Injuries of the pharynx and larynx - damage received by this part of the human body. Their causes may be directly affecting the area factors or indirect impact. Influence is possible external, internal. Currently, in the ICD-10, larynx injury refers to a group of neck injuries, coded by codes S10-S19. Separately, specific damage to the larynx is classified, for example, those received due to burns are encrypted as T20-T32.
About terminology and coding
In the ICD, laryngeal trauma is mainly considered in the group of neck injuries. The same category includes areas near the larynx: the back of the neck, the area above the collarbones. The general group of diagnoses combines injuries, dislocations and fractures of the elements of this area. This classification excludes not only the burns mentioned above, obtained under the influence of chemical components, high temperature. A separate category in the ICD is injuries associated with the penetration of a foreign object into the human body. If this caused damage to the larynx, the diagnosis is T17.3.
Ifopen, closed injuries of the larynx can be explained by frostbite, the ICD case will be coded as T33-T35. Code T63.4 is dedicated to a specific situation: injury as a result of the bite of an animal or insect poisonous to humans.
Types and types
Currently, clinical practice uses a classification system for all cases based on a set of criteria. The main types of trauma to the larynx: internal, external. To be included in the group, they analyze what caused the damage. External injuries in an impressive percentage of cases are combined, in addition to the larynx, other organs and tissues located nearby suffer. Internal cases are often isolated, affecting only the larynx.
It is also customary to distinguish between penetrating and non-penetrating injuries. To belong to a specific group, the fact of penetration of a foreign structure is revealed. Assessing the features of damage, the case is classified as closed or open.
Common Causes
Often the source of all troubles is a blow to the larynx, more often with a blunt object, including a human fist. Often in clinical practice, cases of injuries received during sports activities, in a traffic accident. Finally, the injury may be the result of a strangulation attempt.
With blunt trauma, the ligaments that provide a person with the opportunity to speak are often torn, and the integrity of the hyoid bone also suffers. Such a case is usually accompanied by an injury to the cartilage of the larynx.
Penetrating wounds are more often explainedimpact of a bullet, a knife. About 80% of all cases are penetrating wounds.
Internal trauma may appear on the background of medical measures (biopsy, examination of the bronchi from the inside, intubation). There are frequent (especially in childhood) cases when the injury is associated with the penetration of an object with sharp edges into the larynx.
Finally, a burn occurs when poisonous chemicals or very hot steam are inhaled.
When to see a doctor
Symptoms of a laryngeal injury depend on the location of the injury and its extent. As a rule, breathing is disturbed: from mild problems to the inability to breathe on their own. Dysphonia accompanies laryngeal injuries, it is especially pronounced if the vocal cords are affected. If the integrity of the laryngeal inlet is broken, dysphagia is possible, that is, the patient cannot swallow normally.
Symptoms of trauma to the larynx, accompanied by a violation of the nervous structures, include neuropathic paresis. With external trauma, bleeding is usually fixed, which is noticeable to an external observer. If the injury is internal, the hemorrhage also occurs inside the body. A visual noticeable sign of such a complication is the coughing up of a patient with blood.
How the doctor can help
Treatment of a laryngeal injury begins with anti-shock measures. The task of specialists is to stop bleeding and normalize the functioning of the respiratory system, thereby ensuring a stable supply of air to the lungs and its exchange. The patient must be placed in a horizontal position, slightly raising his head,and fix the neck in a motionless state. Assign maintenance therapy with oxygen, ventilation through an automated system with a mask. Nutrients are introduced through a tube into the digestive system.
During the treatment of trauma of the larynx and trachea, the patient is shown a complex of medications. Features of the course are selected, focusing on the nuances of the case. As a rule, antimicrobial therapy is needed, as well as means to relieve pain, relieve swelling. Often, treatment involves a course to inhibit the activity of inflammatory foci and an infusion program. Antimicrobial formulations are used in the form of inhalations. With large-scale damage and skeletal disorders, progressive emphysema, violation of the integrity of the cartilage, urgent surgery is indicated. It should also be done in case of profuse hemorrhage. Delay in providing assistance can be fatal.
