Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-29T03:31:13.693Z Has data issue: false hasContentIssue false
  • English
  • Français

Laryngeal reconstruction following shrapnel injury in a British soldier: case report

Published online by Cambridge University Press:  03 April 2008

N Sharma ,
M De ,
T Martin  and
P Pracy
N Sharma*
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Birmingham NHS Trust, UK
M De
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Birmingham NHS Trust, UK
T Martin
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Birmingham NHS Trust, UK
P Pracy
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Birmingham NHS Trust, UK
*
Address for correspondence: Mr Neil Sharma, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK. E-mail: neilsharma@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Laryngeal injuries are uncommon but result in high mortality and morbidity rates when they do occur. We report a case of laryngeal fracture due to penetrating shrapnel injury, repaired with miniplates.

Case report:

A 26-year-old soldier was involved in an explosion and sustained a shrapnel wound to his right neck. After immediate airway management at the field hospital he was transferred to the UK, where he underwent a neck exploration, laryngofissure and repair of the thyroid cartilage using miniplates. An endolaryngeal stent was placed, which was removed at a second operation seven days later. Post-operatively, the patient recovered well and his voice improved rapidly. Six months post-operatively, he returned to work.

Discussion:

The cause and nature of laryngeal injury differs between wartime and peacetime. The methods of diagnosis and management strategies are reviewed. The early recognition of injury and protection of the airway are of paramount importance when dealing with laryngeal injury. Delayed laryngeal reconstruction using miniplates can give a good functional result.

Keywords

LarynxNeck InjuriesReconstructive Surgical Procedures
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 2 , February 2009 , pp. 253 - 256
Copyright
Copyright © JLO (1984) Limited 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Thevasagayam, MS, Pracy, P. Laryngeal trauma: a systematic approach to management. Trauma 2005;7:87–94CrossRefGoogle Scholar
2Danic, D, Prgomet, D, Milicic, D, Leovic, D, Puntaric, D. War injuries to the head and neck. Mil Med 1998;163:117–19CrossRefGoogle Scholar
3Bhojani, RA, Rosenbaum, DH, Dikmen, E, Paul, M, Atkins, BZ, Zonies, D et al. Contemporary assessment of laryngotracheal trauma. J Thorac Cardiovasc Surg 2005;130:426–32CrossRefGoogle ScholarPubMed
4Danic, D, Prgomet, D, Sekelj, A, Jakovina, K, Danic, A. External laryngotracheal trauma. Eur Arch Otorhinolaryngol 2006;263:228–32CrossRefGoogle ScholarPubMed
5Rustemeyer, J, Kranz, V, Bremerich, A. Injuries in combat from 1982–2005 with particular reference to those to the head and neck: a review. Br J Oral Maxillofac Surg 2007;45:556–60CrossRefGoogle Scholar
6Schaefer, SD. Primary management of laryngeal trauma. Ann Otol Rhinol Laryngol 1982;91:399–402CrossRefGoogle ScholarPubMed
7Fuhrman, GM, Stieg, FH 3rd, Buerk, CA. Blunt laryngeal trauma: classification and management protocol. J Trauma 1990;30:87–92CrossRefGoogle ScholarPubMed
8Salvino, CK, Dries, D, Gamelli, R, Murphy-Macabobby, M, Marshall, W. Emergency cricothyroidotomy in trauma victims. J Trauma 1993;34:503–5CrossRefGoogle ScholarPubMed
9Grewal, H, Rao, PM, Mukerji, S, Ivatury, RR. Management of penetrating laryngotracheal injuries. Head Neck 1995;17:494–502CrossRefGoogle ScholarPubMed
10Francis, S, Gaspard, DJ, Rogers, N, Stain, SC. Diagnosis and management of laryngotracheal trauma. J Natl Med Assoc 2002;94:21–4Google ScholarPubMed
11Meglin, AJ, Biedlingmaier, JF, Mirvis, SE. Three-dimensional computerized tomography in the evaluation of laryngeal injury. Laryngoscope 1991;101:202–7CrossRefGoogle ScholarPubMed
12Stassen, NA, Hoth, JJ, Scott, MJ, Day, CS, Lukan, JK, Rodriguez, JL, Richardson, RD. Laryngotracheal injuries: does injury mechanism matter? Am Surg 2004;70:522–5CrossRefGoogle ScholarPubMed
13Danic, D, Milicic, D, Prgomet, D, Leovic, D. Acute laryngeal trauma: a comparison between peace time and war injuries. J Laryngol Otol 1996;110:435–9CrossRefGoogle ScholarPubMed
14Jonsson, K, Jensen, JA, Goodson, WH 3rd, Scheusenstuhl, H, West, J, Hopf, HW et al. Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients. Ann Surg 1991;214:605–13CrossRefGoogle ScholarPubMed
15Lykins, CL, Pinczower, EF. The comparative strength of laryngeal fracture fixation. Am J Otolaryngol 1998;19:158–62CrossRefGoogle ScholarPubMed
16Danic, D, Milicic, D, Prgomet, D, Leovic, D. Laryngeal war injuries. Acta Med Croatica 1995;49:33–7Google ScholarPubMed
17Gussack, GS, Jurkovich, GJ, Luterman, A. Laryngotracheal trauma: a protocol approach to a rare injury. Laryngoscope 1986;96:660–5CrossRefGoogle ScholarPubMed
18Brunicardi, F, Andersoen, D, Bullen, T, Dunn, D, Hunter, J, Pollock, R. Schwartz's Principles of Surgery. United States: McGraw-Hill Medical, 2005:235–240Google Scholar
19Freeman, M, Fauzus, M. Voice Disorders and Their Management. London: Whurr, 2000;69–88, 319–39Google Scholar
20Jones, N, Roberts, P, Greenberg, N. Peer-group risk assessment: a post-traumatic management strategy for hierarchical organizations. Occup Med (Lond) 2003;53:469–75CrossRefGoogle ScholarPubMed