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Injuries (trauma) to the larynx and trachea - Diagnosis
Last reviewed: 06.07.2025
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Clarification of the time of injury, detailed characteristics of the traumatic agent and the mechanism of injury are important factors in assessing structural and functional damage to the hollow organs of the neck.
Physical examination
Includes a general examination and assessment of the patient's general somatic condition. When examining the neck, the nature of the injury and the condition of the wound surface are assessed, and hematomas are identified. Palpation of the neck allows one to determine the integrity of the larynx and trachea skeleton, areas of compaction, crepitus zones, the boundaries of which are marked in order to track the dynamics of emphysema or soft tissue infiltration. In case of penetrating wounds, in some cases, probing of the wound canal is permissible. The manipulation must be carried out with great caution due to the possibility of causing additional iatrogenic injury.
Laboratory research
In addition to a general clinical examination aimed at determining the severity of the patient's general somatic condition, it is necessary to determine the gas and electrolyte composition of the blood and conduct a microbiological study of wound discharge.
Instrumental research
- indirect laryngoscopy and microlaryngoscopy;
- X-ray tomography of the larynx and trachea;
- endofibroscopy of the larynx, trachea and esophagus;
- X-ray of the lungs and mediastinum, esophagus with barium;
- CT of the hollow organs of the neck;
- study of external respiratory function;
- microlaryngostroboscopic examination (indicated in the absence of severe injuries or at late stages after injury in order to study the vibratory function of the vocal folds). It is necessary to emphasize the importance of primary endoscopic examination and control at all stages of rehabilitation of a patient with injuries of the hollow organs of the neck. In cases of extensive injuries, surgical revision of the wound is required, since up to 50-70% of traumatic injuries are not diagnosed during a routine examination.
Differential diagnostics of damage (injuries) of the larynx and trachea
In acute trauma of the larynx and trachea, differential diagnostics is not difficult and is carried out based on the disease history. In rare cases of a combination of previous organic pathology of the larynx, especially with the development of infiltration against the background of a tumor process, tuberculosis, chondroperichondritis and a burn with chemicals or a foreign body injury, difficulties in interpreting the laryngoscopic picture may arise. In such situations, a short course of anti-inflammatory therapy and the use of additional examination methods are necessary for differential diagnostics.
Indications for consultation with other specialists
Consultations with other specialists are necessary, since damage to the larynx and trachea in neck trauma is rarely isolated. If there is a suspicion of injury to the esophagus or thyroid gland, a consultation with a surgeon is indicated, for the thoracic part of the trachea - a thoracic surgeon; in case of poisoning with chemicals - a toxicologist; to correct drug treatment - a therapist; to determine the possibility of using physiotherapeutic methods - a physiotherapist. In the long term after the injury, the patient may require treatment with the participation of a speech therapist.
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