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In peacetime, laryngeal injuries are relatively rare. There are closed and open injuries, while closed are divided into internal and external.
Internal injuries result from foreign bodies, medical manipulations, for example, tracheal intubation. Such injuries are not particularly dangerous except for the possibility of developing chondroperichondritis of the cartilage of the larynx when the prognosis becomes serious.
External closed injuries - bruises, compression of the larynx, fractures of cartilage, hyoid bone, tearing of the larynx from the trachea. This can happen as a result of a throat strike on solid objects, in a fight - with the edge of the palm of the hand. The victim often loses consciousness, shock occurs, local hemorrhage, subcutaneous emphysema, which can be, and if it spreads to the fiber of the larynxopharynx, there is a risk of asphyxiation, in such cases a tracheotomy is required. In addition to external examination, indirect laryngoscopy, radiography is of great importance in the diagnosis of laryngeal trauma, not only for the study of cartilage, but also for the spread of emphysema through the internal cellular spaces.
The prognosis for bruised larynx, especially with cartilage fractures, is always serious. The patient is in danger of suffocation not only due to stenosis of the larynx, but also to possible tamponade of the trachea and bronchi with blood that has been poured out and clotted, and in the following days mediastinitis may develop due to the penetration of infection there. Tracheotomy in such cases is necessary not only to restore breathing, but also to suck blood from the bronchial tree. Treatment of such patients is carried out exclusively in a hospital. If necessary, in case of significant crushing of the cartilage, a laryngofissure is performed to remove fragments, hemostasis. Nutrition of patients is carried out through a probe.
There are three types of open laryngeal injuries - cut, stabbed and gunshot (bullet and fragmentation), the latter are extremely rare in peacetime, during the fighting they take first place among all laryngeal injuries.
The analysis of neck injuries during the period of local wars showed that ENT organ injuries among all wounds account for 2-3%, neck injuries 1-1.8% of all injured and up to 80% of the number of ENT wounded, while the bullet wounds of the neck amounted to up to 55%, and among all neck injuries, wounds of the larynx take first place - up to 43% (G.I. Burenkov).
Cut laryngeal lesions occur when the neck is cut, usually in the horizontal plane (from ear to ear), while depending on the height of the incision, the shield-hyoid membrane or conical ligament is dissected.
In the first case, the wound gapes and the laryngopharynx is clearly visible, breathing is not impaired, and breathing due to blood flow may be disturbed with a low incision. The death of the wounded occurs quickly only in case of transection of the carotid arteries. If this does not happen, the prognosis depends on the severity of the inflammation from the larynx and surrounding tissues.
Puncture wounds of the neck with damage to the larynx are applied with thin, narrow, long objects and leave a narrow channel, which, when a wounded object is removed, is blocked along its length by the fascia of the neck (backstage syndrome), which contributes to the formation of emphysema and the development of mediastinitis, so this channel must be dissected. It should also be remembered that with neck injuries of any genesis, especially with damage to blood vessels and nerves, shock develops, which also requires adequate therapy.
Gunshot wounds of the larynx are most often combined, as other organs of the neck are damaged. They are usually divided into end-to-end, blind and tangent. Through wounds, when a wounding projectile (bullet) pierces both walls of the larynx and goes beyond it, with a blind one - the bullet remains in the larynx cavity, moving further either to the throat or to the trachea. With a tangential wound, the bullet only hits the tracheal wall without tearing it.
The principles for helping such wounded do not differ from injuries of a different genesis, but they have their own characteristics. Firstly, in the conditions of military operations it can be difficult to evacuate a wounded man in order to provide adequate assistance in a timely manner, and he dies from shock.
Secondly, about 80% of such wounded people have not an isolated tracheal injury, but a combined one, while such vital organs as the vessels, spine, esophagus, nerves, and thyroid gland can be damaged.
Therapeutic measures are built in two stages - emergency care and subsequent rehabilitation. Emergency care includes ensuring breathing, stopping bleeding, treating a gunshot wound (if necessary, laryngofissure), removing a foreign body (injuring projectile), introducing a probe for nutrition. Combined patients sometimes require the participation of other specialists in emergency care (for example, a neurosurgeon, maxillofacial surgeon). The rehabilitation phase can be quite long, depending on the amount of damage.
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