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Damage (trauma) of the larynx and trachea: diagnosis
Last reviewed: 23.04.2024
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Specification of the time of injury, detailed characteristics of the traumatic agent and the mechanism of damage are important factors in assessing the structural and functional damage to the hollow organs of the neck.
Physical examination
Includes community inspection and assessment of the patient's overall condition. When examining the neck, evaluate the nature of the lesion and the condition of the wound surface, reveal hematomas. Palpation of the neck allows to determine the safety of the larynx and trachea skeleton, compaction sites, crepitus zones, the boundaries of which are marked for the purpose of tracking the dynamics of emphysema or infiltration of soft tissues. With penetrating wounds in a number of cases, it is permissible to probe the wound channel. Manipulation should be carried out with great care because of the possibility of additional iatrogenic injury.
Laboratory research
In addition to a general clinical examination aimed at determining the severity of the patient's overall somatic state, it is necessary to determine the gas and electrolyte blood composition, and conduct a microbiological study of the wound detachable.
Instrumental research
- indirect laryngoscopy and microlaringoscopy;
- X-ray tomography of the larynx and trachea;
- endofibroscopy of the larynx, trachea and esophagus;
- radiography of the lungs and mediastinum, esophagus with barium;
- KT hollow neck organs;
- examination of the function of external respiration;
- Mikrolaringostroboscopic examination (shown in the absence of severe damage or late in the post-trauma period with the purpose of studying the vibratory function of vocal folds). It is necessary to emphasize the importance of primary endoscopic examination and control at all stages of rehabilitation of the patient with injuries to the hollow organs of the neck. In cases of extensive injuries, surgical revision of the wound is required, since up to 50-70% of traumatic injuries are not diagnosed in a routine survey.
Differential diagnosis of lesions of the larynx and trachea
In acute trauma of the larynx and trachea, differential diagnosis does not present difficulties, it is carried out on the history of the disease. In rare cases, combining the previous organic pathology of the larynx, especially with the development of infiltration against the backdrop of the tumor process, tuberculosis, chondroperichondritis and burns with chemicals or foreign body trauma, difficulties in interpreting the laryngoscopic picture may arise. In such situations, a short course of anti-inflammatory therapy and the use of additional examination methods are necessary for differential diagnosis.
Indications for consultation of other specialists
Consultations of other specialists are necessary, since damage to the larynx and trachea with neck injury is rarely isolated. If a suspected injury to the esophagus or thyroid gland is indicated, consult a surgeon or thoracic trachea - a thoracic surgeon; when poisoning with chemicals - toxicologist; for the correction of drug treatment - the therapist; to determine the possibility of using physiotherapy methods - physiotherapist. In the long term after the injury the patient may need treatment with the participation of a phonopaedist.
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