Approach and treatment of a patient with grade IV external laryngeal trauma, according to Schaefer-Fuhrman’s classification: a case report
Abstract
Introduction: External laryngeal trauma is an uncommon injury. To date, no case reports with favorable outcomes have been published. The aim of this study is to describe the clinical course of a patient with grade IV external laryngeal trauma.
Presentation of the case: A 22-year-old male patient presented with a complete lesion of the thyroid cartilage and larynx and pharynx opening. The patient underwent a tracheostomy and pharyngostomy. On day 4 of hospitalization, the patient was withdrawn from mechanical ventilation, and on day 8, a gastrostomy was performed. On day 11, a prosthesis for laryngeal reconstruction was requested, and the patient was transferred to intermediate care. On day 15, he gained functional independence. On day 59, a reconstruction surgery was performed, and on day 71, the patient tolerated occlusion of the cannula with airway protection. After 48 hours,
he met the decannulation criteria, and on day 79, he was decannulated.
Conclusion: We described a patient with grade IV external laryngeal trauma, according to Schaefer-Furhman’s
classification, which is an injury associated with high morbimortality. Nevertheless, this study emphasizes favorable outcomes in terms of both survival and functional recovery.
References
Jewett BS, Shockley WW, Rutledge R. External laryngeal trauma analysis of 392 patients. Arch Otolaryngol Head Neck Surg. 1999 Aug;125(8):877-80. doi: 10.1001/archotol.125.8.877
Crossref
| Google Scholar
Minard G, Kudsk KA, Croce MA, Butts JA, Cicala RS, Fabian TC. Laryngotracheal trauma. Am Surg. 1992 Mar;58(3):181-7.
Jalisi S, Zoccoli M. Management of laryngeal fractures--a 10-year experience. J Voice. 2011 Jul;25(4):473-9. doi: 10.1016/j.jvoice.2009.12.008
Crossref
| Google Scholar
Mercer SJ, Jones CP, Bridge M, Clitheroe E, Morton B, Groom P. Systematic review of the anaesthetic management of non-iatrogenic acute adult airway trauma. Br J Anaesth. 2016 Sep;117 Suppl 1:i49-i59. doi: 10.1093/bja/aew193
Crossref
| Google Scholar
Lee WT, Eliashar R, Eliachar I. Acute external laryngotracheal trauma: diagnosis and management. Ear Nose Throat J 2006; 85: 179- 84. Lee WT, Eliashar R, Eliachar I. Acute external laryngotracheal trauma: diagnosis and management. Ear Nose Throat J. 2006 Mar;85(3):179-84. doi: 10.1177/014556130608500315
Crossref
| Google Scholar
Mandel JE, Weller GER, Chennupati SK, Mirza N. Transglottic high frequency jet ventilation for management of laryngeal fracture associated with air bag deployment injury. J Clin Anesth. 2008 Aug;20(5):369-371. doi: 10.1016/j.jclinane.2007.11.008
Crossref
| Google Scholar
Bertelsen S, Howitz P. Injuries of the trachea and bronchi. Thorax. 1972 Mar;27(2):188-94. doi: 10.1136/thx.27.2.188
Crossref
| Google Scholar
Juárez FJCM, López CA, Pacheco RMA, et al. Trauma laríngeo externo: presentación de un caso atendido en el Centro Médico ABC y revisión de la literatura. An Med Asoc Med Hosp ABC. 2022;67(2):109-118. doi: 10.35366/106026
Crossref
| Google Scholar
Sethi RKV, Khatib D, Kligerman M, Kozin ED, Gray ST, Naunheim MR. Laryngeal fracture presentation and management in United States emergency rooms. Laryngoscope. 2019 Oct;129(10):2341-2346. doi: 10.1002/lary.27790
Crossref
| Google Scholar
Schaefer SD. The acute management of external laryngeal trauma. A 27-year experience. Arch Otolaryngol Head Neck Surg. 1992 Jun;118(6):598-604. doi: 10.1001/archotol.1992.01880060046013
Crossref
| Google Scholar
DePorre AR, Schechtman SA, Hogikyan ND, Thompson A, Westman AJ, Sargent RA, Rosko AJ, Bauer A, Shanks AM, Kupfer RA, Healy DW. Airway Management and Clinical Outcomes in External Laryngeal Trauma: A Case Series. Anesth Analg. 2019 Aug;129(2):e52-e54. doi: 10.1213/ANE.0000000000003843
Crossref
| Google Scholar
Moonsamy P, Sachdeva UM, Morse CR. Management of laryngotracheal trauma. Ann Cardiothorac Surg. 2018 Mar;7(2):210-216. doi: 10.21037/acs.2018.03.03
Crossref
| Google Scholar
Brenmann J, Richard G, Donald P. Resident manual of trauma to the face, head and neck. 1st ed. New York: American Academy of Otolaryngology – Head and Neck Surgery Foundation; 2012.
De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, et al; Groupe de Réflexion et d'Etude des Neuromyopathies en Réanimation. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002;288(22):2859-67. doi: 10.1001/jama.288.22.2859
Crossref
| Google Scholar
Ramirez FJ, Corrotea L, Gutierrez P, Otamendi MA, Giron J, Terrasa S, Midley A. ProMover mobility scale. A unified language for the evaluation of hospitalized patients. Medicina (B Aires). 2022;82(3):415-422. Spanish.
Cid-Ruzafa J, Damián-Moreno J. Valoración de la discapacidad física: el índice de Barthel. Rev Esp Salud Pública [Internet]. 1997 [citado 14 de agosto de 2023];71(2):127–37. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_abstract&pid=S1135-57271997000200004&lng=es&nrm=iso&tlng=es doi: 10.1590/S1135-57271997000200004
Crossref
| Google Scholar
Cameron JL, Reynolds J, Zuidema GD. Aspiration in patients with tracheostomies. Surg Gynecol Obstet. 1973 Jan;136(1):68-70.
Ortiz AL, Barahona AL, Araya CP, Zamorano SR. Trauma laríngeo externo y fractura de cartílago tiroides: Revisión de la literatura. Rev. Otorrinolaringol. Cir. Cabeza Cuello [Internet]. 2019 [citado 14 de agosto de 2023]; 79( 4 ): 465-472. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0718-48162019000400465&lng=es. doi: 10.4067/S0718-48162019000400465
Crossref
| Google Scholar
Kim JP, Cho SJ, Son HY, Park JJ, Woo SH. Analysis of clinical feature and management of laryngeal fracture: recent 22 case review. Yonsei Med J. 2012 Sep;53(5):992-8. doi: 10.3349/ymj.2012.53.5.992
Crossref
| Google Scholar