Relevance of the issue
The statistics show that injuries of the larynx and trachea are relatively rare in our lives. The increase is observed during military conflicts, but in civilian life such problems are more often associated with sports and accidents. However, violent factors are also possible. Assessing the features of the injury, they talk about injury to the subglottic area, the thyroid-hyoid membrane.
Regardless of the nuances of the location and severity of damage, a larynx injury (blunt, cut, stabbed, any other) always leads to a deterioration in a person's condition, a violation of vital functions. Many people have low blood pressure, and cases of laryngeal stenosis are not uncommon. Arisearrhythmia and tachycardia, fever. Some manifestations are explained by respiratory disorders, others - by the injury itself or its consequences, including the invasion of pathological microflora. Injuries and papillomas of the larynx require special medical attention, and if they are suspected, assistance should be provided immediately.
Pay attention
Against the background of an open, closed injury of the larynx, consciousness can be confused, but in some patients it is fully preserved, although cases of a completely unconscious state are also not uncommon. Usually it depends on the scale of damage and the severity of the injury, its nature, features.
Sometimes a cut, stab, blunt injury to the larynx is accompanied by a violation of the integrity of the thyroid gland. This can be suspected if the case is accompanied by heavy bleeding. There is also a possibility of damage to the carotid arteries. This condition is extremely dangerous, in just a few minutes a person can die. There are cases when damage to these arteries provoked death in a matter of seconds.
Nuances of assistance
When the larynx is injured, the first and most important measure is to stop bleeding. If conditions allow, measures to replenish blood loss should immediately begin. In the predominant percentage of cases, patients are shown tracheotomy. In case of violation of the integrity of the thyroid-hyoid membrane, the area should be sutured in layers, as part of the operation, attaching the laryngeal tissues to the hyoid bone. For this, doctors use chrome-plated catgut. When the damage is localized in the subglottic region, it is necessary tolayers to sew up the diseased area.
If, in case of a laryngeal injury, it is necessary to install a probe to provide the patient with food, it is inserted even before suturing the affected area. This minimizes the risk of infection in the wound. Antibiotics to maintain a stable state in the described injury are administered in large doses.
If the injury is puncture, it is necessary to pay attention to emphysema, stenotic breathing: in the presence of such features, additional measures are required to stabilize the patient's condition.
Patient safety first
When the larynx is injured, the main measures are related to the normalization of the respiratory function. As soon as first aid is completed, the patient should be administered anti-tetanus serum. In the future, he will have to endure a long course of anti-inflammatory drugs.
If the injury is a gunshot, only the larynx rarely suffers. As a rule, the integrity of the esophagus and pharynx, vascular and nervous systems is violated. The spinal column, brain, thyroid gland may be involved in the process. It is customary to distinguish blind, through, tangential wounds and those received tangentially. Among the diagnostic measures, X-ray is considered the most interesting and useful - it is possible to quickly and accurately localize a foreign object, assess the state of the laryngeal skeleton from the image. The therapeutic course is aimed at normalizing breathing, eliminating the state of shock, and treating the affected areas. Medications are chosen to stop the activity of inflammatory processes, general strengtheningbody and alleviate the condition of the patient.
Gunshot wounds: features
If the laryngeal injury is due to this very reason, breathing can be normalized by tracheotomy. To block blood flow, vascular ligatures, ligation of the external carotid artery are indicated. If the case requires it, otherwise the person cannot be saved, the common carotid artery is also blocked. Measures to eliminate shock are non-specific, generally accepted for surgical practice.
To suppress inflammation, high-dose antibiotics and semi-synthetic drugs are shown to combat pathological microflora. The use of desensitizers and sulfa drugs is widespread.
Closed Injury
Such an injury can be provoked by the penetration of a foreign object into the organ. The cause may be bones, metal objects and other objects. The injury to the larynx will be closed when strangulated. There are cases when the integrity of the mucosa was broken during intubation or during laryngoscopy. Prolonged and rough influence of medical instruments can cause a specific form of granuloma. Most often, such an injury is localized on the free edge of the fold responsible for the ability to make sounds: the anatomical structure of the human body is such that it is here that organic tissues and medical instruments interact most closely.
