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Trauma symp 2011

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Trauma symp 2011

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  1. 1. 4TH TRAUMA SYMPOSIUM<br />MANAGEMENT OF LARYNGEAL INJURIES<br /> IN<br /> NECK TRAUMA<br /> Dr. M. NaimManhas<br /> E.N.T. Specialist <br /> King Abdul Aziz Hospital-Makkah<br />Dr. Naim Manhas<br />1<br />
  2. 2. trauma symposium—WHY?<br />2<br />Dr. Naim Manhas<br />
  3. 3. trauma symposium—WHY?<br />3<br />Dr. Naim Manhas<br />
  4. 4. trauma symposium—WHY? <br />4<br />Dr. Naim Manhas<br />
  5. 5. “purpose of symposium”<br />5<br />Dr. Naim Manhas<br />
  6. 6. 6<br />Dr. Naim Manhas<br />
  7. 7. Blunt injuries of neck<br />Bruises over the neck<br />Hematoma <br />Surgical emphysema<br />7<br />Dr. Naim Manhas<br />
  8. 8. Blunt injuries of neck<br />8<br />Dr. Naim Manhas<br />
  9. 9. Laryngeal injuries<br />9<br />Dr. Naim Manhas<br />
  10. 10. diagnosis of airway injury <br />10<br />Dr. Naim Manhas<br />
  11. 11. management<br />11<br />Dr. Naim Manhas<br />
  12. 12. problematic<br />12<br />Dr. Naim Manhas<br />
  13. 13. Emergency airway management<br />13<br />Dr. Naim Manhas<br />
  14. 14. pediatric consideration<br />14<br />Dr. Naim Manhas<br />
  15. 15. Pediatric airway<br />15<br />Dr. Naim Manhas<br />
  16. 16. caution<br />16<br />Dr. Naim Manhas<br />
  17. 17. laryngeal trauma(neck-injury)<br />Dr. Naim Manhas<br />17<br />
  18. 18. laryngeal trauma(neck-injury)<br />Dr. Naim Manhas<br />18<br />
  19. 19. surgical exploration<br />19<br />Dr. Naim Manhas<br />
  20. 20. surgical exploration<br />Open exploration of neck with open reduction and internal fixation of fracture without thyrotomy<br />Dr. Naim Manhas<br />20<br />
  21. 21. laryngeal thyrotomy<br />Laryngeal cartilage stable,anteriorcommissure intact<br />ORIF- fractures<br />Repair mucosal laceration<br />Dr. Naim Manhas<br />21<br />
  22. 22. laryngeal thyrotomy<br />ORIF fractures, repair mucosal laceration and endolaryngeal stent<br />Laryngeal cartilage unstable,anteriorcommissuredisrupted,massive mucosal injuries<br />Dr. Naim Manhas<br />22<br />
  23. 23. penetrating neck injuries<br />Neck zones<br />Zone -1 thoracic outlet<br />Cricoid cartilage to sternal notch<br />Zone-2 central<br />Cricoid to angle of mandible<br />Zone-3 skull base<br />Angle of mandible to base of skull<br />Dr. Naim Manhas<br />23<br />
  24. 24. Neck zone concept outdated<br />Dr. Naim Manhas<br />24<br />
  25. 25. Epidemiology of penetrating neck injuries<br />40% of penetrating neck injuries do not involve important structures<br />Structures involved:-<br />-major vein: 15-25%<br />-major artery: 10-15%<br />-pharynx or esophagus: 5-15%<br />Larynx or trachea: 4-12%<br />Major nerves: 3-8%<br />Dr. Naim Manhas<br />25<br />
  26. 26. Debatable issue<br />Some surgeons have advocated mandatory exploration of all penetrating neck wounds on the basis that serious injury can exist in the absence of clinical findings. <br />Others have advocated a selective approach operating only upon patients whose findings suggest a major vascular or visceral injury<br />Dr. Naim Manhas<br />26<br />
  27. 27. penetrating neck injuries<br /> since zone 2nd has all the vital structures and any injury in this area needs immediate neck exploration in case patient is symptomatic.<br />As per the studies it is difficult to make decisions regarding the exact zone for the injuries which are on border line, as the area of neck is small so the indications for immediate surgical exploration----<br />Dr. Naim Manhas<br />27<br />
  28. 28. Indication of immediate surgical exploration<br />Dr. Naim Manhas<br />28<br />
  29. 29. Guidelines<br />Dr. Naim Manhas<br />29<br />
  30. 30. Esophageal injury--diagnosis<br />If missed leads to high morbidity and mortality<br />Contrast swallow study:-<br />Extravasation is diagnostic<br />Negative study is not reliable<br />50% of leak—missed with gastrograffin<br />25% of leaks missed with barium<br />Dr. Naim Manhas<br />30<br />
