Throat injury: causes, symptoms, diagnosis, treatment

The pharynx, anatomically and functionally, is an organ of primary importance. In anatomical terms, it borders on large main vessels, the wounds of which in most cases lead to death, with large nerve trunks that provide innervation of many vital organs. Functionally, the pharynx is an esophagus and airway organ that provides two essential functions - the nutritional and respiratory functions, without which the vital vital functions of the body are impossible, so the damage to this organ in the vast majority of cases leads to serious, sometimes fatal consequences, requiring urgent specialized medical help .

Classification of pharyngeal lesions

On a situational basis

• External damage
• Household:
  • blunt injuries;
  • stab wounds;
  • gunshot wounds.
• Production:
  • blunt injuries;
  • injuries.
• Wartime:
  • gunshot;
  • stab wounds;
  • blunt injuries.
• Internal damage
  • Household:
    • chemical;
    • thermal;
    • foreign bodies.
  • Production:
    • chemical;
    • thermal.
  • Wartime:
    • chemical;
    • thermal.

According to the etiology

• Dull injuries.
• Koloto-cut wounds.
• Gunshot wounds.
• Chemical burns.
• Thermal burns.
• Foreign bodies.

By anatomical principle

• Isolated wounds:
  • injuries of the nasopharynx;
  • injuries of the oropharynx;
  • injuries of the laryngopharynx.
• Combined wounds:
  • injuries of the nasopharynx and surrounding anatomical formations (bases of the skull, upper cervical vertebrae, vascular-neural bundle, auditory tube, internal parts of the braid);
  • injuries of the oropharynx and surrounding anatomical formations (vascular nerve bundle of the neck, cervical vertebrae, anatomical formations of the oral cavity);
  • injuries of the laryngopharynx and surrounding anatomical formations (root of the tongue, epiglottis, arytenoid cartilages, lower cervical vertebrae, vascular bundle);
  • injured throat, combined with injuries of the skull, maxillofacial area, trunk and extremities.
• Combined wounds:
  • isolated throat injury + chemical pharynx lesion;
  • Combined wounds of the pharynx + chemical attack of the pharynx;
  • isolated wound of pharynx + thermal burn of pharynx;
  • Combined wounds of the pharynx + thermal burn of the pharynx;
  • injured throat + foreign body pharynx (gunshot).

According to clinical manifestations

• Pain syndrome.
• Dysphagic syndrome.
• Obstructive syndrome.
• Hemorrhagic syndrome.
• Purulent-inflammatory syndrome.
• Syndrome of foreign body.

The presented classifications together reflect some kind of universal principle of classification of the pharynx lesions, equally acceptable for lesions of other ENT organs, however these classifications do not pretend to exhaustively represent all possible variants of pharyngeal damage, their combinations and combinations with other types of lesions, however, even in Such, in our opinion, incomplete form, these classifications can have a certain didactic value for practical doctors, namely, to orient them in what kind of varieties ntami, combinations and combinations of lesions and wounds of the pharynx they can meet in their work.

External damage to the pharynx. External damage can cause compression and concussion of the pharynx, ruptures of its walls, subluxations and fractures of the hyoid bone and cervical spine, as well as penetrating wounds when exposed to piercing-cutting objects, fragmentation and bullet wounds. The mechanism of external injuries is caused by mechanical action on the neck and indirectly through it - actually on the pharyngeal walls and its anatomical formations. Internal damage is characterized by the fact that the damaging factor penetrates into the pharynx through the oral cavity and, due to its invasive and aggressive properties, causes either mechanical, or thermal and chemical burns of the pharynx. Invasive properties are possessed by wedged foreign bodies possessing a certain volume (obstructive or non-obstructive), cutting and piercing facets, which can cause varying degrees of dysfunction of the pharynx and cause damage to its integrity - from superficial abrasions of the mucous membrane to complete perforation of the pharyngeal wall. Thermal burns of the pharynx from the intake of hot liquids

As already indicated in the above classifications, the wounds of the pharynx are divided into isolated and combined, according to the damaging factor - actually injuries, wedged foreign bodies, burns (chemical and thermal). Combined wounds are mainly related to injuries by stabbing, cutting tools and firearms, in which the injuries of the throat itself can be combined with injuries of other organs of the head and neck (brain, orbit organs, maxillofacial area, larynx, esophagus, temporal bone, large vessels neck and nerves).

Gunshot lesions of the pharynx. Most often to the combined wounds of the pharynx are gunshot wounds penetrating to a greater depth and covering extensive damage zones.

In all cases, external injuries of the pharynx are due to injuries to the neck. In peaceful conditions, these injuries are rare, wounds more often stabbed or cut and, as noted above, are related either to a suicidal attempt, a conflict situation or to murder. Often injuries to the neck arise as a result of bullet or shrapnel defeats on the battlefield during wartime or in the period of local military conflicts. The neck injuries during the Great Patriotic War accounted for about 1% of all gunshot wounds. Wounds of the neck are divided into non-penetrating and penetrating. Non-penetrating wounds are those that do not lead to injuries to large vessels and nerves of the neck and do not penetrate into its hollow organs (pharynx, larynx, trachea). These wounds were encountered four times more often than penetrating. This is due to the fact that many of the wounded with neck penetrating wounds die on the battlefield or on the site of injury in peacetime. The main manifestations of penetrating wounds of the neck are obstructive asphyxia, bleeding from large vessels, air embolism, shock, swallowing up to the impossibility of feeding through the mouth. Special hazards arise from injuries of the spinal cord (tetraplegia, respiratory and cardiac disorders, etc.).

