Ruthlyn S. Pecolera,
Rubiliza D. OnofreTelan Related Institution
Department of Otorhinolaryngology - Head and Neck Surgery - East Avenue Medical Center Publication Information
Publication Sub Type
Philippine Journal of Otolaryngology Head and Neck Surgery
OBJECTIVE: This paper aims to describe an unconventional surgical procedure performed in a case of penetrating neck injury involving the larynx.
Design: Case Report
Setting: Tertiary Government Hospital
RESULTS: A 38-year-old man sustained a hacking laceration to the anterior neck that extended into the hypopharyngeal area, transecting the thyroid cartilage. After pre-emptive tracheostomy, the patient was referred to otorhinolaryngology - head and neck surgery due to the extensive hypopharyngeal injury. Neck exploration performed to control bleeders confirmed a Schaefer-Fuhrman Classification Group 3 penetrating neck injury. Anastomotic reconstruction of the hypopharynx, transected thyroid cartilage and strap muscles was attempted using absorbable sutures with post-operative re-establishment of structural continuity and documentation of full bilateral vocal fold mobility. The patient was about to be discharged home with a tracheotomy and nasogastric tube when he suddenly deteriorated and expired on the eighth post-operative day.
CONCLUSION: Our technique might be utilized in cases where urgent reconstruction of laryngeal structures is considered despite serious damage to the laryngeal skeleton, and may provide a temporary surgical option for similar cases in an emergent setting. However, we cannot recommend it as a routine standard on the basis of one case. KEYWORDS: l arynx; penetrating neck injury; vocal cord; reconstruction, neck exploration References
1. Luqman, Z , Khan, M A, Nazir, Z . "Penetrating pharyngeal injuries in children: Trivial trauma leading to devastating complications."
Pediatr Surg Int 21(6): 432-5, June 2005
2. Demetriades, D , Velmahos, G G, Asenio, J A. "Cervical pharyngoesophageal and laryngotracheal injuries"
World J Surg 25(8): 1044-8, August 2001
3. Kim, J P, Cho, S J, Son, H Y, Park, J J, Woo, S H. "Analysis ofclinical feature and management of laryngeal fracture: Recent 22 case review"
Yonsei Med J 53(5): 992-998, 2012
4. Kim, J P, Park, J J, Won, S J, Woo, S H. "Penetrating carotid artery injuries treated by an urgent endovascular stent technique: report of two cases"
Chonnam Med J 47(2): 134-7, August 2011
5. Omakobia, E , Micallef, A . "Approach to the patient with external laryngeal trauma: the Schaefer Classification"
Otolaryngol Sunnyvale 6(2): 230, 2016
6. Liao, C H, Huang, J F, Chen, S W, Fu, C Y, Lee, L A, Ouyang, C H. "Impact of deferred surgical intervention on the outcome of external laryngeal trauma"
Ann Thorac Surg 98, 477-83, 2014
7. Thevasagayam, M S, Pracy, P . "Laryngeal trauma: asystematic approach to management"
Trauma 7, 87-94, 2005
8. Jewett, B S, Shockley, W W, Rutledge, R . "External laryngealtrauma analysis of 392 patients"
Arch Otolaryngol Head Neck Surg 125, 877-880, 1999
9. The committee on trauma- American College of Surgeons. Chapter 1: Initial assessment and management. In: Merrick C, executive editor. ATLS- Advance Trauma Life Support. Student Course Manual. 10th edition. Chicago: American College of Surgeons, 2018. 2-21.
10. Sniezek, J C, Thomas, R W. Chapter 8: Laryngeal trauma.In: Holt GR, editor. Resident manual of trauma to the face, head and neck. 1st edition.. Virginia: American academy of otolaryngology-head and neck surgery foundation, 2012. 117-187.
11. Attifi, H , Elfarouki, A , Nadour, K , Hmidi, M , Touihem, N , Elboukhani, A . "Diagnosis and management of laryngeal fracture: a case report"
Int J Otorhinolaryngol Head Neck Surg 3(4): 1095-1098, October 2017
12. Randall, D R, Rudmik, L R, Ball, C G, Bosch, J D. "External laryngotracheal trauma: incidence, airway control, and outcomes in a large Canadian center"
Laryngoscope 124(4): E123-133, April 2014
13. Kaya, K H, Koc, A K, Uzut, M , Altintas , A , Yegin, Y , Sayin, I . "Timely management of penetrating neck trauma: report of three cases"
J Emerg Trauma Shock 6(4): 289-292, October 2013-December 2013
14. Sandhu, G S, Nouraei, S R. Chapter 67: Laryngeal and esophageal trauma. In: Flint PW, Haughey BH, Lund VJ, Niparko JK, Robbins KT, Thomas JR,Lesperance MM, editors. Cummings otolaryngology head and neck surgery. 6th edition. Philadelphia: Elsevier Saunders, 2015. 970-981.