Closed trauma of the larynx (due to suffocation, intubation or other aggressive factor) indicates a strong and sharp pain, localized in the area of damage to the integrity of the mucous membranes. Feelings are especially pronounced if you try to swallow something. The brightest pain syndrome is inherent in injuries localized in the arytenoid cartilages covering the epiglottis of the mucous membranes. Infiltration, puffiness initiate abscess formation, it is difficult for the patient to breathe. The inflammatory process can cover nearby tissues and organs, due to which the ability to swallow is disturbed, dysphagia worries. Severe and sharp pain does not allow swallowing even saliva. It can be seen from the side: the patient seeks to maintain his head in a stationary position. To clarify the condition, it is shown to make cervical, laryngeal lateral images. With insufficient information content, a contrast agent is used.
What to do
In case of a closed injury of the larynx, methods of assistance are chosen by assessing the patient's condition, medical history, factors that provoked damage. In case of respiratory stenosis, infiltration, detection of an abscess, the area should be opened, the mucosa should be incised in places of maximum swelling. At the second or third level of stenosis, a tracheotomy is indicated.
High doses of antimicrobials are essential for treatment. Broad-spectrum antibiotics are used. The practice of prescribing sulfonamides is widespread. With severe edema and stenosis, the patient is given drugs for destenotherapy.
External closed injury
If you look at publications for traumatologists and surgeons specializing in this field, you can find out: usually, along with a description of injuries and features of a therapeutic approach in specificcases also illustrate all photo processes. The larynx is a rather complex organ, therefore, for a non-specialist, such photographs carry quite little semantic load, but the text part of specialized publications is of considerable interest. In particular, it is from such textbooks and brochures that one can learn that external closed injuries are diagnosed more often against the background of bruise and compression, cartilage fracture. This is also possible in case of strangulation.
Injuries of this type are the most common among domestic ones, accompanied by damage to the larynx. They are somewhat less common in production. Reflexes and influence on the vessels, the nervous system of the neck quickly lead the injured person into a state of shock. The affected area hurts strongly and sharply, which is especially felt if you swallow saliva. With severe injury, the patient spits up blood, cervical emphysema develops, which soon captures the chest, abdomen, and back. Respiratory function is depressed, stenosis is possible.
How to help
In case of external closed injury, the victim should be immediately hospitalized. Already at the examination stage, attention is paid to the features of the respiratory system, and the relevance of tracheotomy is determined. To eliminate the state of shock, a medication course is prescribed, blood transfusion, and novocaine blockade is done.
The patient is shown to eat soft foods that do not irritate the damaged areas. If the process of eating food is accompanied by throwing particles into the respiratory system, you will have touse a special probe.
Burns of the larynx
There are two types of burns: chemical burns and heat. The first can provoke inhalation, ingestion of concentrated active substances. In the predominant percentage of cases, the vestibular laryngeal apparatus suffers. The area of contact with the active substance is the location of the burn. The reaction of organic tissues in most cases is swelling, redness, fibrinous plaque. If the case is very severe, the integrity of the laryngeal skeleton is violated.
With a laryngeal burn, dysfunction of the area is immediately expressed: it is difficult for the victim to breathe, speak, the voice changes, aphonia is possible. If you perform laryngoscopy, you can localize damage, determine the dimensions of the affected area, assess the change in the glottis, identify the presence of infiltration and its features, and the size of the swelling. Laryngoscopy allows you to clarify the presence of fibrinous plaque, determine how large the areas covered by it are.
Treatment
The possibility of diphtheria should be ruled out immediately. The patient is prescribed a strict regimen and a drug program is selected based on the nuances of the case. The first one and a half to two weeks will have to be strictly silent, and eat only soft and warm foods. The amount of s alt in food is strictly limited. You will have to regularly rinse using chamomile or sage decoctions. Frequency - twice a day; duration - three weeks.
If the burn is accompanied by the formation of fibrinous films, there is a strongand smells bad, rinses with potassium permanganate are put. Good results can be obtained through inhalation treatment. For inhalation, natural essential oils of apricot, doggie, menthol, as well as antimicrobial drugs combined with hydrocortisone in the form of a suspension are used. The duration of the program is up to 15 procedures.
