Trends in blunt laryngotracheal trauma in children

Objective

To examine the presentation, mechanisms, and management of blunt laryngotracheal trauma in a pediatric population, emphasizing the rise in severity.

Design

Retrospective analysis of laryngotracheal trauma evaluated from 1995 to 2008. The presentation, mechanism, management and outcomes data are detailed.

Setting

Tertiary medical center.

Patients

Thirty-five patients were identified with major laryngotracheal trauma.

Main outcome measures

Surgical results, airway patency, voicing, swallowing and other residual disabilities are tabulated.

Results

Average age was 10.8 years, with boys outnumbering girls 22-13. In cases of major trauma, mechanisms were related to motor vehicle accidents (MVAs) in seven patients. Five of 11 major trauma victims were unconscious at presentation. Definitive airway reconstruction involved laryngotracheoplasty and tracheal resection/reanastomosis. Ten of 11 remain decannulated.

Conclusions

In an increasingly mobile society, major laryngotracheal trauma is occurring in a younger population. Victims of major laryngotracheal trauma may be unconscious or have other injuries that obscure airway injury, highlighting the need for vigilance. Once the airway is secured and the patient stabilized, airway reconstruction is undertaken, achieving decannulation in most patients. Hoarseness is often a lasting morbidity.     

Our 12 year experience with Montgomery T-tube in the management of acute blunt laryngotracheal trauma patients

IntroductionThe Montgomery T-tube is a device used as a combined tracheal stent and tracheostomy tube to prevent post-operative tracheal stenosis.ObjectivesThe purpose of this retrospective study is to evaluate the outcome following Montgomery T-tube stenting performed in for neck and airway injury in patients with acute blunt laryngotracheal trauma over a period of 12 years.MethodsBetween 2005 and 2017, 19 patients with acute blunt laryngotracheal trauma underwent Montgomery T-tube stenting. All 19 laryngotracheal trauma patients had undergone a preoperative tracheostomy in the emergency department by an ENT surgeon. Montgomery T-tube stenting was done later through an external approach. The follow up period ranged from 2 to 10 years. The Montgomery T-tube was removed after a period ranging from 6 months to 1½ year.ResultsThe majority of patients in the study were in the age group of 21–30 years. A preoperative tracheostomy was done in all 19 patients. All patients except 3 underwent successful decannulation, and experienced long-term satisfactory result.ConclusionManagement of acute blunt laryngotracheal trauma is a challenging problem that demands a multidisciplinary approach. The ideal treatment option should be individualized according to the patient's condition and characteristics of injury. According to our study we suggest that cases of acute blunt laryngotracheal trauma patients should be managed following the protocol as mentioned in our study, and we strongly emphasize that Montgomery T-tube should be left for at least 1 complete year in the airway as it results in negligible chances of post-traumatic stenosis of airway later.     

Traumatic retropharyngeal hematoma: a rare and critical pathology needed for early diagnosis

Retropharyngeal hematoma occurs rarely. It is located just in front of the cervical spine. Many circumstances can lead to its development. A trauma and/or anticoagulants are often key factors. The assessment must be made extremely carefully as such a hematoma can induce an airway compromise. Trauma being a key factor, it can also present with cervical spine fractures, increasing the risks. Two different cases of retropharyngeal hematomas are reported. The first case required surgical management with tracheotomy, per-oral drainage and naso-gastric tube feeding. A total recovery was obtained in 2 weeks. The second patient underwent medical treatment (methylprednisolone), and recovery was obtained in 6 days. Surgery for retropharyngeal hematoma is not always mandatory. It becomes necessary when a major dysphagia or dyspnea occurs. In other cases, medical treatment and close observation are usually sufficient.     

Dexamethasone delivery for hearing preservation in animal cochlear implant model: continuity,long-term release,and fast release rate

Abstract

Background: Clinically, steroids have been used for hearing preservation both topically and systemically during cochlear implantation.

Objective: This study compared steroid efficacy for hearing preservation among different types of delivery modes using an animal experiment.

Materials and methods: For 76 guinea pigs, topical and systemic delivery methods, four pump types with different infusion rates, delivery durations, and total steroid amounts were used. Threshold changes of 8, 16, and 32?kHz after dummy electrode insertion were evaluated at 1 and 4?weeks and compared among delivery method and pump types. Inflammatory response in the cochlea was histologically compared.

