Injuries to the pharynx and larynx are injuries sustained by this part of the human body. Their causes may be factors directly affecting the area or indirect impact. Influence is possible external, internal. Currently, in ICD-10, a laryngeal injury refers to a group of neck injuries encoded with S10-S19 codes. Specific damage to the larynx is separately classified, for example, those received due to burns are encrypted as T20-T32.
About terminology and coding
In the ICD, laryngeal injury is mainly considered in the neck injury group. Areas near the larynx are also included in this category: the back of the neck, the area above the clavicles. The general group of diagnoses combines injuries, dislocations and fractures of the elements of this area. Not only the burns mentioned above, obtained under the influence of chemical components, high temperature, are excluded from this classification. A separate category in the ICD is injuries associated with the penetration of a foreign object into the human body. If this causes damage to the larynx, the diagnosis is T17.3.
If open, closed laryngeal injuries can be explained by frostbite, the case with the use of the ICD will be encoded as T33-T35. Code T63.4 is dedicated to a specific situation: injury resulting from a bite from an animal or insect poisonous to humans.
Types and Types
Currently, in clinical practice, a classification system is used for all cases based on a number of criteria. The main types of laryngeal injury: internal, external. To be assigned to the group, they analyze what caused the damage. External injuries in an impressive percentage of cases combined, except for the larynx, other organs and tissues located nearby are affected. Internal cases are more often isolated, exclusively affected by the larynx.
It is also customary to isolate penetrating and non-such injuries. For belonging 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, often a blunt object, including a human fist. In clinical practice, there are frequent cases of injuries sustained during sports activities during a traffic accident. Finally, trauma may be the result of an attempt to strangle.
With a blunt injury, the ligaments are often torn, providing a person with the opportunity to speak, and the integrity of the hyoid bone also suffers. Such a case is usually accompanied by trauma to the cartilage of the larynx.
Penetrating wounds are more often explained by the effects of a bullet or knife. About 80% of all cases are through wounds.
Internal trauma can occur against 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, burn appears when inhaling toxic chemical components or very hot steam.
When to visit a doctor
Symptoms of a laryngeal injury depend on the location of the lesion and its extent. As a rule, breathing is disturbed: from mild problems to the inability to breathe on their own. Laryngeal trauma is accompanied by dysphonia, it is especially pronounced if the vocal cords are affected. If the integrity of the laryngeal entrance is impaired, dysphagia is possible, that is, the patient cannot swallow normally.
Symptoms of a laryngeal injury, accompanied by a violation of the nerve structures, include neuropathic paresis. With external injury, bleeding is usually recorded, noticeable to the external observer. If the injury is internal, hemorrhage also occurs inside the body. A visual noticeable sign of such a complication is the coughing of a patient with blood.
How the doctor will help
Treatment for laryngeal injury begins with anti-shock measures. The task of specialists is to stop bleeding and normalize the respiratory system, thereby ensuring a stable flow of air into the lungs and its exchange. The patient must be placed in a horizontal position, slightly raising his head, and fix the neck in a stationary state. Assign maintenance oxygen therapy, ventilation through an automated system with a mask. Nutrient components are introduced through a tube into the digestive system.
During treatment of trauma to 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 tools to alleviate pain, relieve swelling. Often, treatment involves a course to inhibit the activity of inflammatory foci and an infusion program. Antimicrobial formulations are used as inhalations. For large, large-scale damage and skeletal disorders, progressive emphysema, violation of the integrity of the cartilage, an urgent operation is indicated. It should be done in case of profuse hemorrhage. Delayed assistance may result in death.
Relevance of the issue
Statistics show that trauma to the larynx and trachea are relatively rare in our lives. The increase is observed during the period of 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 wound, they say about trauma to the sub-follicular area, the thyroid-hyoid membrane.
Regardless of the nuances of the location and the strength of the injuries, a laryngeal injury (blunt, cut, punctured, any other) always leads to a deterioration in the condition of a person, a violation of vital functions. Many people have low blood pressure, cases of laryngeal stenosis are not uncommon. Arrhythmia and tachycardia, fever. Some manifestations are due to respiratory failure, others due to trauma 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, help should be provided immediately.
Note!
Against the background of an open, closed injury to the larynx, consciousness may be confused, but in some patients it remains fully, although cases of a completely unconscious state are also not uncommon. Usually it depends on the extent of the damage and the severity of the injury, its nature, features.
