THÔNG TIN TÀI LIỆU
FIGURE 106.4 Loss of thyroid cartilage prominence and associated acute airway obstruction secondary to laryngeal fracture SG, narrowed subglottic space; TC, fracture of thyroid cartilage Initial Assessment History of a mechanism concerning for laryngeal trauma should be elicited This may include a “clothes line” injury or blunt force from an object across the neck Emergency clinicians should determine if there has been any change in the quality of voice, hemoptysis, or significant neck pain On physical examination, anterior neck tenderness, crepitus, or presence of abnormal laryngeal/tracheal cartilage contours are concerning for injury (see Fig 106.4 ) Stable patients may be evaluated by an otolaryngologist with an awake fiberoptic nasopharyngoscope Unstable patients in respiratory distress may require direct laryngoscopy, intubation, rigid bronchoscopy, or emergent tracheostomy An otolaryngologist or general surgeon should be prepared to intervene with any of these procedures For children without distress, plain radiographs may help assess the thyroid cartilage or trachea for injury, and to identify subcutaneous air from related injuries CT scans provide more details regarding the laryngeal structures in the setting of trauma Penetrating trauma may require MRA/MRV to evaluate the vasculature of the neck Surgical exploration should be considered for patients with penetrating injuries to zone of the neck, even if clinically stable Any patients with distress or penetrating injury should be admitted either directly to the operating room for airway management and exploration, or after complete work up in consultation with appropriate surgical specialists Mildly symptomatic children with blunt trauma but who are otherwise stable and are determined not to have clinically significant injury by history and examination, and possibly with additional imaging and/or surgical specialty consultation, may be observed in the ED and discharged home if there is no worsening of symptoms over time Suggested Readings and Key References Ear Greywoode JD, Pribitkin EA, Krein H Management of auricular hematoma and the cauliflower ear Facial Plast Surg 2010;26:451–455 Karimnejad K, Nelson EJ, Rohde RL, et al External auditory canal foreign body extraction outcomes Ann Otol Rhinol Laryngol 2017;126(11):755–761 Olson MD, Saw J, Visscher SL, et al Cost comparison and safety of emergency department conscious sedation for the removal of ear foreign bodies Int J Pediatr Otorhinolaryngol 2018;110:140–143 Schuldt T, Großmann W, Weiss NM, et al Aural and nasal foreign bodies in children—Epidemiology and correlation with hyperkinetic disorders, developmental disorders and congenital malformations Int J Pediatr Otorhinolaryngol 2019;118:165–169 Svider PF, Vong A, Sheyn A, et al What are we putting in our ears? A consumer product analysis of foreign bodies Laryngoscope 2015;125(3):709–714 Nose and Sinuses Cakabay T, Ustun Bezgin S Pediatric nasal traumas: contribution of epidemiological features to detect the distinction between nasal fractures and nasal soft tissue injuries J Craniofac Surg 2018;29(5):1334–1337 Hwang K, Yeom SH, Hwang SH Complications of nasal bone fractures J Craniofac Surg 2017;28(3):803–805 Perkins V, Vijendren A, Egan M, et al Optimal timing for nasal fracture manipulation—Is a 2-week target really necessary? A single-centre retrospective analysis of 50 patients Clin Otolaryngol 2017;42(6):1377–1381 Sanyaolu LN, Farmer SE, Cuddihy PJ Nasal septal haematoma BMJ 2014;349:g6075 Schlosser RJ, Bolger WE Nasal cerebrospinal fluid leaks: critical review and surgical considerations Laryngoscope 2004;114:255–265 Schoinohoriti O, Igoumenakis D, Rallis G Fractures of the nasal bones: is external splinting really warranted? J Craniofac Surg 2017;28(8):e760–e763 Oral Cavity and Pharynx Brietzke SE, Jones DT Pediatric oropharyngeal trauma: what is the role of CT scan? Int J Pediatr Otorhinolaryngol 2005;69:669–679 Ferreira PC, Amarante JM, Silva PN, et al Retrospective study of 1251 maxillofacial fractures in children and adolescents Plast Reconstr Surg 2005;115(6):1500–1508 Hennelly K, Kimia A, Lee L, et al Incidence of morbidity from penetrating palate trauma Pediatrics 2010;126:e1578–e1584 Soose RJ, Simons JP, Mandell DL Evaluation and management of pediatric oropharyngeal trauma Arch Otolaryngol Head Neck Surg 2006;132:446–451 Usta M, Erkan T, Cokugras FC, et al High doses of methylprednisolone in the management of caustic esophageal burns Pediatrics 2014;133(6):E1518– E1524 Larynx and Trachea Abujamra L, Joseph MM Penetrating neck injuries in children: a retrospective review Pediatr Emerg Care 2003;19(5):308–313 Duval EL, Geraerts SD, Brackel HJ Management of blunt tracheal trauma in children: a case series and review of literature Eur J Pediatr 2007;166:559– 563 Gold SM, Gerber ME, Shott SR, et al Blunt laryngotracheal trauma in children Arch Otolaryngol Head Neck Surg 1997;123(1):83–87 Mace SE Blunt laryngotracheal trauma Ann Emerg Med 1986;15(7):836–842 Merritt RM, Bent JP, Porubsky ES Acute laryngeal trauma in the pediatric patient Ann Otol Rhinol Laryngol 1998;107:104–106 Additional Resources Videos Friedman EM Videos in clinical medicine: Removal of foreign bodies from the ear and nose N Engl J Med 2016;374(7):e7 Available online at https://www.nejm.org/doi/full/10.1056/NEJMvcm1207469 Holsinger FC, Kies MS, Weinstock YE, et al Videos in clinical medicine: examination of the larynx and pharynx N Engl J Med 2008;358:e2 Available online at http://www.nejm.org/doi/full/10.1056/NEJMvcm0706392 ... Incidence of morbidity from penetrating palate trauma Pediatrics 2010;126:e1578–e1584 Soose RJ, Simons JP, Mandell DL Evaluation and management of pediatric oropharyngeal trauma Arch Otolaryngol Head... Porubsky ES Acute laryngeal trauma in the pediatric patient Ann Otol Rhinol Laryngol 1998;107:104–106 Additional Resources Videos Friedman EM Videos in clinical medicine: Removal of foreign bodies... warranted? J Craniofac Surg 2017;28(8):e760–e763 Oral Cavity and Pharynx Brietzke SE, Jones DT Pediatric oropharyngeal trauma: what is the role of CT scan? Int J Pediatr Otorhinolaryngol 2005;69:669–679
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