The patient is shown a course of general strengthening of the body and anti-inflammatory drugs to reduce the likelihood of complications. Painkillers are used.
Thermal burn
More often it is provoked by accidental or deliberate inhalation of hot gas, steam. In clinical practice, such cases are rare. Rarely, only the larynx suffers, usually the patient arrives with combined injuries covering the pharynx. To clarify the condition, laryngoscopy is indicated. Usually, swelling of the mucous membranes is detected. The therapeutic approach is the same as described above.
Concussion, contusion
Concussion can occur due to an aggressive effect on the skeletal parts, mucous membranes, and the nervous system. A contusion is a complex of violations due to a push, concussion, impact. At the same time, the integrity of the skin is preserved, the laryngeal skeleton is not displaced and does not break. Damage causes infiltration, swelling of the zone, leading to hematoma due to hemorrhage. At the moment of applying the effort, there is a possibility of a short loss of consciousness and even death. Local symptoms - shortness of breath, impaired and painful swallowing.
Therapeutic course - general. Shown to control the work of the heart and blood vessels. Canprescribe anti-inflammatory and antimicrobial drugs. If stenosis develops, a tracheotomy should be done.
Dislocation
In some cases, the injury is general. This develops if the larynx is squeezed by hands, objects. A partial form of dislocation is a case when only a single element of the larynx is damaged, for example, a joint. The injury provokes cyanosis, the patient cannot breathe, laryngoscopy shows the narrowing of the laryngeal lumens and the limitation of the functionality of the vocal fold. Individual cartilages deviate from the anatomically correct position.
To help the patient, cartilage should be set. This is possible only in the first time after the injury. There are often cases when the only option for reduction is surgery. Possible complication of the case is a violation of the integrity and functionality of the glossopharyngeal nerve, the victim cannot swallow.
Fracture
In adulthood, the cartilaginous laryngeal system gradually ossifies, therefore, an injury can cause a fracture. It can also be with a direct one-sided, two-sided factor or in a circle. As a rule, a cartilage fracture leads to impaired blood flow. In clinical practice, more often you have to deal with a violation of the integrity of the thyroid, cricoid elements.
At first, the victim loses consciousness, the skin turns pale, there is severe pain. Soreness is activated if you turn your head, try to speak or move. Typical symptoms include cough, hoarseness, and trouble swallowing. Stenosis develops gradually. The victim is thrown into a cold sweat, he is anxious, signs of heart failure are growing.
Important Features
At first, the diagnosis of the case is usually not difficult: already at the examination stage, one can notice the displacement of the laryngeal protrusion, and touching this area provokes severe pain. When touched, you can hear a characteristic sound - this is called crepitus. Separate sections of cartilage rub against each other, which also creates a specific sound. Puffiness gradually increases, emphysema forms under the skin, hiding the described primary symptoms. Laryngoscopy for a laryngeal fracture is difficult, examination shows a dark red area and limited mobility.
To clarify the area of localization of damage, the nature of the violations, an x-ray of the neck should be taken. The condition can be complicated by strangulation, secondary infection, bleeding. Usually, complications occur quite early.
Treatment involves tracheotomy, reduction of the fracture, possibly surgery. Tamponade is shown to fix the fragments.
Wounded
The reason may be an object, a tool with a sharp edge, piercing. As a rule, the localization area is the area of the smallest resistance, that is, the membrane (cricothyroid, thyroid-hyoid). If the wound is caused by a shot, an explosion, then it has a polymorphic character. Usually, many fractures are detected, the damage is torn, penetrating areas are possible and are not. Sometimesexternal symptoms are rather minor, for example, with a stab injury, in other cases they are immediately noticeable (wound by shrapnel). Excretion of blood, aspiration can cause suffocation. Most have emphysema, severe coughing and dysphagia. The moment of injury is accompanied by shock and respiratory depression. There is a high probability of secondary infection, chronic stenosis.
The victim is shown an urgent operation to restore respiratory function, treatment of the affected area. Administer drugs against shock and infectious invasion. After some time, the patient is sent for surgery to eliminate scars that can provoke stenosis.