Sometimes a cut, stabbed, blunt laryngeal injury 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 the possibility of damage to the carotid arteries. This condition is extremely dangerous, in just a few minutes a person can die. Such cases are known when damage to these arteries provoked death in a matter of seconds.
The nuances of helping
With a laryngeal injury, the first and most important measure is the relief of bleeding. If conditions allow this, you should immediately begin activities to replenish blood loss. In a predominant percentage of cases, patients are shown a tracheotomy. In case of violation of the integrity of the thyroid hyoid membrane, the region should be sutured in layers, attaching laryngeal tissues to the hyoid bone as part of the operation. For this, doctors use chromed catgut. When damage is localized in the sub-folding area, it is necessary to sew up the affected area in layers.
If, in case of a laryngeal injury, it is necessary to install a probe to provide the patient with nutrition, it is inserted before suturing the affected area. This minimizes the risk of infection in the wound. Antibiotics are administered in large doses to maintain a stable condition with the described injury.
If the damage is punctured, 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
In case of laryngeal injury, the main measures are associated with the normalization of respiratory function. As soon as first aid has been completed, tetanus serum should be administered to the patient. In the future, he will have to postpone a long course of treatment with anti-inflammatory drugs.
If the injury is 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 received tangentially. Among the diagnostic measures, the most interesting and useful is the X-ray - from the picture it is possible to quickly and accurately localize a foreign object, to assess the condition of the laryngeal skeleton. The therapeutic course is aimed at normalizing breathing, eliminating the shock state, and treating the affected areas. Medications are chosen for stopping the activity of inflammatory processes, general strengthening of the body and alleviation of the patient's condition.
Gunshot wounds: features
If the injury to the larynx is due precisely to this reason, tracheotomy can normalize breathing. To block blood flow, vascular ligatures, ligation of the external carotid artery are indicated. If this is required by chance, 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 inhibit inflammation, antibiotics in high dosage and semi-synthetic drugs to combat pathological microflora are indicated. The use of drugs to reduce sensitivity and sulfa drugs is widespread.
Closed injury
Such an injury can provoke the penetration of a foreign object into the organ. The reason may be bones, metal objects and other objects. Closed will be a trauma to the larynx during asphyxiation. There are cases when the integrity of the mucosa was impaired during intubation or during laryngoscopy. The prolonged and gross influence of medical instruments can cause a specific form of granuloma. Most often, such an injury is localized on the free edge responsible for the ability to make fold sounds: the anatomical structure of the human body is such that it is here that the organic tissues and the medical instrument interact most closely.
A closed laryngeal trauma (with suffocation, intubation, or another aggressive factor) indicates a severe 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 most striking pain syndrome is inherent in injuries localized in the arytenoid cartilage covering the epiglottis of the mucous membranes. Infiltrate, swelling initiate abscess formation, it is difficult for the patient to breathe. The inflammatory process can cover nearby tissues, organs, due to which the ability to swallow is disturbed, dysphagia worries. Severe and sharp pain does not allow swallowing even saliva. From the side it is visible: 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 use a contrast medium.
What to do
With a closed laryngeal injury, help methods are chosen, assessing the patient's condition, medical history, and the factors that provoked the damage. With stenosis of respiration, infiltrate, and the detection of an abscess, the area should be opened, incised mucosa in places of maximum swelling. At the second or third level of stenosis, tracheotomy is indicated.
During treatment, high doses of antimicrobial agents cannot be dispensed with. They use antibiotics with a wide spectrum of effectiveness. It is common practice to prescribe sulfonamides. With severe edema and stenosis, the patient is administered drugs for destenosis.
External closed injury
If you look at the publications for traumatologists and surgeons specializing in this field, you can find out: usually along with a description of injuries and the features of the therapeutic approach in specific cases, all the photo processes are also illustrated. The larynx is a rather complex organ, so for a layman such photographs carry quite a bit of semantic load, but the textual 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, a cartilage fracture. It is also possible in case of strangulation.
Injuries of this type are the most common among household, accompanied by damage to the larynx. Somewhat less often they are found in production. Reflexes and the effect on blood vessels, the nervous system of the neck quickly lead a person who has been injured to a shock state. The affected area hurts severely and sharply, which is especially felt if you swallow saliva. With severe trauma, the patient coughs up blood, cervical emphysema develops, soon capturing the chest, abdomen, and back. Respiratory function is inhibited, stenosis is possible.