  31. 31. Recommendations<br />If gastrograffin study is negative then repeat with Barium<br />Avoid gastrograffin in patients without gag / cough reflex or unprotected airway.( causes pneumonitis if aspirated)<br />Endoscopy 50% of injuries can be missed , esp. if the patient is on ventilator.<br />Combination of contrast study with esophagoscopy reduces missed injuries to 5%<br />Dr. Naim Manhas<br />31<br />
  32. 32. latrogenic laryngeal injuries<br />Dr. Naim Manhas<br />32<br />
  33. 33. latrogenic laryngeal injuries<br />Dr. Naim Manhas<br />33<br />
  34. 34. Acute complication of intubation<br />Dr. Naim Manhas<br />34<br />
  35. 35. Dr. Naim Manhas<br />35<br />
  36. 36. Acute complication of intubation<br />Hematoma formation<br />Laceration <br />Avulsion<br />Scarring and granuloma formation<br />Dislocation of arytenoid cartilage<br />Dr. Naim Manhas<br />36<br />
  37. 37. Sequelae of prolonged intubation<br />Dr. Naim Manhas<br />37<br />
  38. 38. pathogensis<br />Dr. Naim Manhas<br />38<br />
  39. 39. pathogensis<br />Dr. Naim Manhas<br />39<br />
  40. 40. pathogenesis<br />Dr. Naim Manhas<br />40<br />
  41. 41. Sequelae of prolonged intubation<br />Dr. Naim Manhas<br />41<br />
  42. 42. Sequelae of prolonged intubation<br />Abduction of the vocal cords are limited <br />Misdiagnosed as bilateral abductor paralysis<br />Peudolaryngeal paralysis<br />Dr. Naim Manhas<br />42<br />
  43. 43. Sequelae of prolonged intubation<br />Dr. Naim Manhas<br />43<br />
  44. 44. Sequelae of prolonged intubation<br />Dr. Naim Manhas<br />44<br />
  45. 45. Prevention of postintubation injuries <br />Dr. Naim Manhas<br />45<br />
  46. 46. Prevention of postintubation injuries <br />Time of intubation<br />More than 10 days and less than 10 days<br />Dr. Naim Manhas<br />46<br />
  47. 47. Prevention of postintubation injuries <br />Dr. Naim Manhas<br />47<br />
  48. 48. Prevention of postintubation injuries <br />Dr. Naim Manhas<br />48<br />
  49. 49. Prevention of postintubation injuries <br />Dr. Naim Manhas<br />49<br />
  50. 50. Result of recent studies done at university hospital Vall”Hebron-spain<br />Dr. Naim Manhas<br />50<br />
  51. 51. Result of serial laryngeal examinations<br />Dr. Naim Manhas<br />51<br />
  52. 52. conclusion<br />Intubation injury to the larynx is relatively common and all types of injury have been reported . In patients intubated for prolonged period ,certain types of injury can be expected. The surgeon asked to evaluate a patient for intubation injury should have a clear idea of the type of injury that may be encountered as well as through knowledge of the best methods of prevention and intervention.<br />Dr. Naim Manhas<br />52<br />
  53. 53. conclusion<br />In many cases, the injury will resolve without incident, while in others the injury is irreversible. Frequently the process can be corrected with good results if the proper treatment is instituted.<br />THANK YOU <br />Dr. Naim Manhas<br />53<br />

Transcrição

  1. 1. 4TH TRAUMA SYMPOSIUM<br />MANAGEMENT OF LARYNGEAL INJURIES<br /> IN<br /> NECK TRAUMA<br /> Dr. M. NaimManhas<br /> E.N.T. Specialist <br /> King Abdul Aziz Hospital-Makkah<br />Dr. Naim Manhas<br />1<br />
  2. 2. trauma symposium—WHY?<br />2<br />Dr. Naim Manhas<br />
  3. 3. trauma symposium—WHY?<br />3<br />Dr. Naim Manhas<br />
  4. 4. trauma symposium—WHY? <br />4<br />Dr. Naim Manhas<br />
  5. 5. “purpose of symposium”<br />5<br />Dr. Naim Manhas<br />
  6. 6. 6<br />Dr. Naim Manhas<br />
  7. 7. Blunt injuries of neck<br />Bruises over the neck<br />Hematoma <br />Surgical emphysema<br />7<br />Dr. Naim Manhas<br />
  8. 8. Blunt injuries of neck<br />8<br />Dr. Naim Manhas<br />
  9. 9. Laryngeal injuries<br />9<br />Dr. Naim Manhas<br />
  10. 10. diagnosis of airway injury <br />10<br />Dr. Naim Manhas<br />
  11. 11. management<br />11<br />Dr. Naim Manhas<br />
  12. 12. problematic<br />12<br />Dr. Naim Manhas<br />
  13. 13. Emergency airway management<br />13<br />Dr. Naim Manhas<br />
  14. 14. pediatric consideration<br />14<br />Dr. Naim Manhas<br />