Results: For topical delivery groups, long-term release showed advantages in preserving hearing. Systemic delivery groups showed smaller threshold shifts than control group in all frequencies (p?>?.05). In short-term low dose application, compared to topical delivery, systemic delivery showed advantage in hearing preservation at both time point. However, others fail to show significant difference between two methods. Histologically, inflammatory response in the scala tympani at the basal turn was less in systemic delivery, especially in high dose and long-term.

Conclusion and significance: The difference of hearing preservation was not obvious between two delivery methods. Higher dose and longer duration might have advantages in hearing preservation.     

War, politics, and voice: the vocal fold paralysis of George Orwell

BACKGROUND: In 1936, like many individuals who felt the menace of fascism, George Orwell traveled to Spain to lend his support to the cause of the Republic, battling a right-wing coup. Spain, during its Civil War, was an eye-opening experience for him, yielding insights that allowed, and even compelled him to write Animal Farm and 1984. Spain was also a close brush with death. In May of 1937, in a trench on a windswept ridge near Huesca, Orwell was shot through the neck by a sniper, leaving him with a paralyzed vocal fold. DESIGN: A thorough review of firsthand accounts of Orwell's injury and subsequent care was made. These are presented in the context of current knowledge of ballistics, penetrating neck trauma, and vocal fold paralysis. RESULTS AND CONCLUSION: Orwell survived largely because of the nature of his wounding with a high-velocity jacketed military round. His recovery followed a course in many ways typical for patients with vocal fold paralysis. His writings leave us a unique and extraordinary account of the experience of being shot, of the medical care of the day, of the handicap of paralytic dysphonia, and of survival and heroism under extraordinary circumstances.     

Temporary threshold shift,adaptation, and recovery characteristics of frog auditory nerve fibers

While recording from single auditory nerve fibers in a frog, a monaural 3 min pure tone stimulus at CF was used to induce temporary threshold shift (TTS). TTS magnitude was correlated with the exposure tone intensity relative to the pre-exposure best threshold of the neuron, but not with exposure tone absolute intensity. CF and spontaneous spike rate were also uncorrelated with TTS magnitude. Comparison of frequency-threshold curves (FTCs) made before and successively after exposure revealed either a maximum sensitivity loss at the tip of the FTC or an equal shift at all frequencies. Neurons tended to recover from TTS within 3 min post-exposure, regardless of the initial TTS. Thus, recovery from TTS was more rapid for larger shifts. Recovery dynamics followed single or a double negative exponential functions.     

闭合性喉外伤的诊治进展

闭合性喉外伤是一种具有隐匿性、复杂的、可危及生命的损伤,可遗留严重影响生活质量的并发症。由于其早期症状无特异性,且常合并其他部位的严重损伤,早期易被漏诊或误诊。在损伤的急性期,保证和维持气道的稳定是成功救治的基础。延迟识别和不恰当的干预均会影响患者预后,导致其正常的呼吸、吞咽及发声功能恢复困难。因此需依据详细询问病史和查体、结合内镜及影像学等检查结果,必要时行颈部探查术,对损伤进行全面、准确的评估,以指导个体化治疗策略的制定。为了提高闭合性喉外伤的早期识别率,并为诊治方案的选择、相关并发症的处理提供思路,现对近年来闭合性喉损伤诊治的相关文献进行综述,针对治疗难点,总结诊治方案。     

Astragaloside IV inhibits apoptotic cell death in the guinea pig cochlea exposed to impulse noise

X-ray microtomography (micro-CT) is a new technique allowing for visualization of the internal structure of opaque specimens with a quasi-histological quality. Among multiple potential applications, the use of this technique in otology is very promising. Micro-CT appears to be ideally suited for in vitro visualization of the inner ear tissues as well as for evaluation of the electrode damage and/or surgical insertion trauma during implantation of the cochlear implant electrodes. This technique can greatly aid in design and development of new cochlear implant electrodes and is applicable for temporal bone studies. The main advantage of micro-CT is the practically artefact-free preparation of the samples and the possibility of evaluation of the interesting parameters along the whole insertion depth of the electrode. This paper presents the results of the first application of micro-CT for visualization of the inner ear structures in human temporal bones and for evaluation of the surgical positioning of the cochlear implant electrodes relative to the intracochlear soft tissues.     

