Blunt, external laryngeal trauma, clinincal analysis and management, experience at combined military hospital, Rawalpindi

ABSTRACT

18 cases of external laryngeal trauma are being analyzed retrospectively. Main etiological factors were road traffic accidents 11 cases [61.11%] accidental strangulation 3 cases [16.66%], blunt trauma due to fall 1 case [5.5%] during fight 2 cases [11.11%] and suiccidal attempt 1 case [5.55%]. Most of the patients presented with hoarseness or aphonia 8 cases [44.44%], pain and tenderness of neck 6 cases [33.33%], odynophagia 6 cases [33.33%] and swelling of the neck one case [5.55%]. After careful history, meticulous examination and detailed investigations patients were grouped according to clinical findings. Group one had 4 patients having supraglottic swelling, edema, ore stenosis occurs as a squalal of lalpferl trauma ad occurs after sometime, not immediatily after trauma hamatoma [22.22%], group two had six patients having supraglottic stenosis [33.33%] group three had subglottic stenosis. Number of patients was again 6 [33.33%]. Group four had two patients having subglottic stenosis and tracheal stenosis [11.11%]. Treatment was varied depending upon the severity of the injuries. Fourpatients [22.22%] were managed by tracheostomy and conservative measures i.e., voice rest, humidification and bed rest. Fourpatients [22.22%] underwent laryngotracheal reconstruction with hyoid descent, three patients [16.66%] had suprahyoid release, resection and reanastomosis of stenotic segment. Two patients [11.11%] had laser ablation, two patients [11.11%] had laser ablation and serial dilations and one patient [5.55%] had laryngotracheal reconstruction with hyoid descent and augmentation with septal cartilage. Three patients [16.66%] underwent more than one operation. Fifteen patients out of eighteen [83.33%] recovered un-eventfully having stable air way, voice capable of verbal communication, decannulation and swallowing without aspiration, two patients [11.11%] are still not decannulated and are declared unsuccessful, one patient [5.55%] has got left vocal cord paralysis. A delay in early detection of external laryngeal trauma may precipitate life threatening airway compromise later on, therefore prompt and accurate diagnosis should immediately be followed by skillful air way management