The laryngeal trauma - a fulminant emergency

Introduction Accidents or grave offenses may cause varying degrees of laryngeal injury. An initially banal bruise can develop into a sudden life-threatening situation.

Case report A 72-year-old patient with Parkinson's disease, decreased responsiveness and walking ability had fallen and hit his neck on an edge.

Results In our emergency department, the patient was initially awake, maintaining stable respiratory and circulatory conditions, laryngoscopically having a wide glottis. During advanced diagnostics using CT scan, the patient developed progressive dyspnea. Immediately after imaging, the control endoscopy was performed. Pronounced laryngeal edema with a minimal glottic residual gap was seen, the fiber-optic wake intubation was therefore performed. A dislocated longitudinal fracture of the larynx with extensive soft tissue emphysema to the mediastinum was detected in the CT scan. On re-examination an extended crepitation of the Larynx was palpable. The indication for surgery was confirmed. Rigid laryngoscopy was performed the following day, where edematous vocal folds with ventral shift of the left vocal cord were seen. After tracheostomy, the fracture treatment was performed by plate chondrosynthesis. There was a complete longitudinal fracture of the thyroid cartilage from the left laryngeal incisure to the lower edge of the thyroid cartilage with intact mucosa. Ten days after fracture treatment, decannulation was performed resulting in the patient having a good voice.

Summary Patients with laryngeal trauma should be regarded as potentially vital threatened even with initially stable conditions and inconspicuous glottis findings and should be closely monitored in the emergency department.

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Artikel online veröffentlicht:
10. Juni 2020