Modulation of cochlear responses in the guinea pig by low-frequency,phase-shifted maskers following noise trauma

Low-frequency acoustic biasing using an intensive phase-shifted, low-frequency masker was studied according to its ability to determine disorders of cochlear micromechanics following noise trauma in the guinea pig as animal model. Statistical analyses proved that this technique allowed electrophysiological differentiation of controls versus groups with different degrees of experimentally induced threshold shifts. To substantiate group differences an intensity of at least 70 dB SPL was required for the 52 Hz masker and the difference in relation to the test-tone intensity had to be ±10 or ±20 dB SPL. The noise-traumatized cochlea could be identified by means of a threshold shift for the 5 V pseudothreshold, a low modulation span of the compound action potential amplitude (< 25–50LV frequency dependent), and reduced positive summating potential amplitude with negative non-modulating values within the different measurement phases for 1 and 2kHz stimulation.     

对严重开放性颌面耳鼻咽喉头颈复合型外伤的护理

目的探讨对严重开放性颌面耳鼻咽喉头颈部复合型外伤患者入院至手术前高危时期病情进行准确评估并进行护理的方法,提高术前的抢救成功率,为顺利手术奠定基础。方法对57例开放性颌面耳鼻咽喉头颈部复合型外伤患者,护士通过"看、问、听、摸、测"的方法对患者病情进行评估,判断出威胁患者生命的首要因素,采取针对性的救护措施配合医生实施术前抢救。结果 57例患者均顺利完成手术,痊愈出院,无1例死亡。结论"看、问、听、摸、测"的方法用于严重开放性颌面耳鼻咽喉头颈部复合型外伤患者的术前病情评估,简单实用,为采取针对性的护理提供了依据。     

Interlocking calvarial bone grafts: a solution for the short, depressed nose

OBJECTIVES/HYPOTHESIS: In patients severely affected with collapse of the nose, deprojection and upward rotation of the nasal tip are commonly seen. Traditional maneuvers to derotate and project the tip may be insufficient, because of the natural tendency of the nasal skin/soft tissue envelope to pull the tip in a cephalic and posterior direction. If the forces of scar contracture can be resisted, the tip and dorsum should remain adequately positioned. STUDY DESIGN: Retrospective chart review of 20 cases. METHODS: Using an open rhinoplasty approach, two strips of calvarial bone are fitted together in a tongue-in-groove fashion, and esthetics are analyzed. Rotation and projection are altered as indicated. A screw inserted at the indicated level along the caudal bone graft acts to prevent retrodisplacement of either the dorsal or caudal strut as scarring occurs. RESULTS: The procedure has been used in 20 patients. Two patients had displacement of the dorsal bone graft. Two patients have been lost to follow-up. Follow-up in the remainder has ranged from 6 weeks to 4 and a half years. All have maintained adequate tip and dorsal projection without excess upward tip rotation. Bone grafts have undergone minimal resorption. CONCLUSION: The interlocking calvarial bone graft technique stabilizes the nasal tip and dorsum in such a way that resists the forces of contracture and provides improved esthetics and function.     

Pneumolabyrinth without temporal bone fracture: different outcomes for hearing recovery

Pneumolabyrinth is a rare clinical manifestation seen in the practice of otology. It occurs usually after head trauma with temporal bone fracture. However, pneumolabyrinth without temporal bone fracture is a very rare occurrence. When it occurs, it is usually diagnosed by high-resolution computed tomography of the temporal bone. Therapy for pneumolabyrinth is conservative treatment or an exploratory tympanotomy. Recently, we saw two cases of pneumolabyrinth after trauma without temporal bone fracture. The patients were treated with conservative management for the pneumolabyrinth. However, the degree of recovery from hearing loss was different for each patient.     

开放性喉外伤的救治体会

目的探讨开放性喉外伤的救治方法。方法回顾2000年4月～2008年12月收治的36例开放性喉外伤患者的临床资料,并分析其救治体会。36例开放性喉外伤患者均行气管切开加创伤探查术,对有严重喉气管损伤者行喉气管成形术。结果36例患者术后均拔管,无死亡病例,1例并发喉狭窄。1例喉软骨缺损严重患者在取除喉模4周后出现呼吸困难行支气管镜下肉芽气化切除,4周后复查呼吸困难缓解,声门下光滑。结论在开放性喉外伤的救治中,应以保持患者呼吸道通畅、抢救患者生命为原则,尽可能减少并发症,恢复喉功能。     

Sequelae of traumatic laryngotracheal separation: the need for individualized long term treatment plan

Laryngotracheal separation is a rare variant of laryngeal trauma. However it is life threatening and potentially fatal. Patients with this injury usually succumb at the site of the accident itself. Here we present two cases of laryngotracheal separation of different etiology and of different outcomes. The treatment advocated for laryngotracheal separation is initially airway stabilization followed by formal repair of the transected trachea. However both our cases illustrates that the outcomes can be different and that a long term treatment plan should be individualized to each patient.