Symptoms of laryngeal and tracheal injuries

The severity of clinical manifestations depends on the degree of damage to the organs and structures of the neck, on the general condition of the patient, which is affected by the extent of the impact and the nature of the traumatic agent. The first and main symptom of traumatic damage to the larynx and trachea is respiratory dysfunction of varying severity. Respiratory failure can develop immediately after exposure to a traumatic factor or at a later date due to increasing edema, hematoma, tissue infiltration.

Dysphonia is typical for any damage to the larynx, especially its vocal section. Deterioration in voice quality can be sudden or gradual. In case of damage to the trachea or bilateral paralysis of the larynx with stenosis of the lumen, the vocal function suffers to a lesser extent.

Characteristic symptoms also include pain when swallowing, in the projection of the larynx and trachea, "a feeling of a foreign body". Dysphagia, a violation of the dividing function of the larynx, often occur with pathology of the entrance to the larynx or paresis of the larynx, pathology of the esophagus or pharynx. The absence of dysphagia does not indicate the absence of pathology of the larynx and esophagus.

Cough is also an inconstant symptom and may be caused by the presence of a foreign body, an acute inflammatory reaction, or internal bleeding.

The appearance of subcutaneous emphysema indicates a penetrating nature of the injury to the larynx or trachea. In the latter case, emphysema grows especially quickly, spreading to the neck, chest, and mediastinum. Increased infiltration, leading to changes in the contour of the neck, is a sign of aggravation of the wound process.

Bleeding from damage to hollow organs and soft tissues of the neck is considered life-threatening in the case of open trauma to large vessels and in the case of internal bleeding, causing aspiration of blood or the formation of hematomas that narrow the lumen of the larynx and trachea.

Cough, hemoptysis, pain syndrome, dysphonia, dyspnea, development of subcutaneous and intermuscular emphysema are expressed to a significant extent in transverse ruptures of the larynx and trachea. In case of rupture of the larynx from the hyoid bone, laryngoscopic examination reveals elongation of the epiglottis, unevenness of its laryngeal surface, abnormal mobility of the free edge, low position of the glottis, accumulation of saliva, impaired mobility of the larynx elements. Based on the change in the configuration of the neck, the mutual topography of the larynx, trachea and hyoid bone, areas of retraction of soft tissues in the rupture zone, one can judge the rupture of the larynx from the hyoid bone, the larynx from the trachea, and a transverse rupture of the trachea. An increase in the distance between the upper edge of the thyroid cartilage and the hyoid bone by 2-3 times indicates a rupture of the thyrohyoid membrane or a fracture of the hyoid bone with rupture of the larynx. In this case, the dividing function is impaired, which is confirmed by a radiopaque examination of the esophagus - a descent of the larynx by 1-2 vertebrae and a high position of the epiglottis are detected. When the larynx is torn from the trachea, a high position of the epiglottis, paralysis of the larynx, impaired dividing function, edema and infiltration of soft tissues in the area of damage are noted; a violation of the integrity of the anterior pharyngeal wall is possible.

In case of penetrating wounds of the thyrohyoid membrane (sublingual pharyngotomy), as a rule, the epiglottis is completely transected and displaced upward, and laryngeal paralysis occurs. Anterior tilt of the thyroid cartilage and drooping of the larynx are noted. A gaping defect is visible upon examination. In case of penetrating wound of the conical ligament, a defect is formed between the cricoid and thyroid cartilage, which subsequently leads to the formation of cicatricial stenosis of the subglottic part of the larynx.

Laryngeal hematomas may be limited, occupying only one vocal fold, or extensive, leading to obstruction of the airways. Laryngoscopy reveals infiltration of soft tissues and their imbibition with blood. The mobility of the laryngeal elements is severely impaired and may return to normal after the hematoma resolves. Deformation of the internal walls of the larynx and trachea, their thickening and infiltration indicate the onset of chondroperichondritis.

Intubation trauma is characterized by injury to the tissues of the posterior larynx. When the arytenoid cartilage is dislocated or subluxated, it moves medially and anteriorly or laterally and posteriorly. The vocal fold is shortened, its mobility is impaired, which can be determined by probing. Hemorrhages into soft tissues, linear ruptures of the mucous membrane with bleeding, ruptures of the vocal folds, and the development of acute edematous or edematous-infiltrative laryngitis are possible. Post-intubation trauma can cause the formation of granulomas and ulcers, laryngeal paralysis, adhesions, and cicatricial deformities of the larynx and trachea in the long term. Hemorrhage into the vocal fold disrupts its vibratory ability, which leads to hoarseness. A cyst, cicatricial deformity, or persistent vascular changes in the vocal fold may subsequently form.

Burn injuries caused by exposure to hot liquids are usually limited to the epiglottis and manifest as acute edematous-infiltrative laryngitis, often with stenosis of the lumen of the respiratory tract. When chemicals enter the body, changes in the esophagus may be more severe than in the oropharynx and larynx. Patients often complain of pain in the throat, chest and abdomen, dysphagia, dysphonia and respiratory failure. Burn inhalation injuries are much more serious. A severe inflammatory process develops, accompanied by edema, then granulation, scarring and stenosis of the lumen of the respiratory tract: changes in the mucous membrane of the nose and oropharynx in the form of acute edematous-infiltrative inflammation.

Burn injuries are often complicated by pneumonia. The general condition of the patient in such situations depends on the toxicity of the traumatic agent and the extent of the injury. According to the endoscopic picture, several degrees of burn injury can be distinguished:

• the first is swelling and hyperemia of the mucous membrane;
• the second is damage to the mucous, submucous layer and muscular lining (can be linear or circular, the latter is usually more severe);
• the third is extensive damage with the development of necrosis, mediastinitis and pleurisy, accompanied by high mortality.