External laryngeal injuries in children—Comparison of diagnostic methods

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Abstract

Objectives

The injuries of the larynx constitute around 1% of all injuries. The great majority of the injuries of the larynx happens during playing. The effects of these injuries may appear insignificant however, not always the direct clinical symptoms correlate with the degree of respiratory tract failure. The symptoms of laryngeal injuries depend on the extension and strength of the trauma and always relate to impair patency of respiratory tract. The aim of the study is to compare two diagnostic methods: laryngoscopy and ultrasonography in evaluation of laryngeal injuries in children.

Methods

In the Department of Pediatric Otolaryngology, Medical University of Warsaw, in the period between 2004 and 2010 there were hospitalised 15 children with external injury of the larynx.

Results

From among 15 hospitalized children, 7 were qualified as not serious trauma and were treated preservatively and the other 8 as sever trauma. The mechanism of traumas was diverse. Dyspnea was a predominating symptom, the others included hoarsness, change in voice quality, even aphonia, pain while speaking and swallowing, cough and hemoptysis.

Conclusions

Direct laryngoscopy is a standard in diagnostics of the injuries of the larynx. Ultrasonography of the larynx is recommended in every case of laryngeal injury as an additional non-invasive complementary diagnostic examination.

Introduction

The injuries of the larynx constitute around 1% of all injuries. In children external injuries of the larynx are more frequent than in adults. The great majority of the injuries of the larynx happens during playing. The effects of these injuries may appear insignificant however, not always the direct clinical symptoms correlate with the degree of respiratory tract failure. The symptoms of laryngeal injuries depend on the extension and strength of the trauma and always relate to impair patency of respiratory tract. It means that patient with the injury of the larynx even with minimal symptoms is in the life threatening condition. The symptoms can aggravate during 24 h. Direct hit in the area of the larynx can cause fracture with or without dislocation of laryngeal cartilages, subluxation in cricoarytenoid joint, hematomas and edemas of subglottic area, perforation of respiratory tract, damage of laryngeal nerves and mucosa of the larynx and trachea 1, 2, 3.

Section snippets

Aim

The aim of the study is to compare two diagnostic methods: laryngoscopy and ultrasonography in evaluation of laryngeal injuries in children.

Materials and methods

In the Department of Pediatric Otolaryngology, Medical University of Warsaw, in the period between 2004 and 2010 there were hospitalised 15 children with external injury of the larynx. The group consisted of 6 girls and 9 boys, aged 5–14. Our estimation was retrospective. All children underwent necessary diagnostics, which included laryngoscopy under general anesthesia, ultrasound of the larynx and other radiological examinations (X-ray, computed tomography). The ultrasound examination was

Results

From among 15 hospitalized children, 7 were qualified as not serious trauma and were treated preservatively and the other 8, with severe trauma, demanded more invasive treatment. In 4 cases short-term intubation was performed, in 2 cases intralaryngeal procedures were performed and the other 2 children underwent tracheotomy.

The mechanism of traumas was diverse, in the study group of 15 children we observed: in 10 cases a hit into a blunt object, in 2 cases strangulation with a rope or scarf, in

Discussion

Injury of the larynx is a life-threatening condition because of impairment of patency of respiratory tract or cardiogenic shock due to bradycardia, arrhythmia, blood pressure drop or cardiac arrest. It has close a connection with innervation of the larynx by the vagus nerve through the laryngeal nerves. The right vagus nerve supplies the sinus node, while the left vagus nerve supplies the vestiboventricular node. That is why every patient with an injury of the larynx should stay under

Conclusions

Direct laryngoscopy is a standard in diagnostics of the injuries of the larynx.

Ultrasonography of the larynx is recommended in every case of laryngeal injury as an additional non-invasive complementary diagnostic examination.

Ultrasonography in comparison with laryngoscopy under general anesthesia more precisely evaluates mobility of vocal folds and diagnoses fractures of cartilages without dislocation. Direct laryngoscopy precisely evaluates all areas of the larynx, and differentiates primary

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