Hostname: page-component-89b8bd64d-b5k59 Total loading time: 0 Render date: 2026-05-08T21:33:33.599Z Has data issue: false hasContentIssue false
  • English
  • Français

Unusual airway injury following a motor vehicle collision

Published online by Cambridge University Press:  27 February 2015

Christopher Sampson
Christopher Sampson*
Affiliation:
Department of Emargency Medicine, Columbia, United States.
*
Correspondence to: Dr. Christopher Sampson, Department of Emergency Medicine, University of Missouri, 1 Hospital Drive DC 029.1, Columbia, MO 65212. Email: sampsoncs@health.missouri.edu

Extract

A 16-year-old male presented to the emergency department following a single-truck motor vehicle collision. The patient was the driver of an older model pickup truck that he lost control of while driving and went off of the road. He was restrained with a lap belt only, given the age of the vehicle. His only complaint at the presenting hospital was left-sided neck pain and hoarseness.

Information

Type
Knowledge to Practice
Information
Canadian Journal of Emergency Medicine , Volume 17 , Issue 5 , September 2015 , pp. 569 - 570
Copyright
Copyright © Canadian Association of Emergency Physicians 2015 

Direct visualization of his airway using fiber optics is shown in Figure 1. Computed tomography imaging was obtained (Figure 2). The diagnosis was laryngeal injury resulting in avulsion of the left false cord.

Figure 1

Direct visualization of patient airway using fiber optics.

Figure 2

Computed tomography scan of laryngeal injury resulting in avulsion of the left false cord.

Discussion

Blunt neck trauma occurs in 5% of traumas and is more common than penetrating neck injuries.Reference Levy 1 The most common mechanism is a motor vehicle collision where rapid acceleration or deceleration occurs. Laryngotracheal injuries in blunt neck trauma are second only to intracranial hemorrhage as cause of death among patients with head and neck trauma. Mortality has been reported from 2% to 15% and increases with advancing age.Reference Jewett, William and Rutledge 2 The most common presenting symptom in these patients is hoarseness.Reference Juutilainen, Vintturi and Robinson 3

Airway control in these patients should be a priority.Reference Rathlev, Medzon and Bracken 4 Cervical spine control should be maintained. Intubation may be difficult, secondary to additional facial injuries. High suspicion for pharyngeal, esophageal, cervical spine, and head injuries needs to be maintained.

This patient was taken to the operating room for tracheostomy placement and repair of laryngeal injury and mandibular fixation. He did well postoperatively, and the tracheostomy was eventually removed.

References

1. Levy, D. Neck trauma. eMedicine. Available at: http://emedicine.medscape.com/article/827223 (accessed February 18, 2014).Google Scholar
2. Jewett, BS, William, SW, Rutledge, R. External laryngeal trauma analysis of 392 patients. Arch Otolaryngol Head Neck Surg 1999;125:877-880.Google Scholar
3. Juutilainen, M, Vintturi, J, Robinson, S, et al. Laryngeal fractures: clinical findings and considerations on suboptimal outcome. Acta Otolaryngol 2008;128:213-218.Google Scholar
4. Rathlev, NK, Medzon, R, Bracken, M. Evaluation and management of neck trauma. Emerg Med Clin North Am 2007;25(3):679-694; viii.CrossRefGoogle ScholarPubMed
Figure 0

Figure 1 Direct visualization of patient airway using fiber optics.

Figure 1

Figure 2 Computed tomography scan of laryngeal injury resulting in avulsion of the left false cord.