Symptoms of traumas of the larynx and trachea

The severity of clinical manifestations depends on the degree of damage to the organs and structures of the neck, the general condition of the patient, which is affected by the vastness of the impact and the nature of the traumatic agent. The first and the main symptom of traumatic injury of the larynx and trachea is a violation of the function of respiration of different severity. Respiratory failure can develop immediately after the impact of the traumatic factor or in later periods due to the increase in edema, hematoma, and tissue infiltration.

Dysphonia is typical for any damage to the larynx, especially its voice department. The deterioration in the quality of the voice can be sudden or gradual. If the trachea is damaged or bilateral paralysis of the larynx with stenosis of the lumen, the voice function suffers less.

Symptoms are also considered pain when swallowing, in the projection of the larynx and trachea, "the feeling of a foreign body." Dysphagia, a violation of the laryngeal function is more likely to occur with the pathology of entering the larynx or paresis of the larynx, the 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 a non-permanent symptom, it can be caused by the presence of a foreign body, acute inflammatory reaction or internal bleeding.

The appearance of subcutaneous emphysema indicates the penetrating nature of the wound of the larynx or trachea. In the latter case, emphysema grows particularly rapidly, spreading to the neck, chest, to the mediastinum. An increase in infiltration, leading to changes in the contour of the neck, is a sign of weighting the course of the wound process.

Bleeding due to damage to the hollow organs and soft tissues of the neck is considered life threatening with open trauma of large vessels and in case of internal bleeding that causes aspiration of blood or formation of hematomas narrowing the larynx and trachea lumen.

Coughing, hemoptysis, pain syndrome, dysphonia, shortness of breath, development of subcutaneous and intermuscular emphysema are expressed to a large extent with transverse ruptures of the larynx and trachea. When the larynx is detached from the hyoid bone, laryngoscopy reveals elongation of the epiglottis, unevenness of its laryngeal surface, abnormal mobility of the free edge, low location of the glottis, accumulation of saliva, impaired mobility of the larynx elements. By changing the configuration of the neck, the mutual topography of the larynx, the trachea and the hyoid bone, areas of soft tissue delamination in the rupture zone, one can judge the separation of the larynx from the hyoid bone, the larynx from the trachea, and the transverse rupture of the trachea. The increase in the distance between the upper edge of the thyroid cartilage and the hyoid bone is 2-3 times that of the rupture of the hypoglossal membrane or the fracture of the hyoid bone with laryngeal separation. This breaks the separation function, which is confirmed by radiopaque examination of the esophagus - the larynx is lowered to 1-2 vertebrae and the high standing of the epiglottis. When the larynx is separated from the trachea, the high standing of the epiglottis, paralysis of the larynx, violation of the separation function, swelling and infiltration of soft tissues in the area of damage are noted; may violate the integrity of the anterior pharyngeal wall.

With penetrating wounds of the area of the thyrotilaginous membrane (sublingual pharyngotomy), as a rule, there is a complete intersection of the epiglottis and a shift to the top, paralysis of the larynx occurs. The inclination of the thyroid cartilage is forward and the larynx is lowered. When viewed, a gaping defect is visible. With a penetrating wound of the conical ligament a defect arises between the cricoid and thyroid cartilage, which subsequently leads to the formation of cicatricial stenosis of the pharyngeal larynx.

Hematomas of the larynx can be limited, occupying only one vocal fold, and extensive, leading to a violation of airway patency. When laryngoscopy is detected, infiltration of soft tissues and imbibition with their blood. The mobility of the larynx elements is severely impaired and can be normalized after resorption of the hematoma. Deformation of the inner walls of the larynx and trachea, their thickening and infiltration testify to the onset of chondroperichondritis.

Intubation injury is characterized by injury to the tissues of the posterior larynx. With dislocation and subluxation of the arytenoid cartilage, it moves medially and anteriorly, either laterally or posteriorly. The voice crease is shortened, its mobility is disturbed, which can be determined by probing. Possible hemorrhages in soft tissues, linear ruptures of the mucous membrane with bleeding, tearing of the vocal folds, development of acute edematous or edema-infiltrative laryngitis. Post-traumatic injury can be the cause of the formation of granulomas and ulcers, paralysis of the larynx, synechia, cicatricial deformities of the larynx and trachea in the long term. Hemorrhage into the vocal crease violates its vibratory ability, which leads to the appearance of hoarseness. In the future, a cyst, scar scar tissue or persistent vascular changes in the vocal fold can be formed.

Burn injuries that occur when exposed to hot liquids are usually limited to the epiglottis and are manifested by acute edema-infiltrative laryngitis, often with stenosis of the airway lumen. When chemicals get in the way, the changes in the esophagus can be more severe than the oropharynx and larynx. Patients often complain of pain in the throat, chest and abdomen, dysphagia, dysphonia and respiratory failure. Burn inhalation lesions are much more serious. A severe inflammatory process develops, accompanied by swelling, then granulation, scarring and stenosis of the airway lumen: changes in the mucous membrane of the oropharyngeal nose in the form of acute edema-infiltrative inflammation.

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

• the first - the edema and hyperemia of the mucosa;
• the second - damage to the mucous membrane, submucosal layer and muscular lining (can be linear or circular, the latter usually heavier);
• the third - extensive damage with the development of necrosis, mediastinitis and pleurisy, accompanied by high mortality.