jan;109(1):118-22. PMID:9917052

8.3.13 What is the proper work-up of a patient with a GSW to the neck?

Mohammed GS, Pillay WR, Barker P, Robbs JV. The role of clinical examination in excluding vascular injury in haemodynamically stable patients with gunshot wounds to the neck. A prospective study of 59 patients. Eur J Vasc Endovasc Surg. 2004 Oct;28(4):425-30. PMID:15350568

van As AB, van Deurzen DF, Verleisdonk EJ. Gunshots to the neck: selective angiography as part of conservative management. Injury. 2002 Jun;33(5):453-6. PMID:12095728

8.3.14 A trauma patient experiences a 1 cm tear of the hypopharynx? Would you manage this differently than a similar tear in the lower cervical esophagus?