The wounded with penetrating wounds of the neck with damage to vital organs are usually delivered to the medical institution in a coma, while they are sent directly to the operating room for emergency surgical help (stopping bleeding, fighting asphyxia, getting out of the coma). In foreign clinics, a scale for assessing the depth of coma in scores is widely used for prognostic assessment of the patient's condition necessary for predicting the outcome and selecting the right treatment tactics according to the method developed at the University of Glasgow.

The injuries of the nasopharynx are often combined with injuries of the nose and paranasal sinuses. When wounded in the front, the wound channel usually passes through the nasal cavity or one of the anterior paranasal sinuses, less often through the orbit. The most dangerous are penetrating wounds of the pharynx, which are combined with damage to the latticed bone, the posterior frontal sinus wall, and the sphenoid sinus. Often combined diseases of the nasopharynx are accompanied by a nasal liquorrhea. Dangerous also nasopharyngeal and I neck cervical lesions with damage to the spinal cord. Such injuries are often incompatible with life. Injuries to the nasopharynx are usually complicated by tubootitis or hematotympanum followed by possible acute purulent otitis media.

Gunshot wounds of the nasopharynx with the penetration of a wounding projectile from behind are fatal, since the wounding shell, before reaching the pharynx, damages I and II cervical vertebrae and spinal cord. As Yu.K. Yanov and LA Glaznikov (1993) note, common symptoms of nasopharyngeal injury include loss of consciousness, shock and coma, caused mainly by a combination of nasopharyngeal wound and injury to the occipital region of the skull.

Gunshot wounds of the middle and lower throat, especially those applied at close range (shot in the mouth), are accompanied by extensive destruction of the maxillofacial region, sometimes complete violation of the integrity of the pharynx, the defeat of the cervical vertebrae and the wound of the spinal canal. Such wounds are almost never isolated and are combined, as already mentioned, with injuries of the spine, as well as the hyoid bone, large vessels and nerves of the neck. The latter, as a rule, leads to rapid death of the patient at the scene.

Typical injuries of the pharynx are cut transverse and chopped wounds inflicted for killing, suicide, knife, razor, etc. The most dangerous are stab wounds applied to the anterior edge of the sternocleidomastoid muscle at the angle of the lower jaw, where the common carotid artery passes. Less dangerous are transverse wounds, applied with a head thrown back. In this case, the trachea or larynx is damaged, but not the carotid arteries, which, when tilting the head, are displaced posteriorly and do not enter the area of action of the cutting implement. If the brine is applied above the hyoid bone, the root of the tongue and the muscles that lift the larynx are usually cut; if directly below the hyoid bone, the epiglottis is wounded and sometimes completely cut off, which in this case falls out into the wound or goes up into the lumen of the oropharynx. A wound below the Adam's apple leads to damage to the larynx.

Wounds of the pharynx lead to significant violations of many of its functions and functions of other organs, especially when the corresponding nerve trunks (vagus nerve, sympathetic ganglia and trunks) are affected. In these cases, there are aphagia, aphonia, apnea, a violation of articulation. If death does not come from blood loss or mechanical asphyxia, then the victim is trapped by another danger: secondary complications in the form of phlegmon perifarinealyuyu fiber, arrosion of large blood vessels, perichondritis of the larynx, descending cervicothoracic mediastinitis.

The main symptoms of the wound of the pharynx are the presence of a wound, bleeding from it or from the oral cavity and nose (with nasopharyngeal injury), swallowing disorder, voice formation, pain, blood blister in the wound channel when trying to exhale with a closed mouth and a clamped nose. In the future, it is possible to impede breathing due to tongue twisting in case of damage to the hyoid bone and the muscles attached to it. With a narrow wound channel and edema in the hypopharynx, subcutaneous or mediastinal emphysema may occur.

Treatment of injuries of the neck and throat. The main task of first aid is a temporary stop of bleeding (if any). Apply finger compression of the carotid artery to the transverse process of the sixth cervical vertebra, and then apply a pressure bandage with a pelota and a tire laid on the shoulder of the healthy side and on the head. The tire can be replaced by the upper limb of the healthy side wound on the head, according to A. Kaplan. When providing the first medical aid, tracheotomy can be performed according to vital indications. At the stage of providing qualified medical care, the indication for surgery is primarily bleeding. However, the revision of the neurovascular bundle is an obligatory measure even when a large vessel is suspected of injury. An urgent indication for surgical treatment of the wound is also the wound of the esophagus. In this case, the wound is widely dissected and tamponized. Finally, tracheostomy may be required for secondary respiratory obstruction at the level of the larynx and throat. If there are no vital indications for the operation, the wounded in the neck are evacuated to a specialized department where they will receive definitive surgical care.

[1], [2], [3], [4], [5], [6]