Results

Larynx and upper trachea. If principles of management are strictly observed for isolated laryngeal and upper tracheal trauma (see Chapter 31, "Repair of Tracheobronchial Trauma"), the results of treatment of acute injuries are generally very good (Table 9-2). Since tissues beyond the actual area of injury are essentially normal, precise reconstruction with accepted techniques generally produces a permanently satisfactory airway. In a series of 10 patients treated promptly for acute injuries, all achieved an excellent airway, and there were no instances of later tracheal stenosis.2 Couraud and associates treated 19 patients with laryngotracheal disruption; 11 within 5 days of injury, 17 by similar repairs but with stenting in 13, and 2 by laser and stent-ing.3 Excellent respiratory results were achieved in all. Phonation was good in 7 of the patients and fair in 13, reflecting the impossibility of restoring true vocal cord normalcy. Schaeffer reported excellent results in treatment of acute laryngeal trauma.4 Early definitive treatment was emphasized based on classification by severity of the laryngeal injury, with observation only in the absence of mucosal laceration or cartilaginous fracture and displacement. Functional results are generally better, following early rather than delayed repair.

Delayed management of these injuries presents a multitude of problems, depending on the individual injury and the nature of the prior treatment. Where both recurrent laryngeal nerves are permanently damaged, a wholly adequate albeit husky voice can be obtained. A paralyzed larynx can still function satisfactorily for speech. The glottic aperture must be fixed at approximately 4 mm (see Chapter 35, "Laryn-gologic Problems Related to Tracheal Surgery"). This provides for clear speech, which is produced largely by the pharyngeal musculature, with the lung bellows providing an air column in a more efficient way than the stomach and esophagus do for so-called "esophageal speech" after laryngectomy. Modulation of voice is lacking. A high school senior who had suffered tracheal separation with bilateral cord paralysis reported, after repair of glottis and trachea, that he was able to return to the debating team but not to the glee club. If the glottic aperture is made narrower, speech may be improved, but the patient will not be able to move

figure 9-8 Late findings 6 months after a motorcycle-cable injury in a 15-year-old, resulting in high tracheal separation and esophageal avulsion at the cricopharyngeus. The left vocal cord was paralyzed and the right functioned suboptimally. A, Anteroposterior tomographic section showing severe stenosis of cervical trachea. The subglottic larynx lies at the top. Arrow at site of stricture. B, Lateral neck view with swallow of barium. Arrow indicates stricture of the trachea. Severe stenosis of the esophagus is demonstrated by contrast medium. Both injuries were successfully corrected surgically in a single procedure.

figure 9-8 Late findings 6 months after a motorcycle-cable injury in a 15-year-old, resulting in high tracheal separation and esophageal avulsion at the cricopharyngeus. The left vocal cord was paralyzed and the right functioned suboptimally. A, Anteroposterior tomographic section showing severe stenosis of cervical trachea. The subglottic larynx lies at the top. Arrow at site of stricture. B, Lateral neck view with swallow of barium. Arrow indicates stricture of the trachea. Severe stenosis of the esophagus is demonstrated by contrast medium. Both injuries were successfully corrected surgically in a single procedure.

figure 9-9 Another 15-year-old who suffered a motorcycle-cable injury 4 months earlier. Airway obstruction was emergently treated with tracheostomy at an outside hospital, and subluxation of C2-C3 was managed with Crutchfield tongs and traction. After initial recovery, the patient was able to swallow liquids and semisolids only. A, Contrast outlines the subglottic larynx and a short segment of the proximal trachea. The arrow marks the point of transection. The channel below is the esophagus. B, Lateral view shows barium in the larynx above (at left) passing through a narrow fistula (arrow) to the distal esophagus. Retracted pouch of avulsed pharynx is seen behind the larynx on the right with a blind sinus below it. Tracheostomy provided access to the distal trachea. C, Lateral view following reconstruction of trachea and esophagus. Air column of trachea is seen (at left) anterior to the contrast-filled upper esophagus, showing a good lumen at the site of repair. Thyrohyoid muscle was interposed between the suture lines. The right vocal cord had sufficient function to provide satisfactory voice. Swallowing returned satisfactorily

Was this article helpful?

0 0
Peripheral Neuropathy Natural Treatment Options

Peripheral Neuropathy Natural Treatment Options

This guide will help millions of people understand this condition so that they can take control of their lives and make informed decisions. The ebook covers information on a vast number of different types of neuropathy. In addition, it will be a useful resource for their families, caregivers, and health care providers.

Get My Free Ebook


Post a comment