How to help
With external closed injury, the victim should be hospitalized immediately. Already at the stage of examination pay attention to the features of the respiratory system, determine the relevance of the tracheotomy. To eliminate the shock state, a drug course, a blood transfusion are prescribed, a novocaine blockade is made.
The patient is shown to eat soft foods that do not irritate damaged areas. If the process of eating food is accompanied by throwing particles into the respiratory system, you will have to use a special probe.
Larynx burns
There are two types of burns: those obtained due to the influence of chemical components and high temperature. 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, the dysfunction of the area is immediately expressed: it is difficult for the victim to breathe, speak, the voice changes, aphonia is possible. If laryngoscopy is performed, it is possible to localize the lesions, determine the dimensions of the affected area, assess the change in the glottis, reveal the presence of infiltrate and its features, the size of the swelling. Laryngoscopy allows you to clarify the presence of fibrinous plaque, to determine how large the areas covered by it.
Treatment
The likelihood of diphtheria should be immediately ruled out. The patient is prescribed a strict regimen and a medication 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. Strictly limited salt content in dishes. You will have to regularly rinse using chamomile or sage decoctions. Frequency - twice a day; duration is three weeks.
If the burn is accompanied by the formation of fibrinous films, the patient smells strongly and badly from the patient’s mouth, rinses with potassium permanganate are put. Good results can be obtained through inhalation treatment. For inhalation, natural apricot, doggie, menthol essential oils are used, as well as antimicrobial medications combined with hydrocortisone in the form of a suspension. 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. They use painkillers.
Thermal burn
More often it provokes accidental or deliberate inhalation of hot gas, steam. In clinical practice, such cases are rare. Rarely, only the larynx suffers, usually the patient comes with combined damage covering the pharynx. To clarify the condition, laryngoscopy is indicated. Usually reveal swelling of the mucous membranes. The therapeutic approach is similar to that described above.
Concussion, concussion
Concussion can occur due to aggressive effects on the skeletal parts, mucous membranes, and nervous system. Concussion is a complex of violations due to shock, concussion, shock. At the same time, the integrity of the skin is preserved, the laryngeal skeleton does not move and does not break. Damage cause infiltration, swelling of the area, lead to hematoma due to hemorrhage. . – , .
– . . . , .
. , , . – , , , . , , . .
To help the patient, cartilage should be repaired. This is only possible the first time after injury. There are frequent cases when the only option of reduction is surgery. A complication of the case is possible with 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, trauma can cause a fracture. It can be with direct unilateral, bilateral factor or in a circle. As a rule, a cartilage fracture leads to impaired blood flow. In clinical practice, it is often necessary to deal with a violation of the integrity of the thyroid, cricoid elements.
At first, the victim loses consciousness, the skin turns pale, severe pain occurs. Soreness is activated if you turn your head, try to talk or move. Typical symptoms include coughing, hoarseness, and a swallowing disorder. Gradually, stenosis develops. The victim is thrown into a cold sweat, he is worried, signs of heart failure are growing.
Important features
At first, the diagnosis of the case usually does not cause difficulties: already at the stage of examination, you can notice a 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 the cartilage rub against each other, which also creates a specific sound. Swelling gradually increases, emphysema forms under the skin, hiding the described primary symptoms. Laryngoscopy for a laryngeal fracture is difficult, examination reveals a dark red area and limited mobility.
To clarify the area of localization of lesions, the nature of violations, you should make an x-ray of the neck. The condition may be complicated by asphyxiation, secondary infection, bleeding. Complications usually occur quite early.
Treatment involves tracheotomy, reduction of the fracture, possibly surgical intervention. To fix the fragments, tamponade is indicated.
Wound
The reason may be an object, a sharp-edged tool, stitching. As a rule, the area of localization is the site of the smallest resistance, that is, the membrane (cricothyroid, thyroid-lingual). If the wound is caused by a shot, an explosion, then it has a polymorphic character. Usually a lot of fractures are revealed, the damage is torn, penetrating areas are possible and are not such. Sometimes external symptoms are quite insignificant, for example, with puncture damage, in other cases they are immediately noticeable (wound by fragments). Blood excretion, aspiration can cause strangulation. Most fix emphysema, severe cough and dysphagia. The moment of damage is accompanied by shock and respiratory depression. High probability of secondary infection, chronic stenosis.
The victim is shown an urgent operation to restore respiratory function, treatment of the affected area. They inject drugs against shock and infectious invasion. After some time, the patient is sent for surgery to eliminate scars that can provoke stenosis.