  15. 15. Pediatric airway<br />15<br />Dr. Naim Manhas<br />
  16. 16. caution<br />16<br />Dr. Naim Manhas<br />
  17. 17. laryngeal trauma(neck-injury)<br />Dr. Naim Manhas<br />17<br />
  18. 18. laryngeal trauma(neck-injury)<br />Dr. Naim Manhas<br />18<br />
  19. 19. surgical exploration<br />19<br />Dr. Naim Manhas<br />
  20. 20. surgical exploration<br />Open exploration of neck with open reduction and internal fixation of fracture without thyrotomy<br />Dr. Naim Manhas<br />20<br />
  21. 21. laryngeal thyrotomy<br />Laryngeal cartilage stable,anteriorcommissure intact<br />ORIF- fractures<br />Repair mucosal laceration<br />Dr. Naim Manhas<br />21<br />
  22. 22. laryngeal thyrotomy<br />ORIF fractures, repair mucosal laceration and endolaryngeal stent<br />Laryngeal cartilage unstable,anteriorcommissuredisrupted,massive mucosal injuries<br />Dr. Naim Manhas<br />22<br />
  23. 23. penetrating neck injuries<br />Neck zones<br />Zone -1 thoracic outlet<br />Cricoid cartilage to sternal notch<br />Zone-2 central<br />Cricoid to angle of mandible<br />Zone-3 skull base<br />Angle of mandible to base of skull<br />Dr. Naim Manhas<br />23<br />
  24. 24. Neck zone concept outdated<br />Dr. Naim Manhas<br />24<br />
  25. 25. Epidemiology of penetrating neck injuries<br />40% of penetrating neck injuries do not involve important structures<br />Structures involved:-<br />-major vein: 15-25%<br />-major artery: 10-15%<br />-pharynx or esophagus: 5-15%<br />Larynx or trachea: 4-12%<br />Major nerves: 3-8%<br />Dr. Naim Manhas<br />25<br />
  26. 26. Debatable issue<br />Some surgeons have advocated mandatory exploration of all penetrating neck wounds on the basis that serious injury can exist in the absence of clinical findings. <br />Others have advocated a selective approach operating only upon patients whose findings suggest a major vascular or visceral injury<br />Dr. Naim Manhas<br />26<br />
  27. 27. penetrating neck injuries<br /> since zone 2nd has all the vital structures and any injury in this area needs immediate neck exploration in case patient is symptomatic.<br />As per the studies it is difficult to make decisions regarding the exact zone for the injuries which are on border line, as the area of neck is small so the indications for immediate surgical exploration----<br />Dr. Naim Manhas<br />27<br />
  28. 28. Indication of immediate surgical exploration<br />Dr. Naim Manhas<br />28<br />
  29. 29. Guidelines<br />Dr. Naim Manhas<br />29<br />
  30. 30. Esophageal injury--diagnosis<br />If missed leads to high morbidity and mortality<br />Contrast swallow study:-<br />Extravasation is diagnostic<br />Negative study is not reliable<br />50% of leak—missed with gastrograffin<br />25% of leaks missed with barium<br />Dr. Naim Manhas<br />30<br />
  31. 31. Recommendations<br />If gastrograffin study is negative then repeat with Barium<br />Avoid gastrograffin in patients without gag / cough reflex or unprotected airway.( causes pneumonitis if aspirated)<br />Endoscopy 50% of injuries can be missed , esp. if the patient is on ventilator.<br />Combination of contrast study with esophagoscopy reduces missed injuries to 5%<br />Dr. Naim Manhas<br />31<br />
  32. 32. latrogenic laryngeal injuries<br />Dr. Naim Manhas<br />32<br />
  33. 33. latrogenic laryngeal injuries<br />Dr. Naim Manhas<br />33<br />
  34. 34. Acute complication of intubation<br />Dr. Naim Manhas<br />34<br />
  35. 35. Dr. Naim Manhas<br />35<br />
  36. 36. Acute complication of intubation<br />Hematoma formation<br />Laceration <br />Avulsion<br />Scarring and granuloma formation<br />Dislocation of arytenoid cartilage<br />Dr. Naim Manhas<br />36<br />
  37. 37. Sequelae of prolonged intubation<br />Dr. Naim Manhas<br />37<br />
  38. 38. pathogensis<br />Dr. Naim Manhas<br />38<br />
  39. 39. pathogensis<br />Dr. Naim Manhas<br />39<br />
  40. 40. pathogenesis<br />Dr. Naim Manhas<br />40<br />
  41. 41. Sequelae of prolonged intubation<br />Dr. Naim Manhas<br />41<br />
  42. 42. Sequelae of prolonged intubation<br />Abduction of the vocal cords are limited <br />Misdiagnosed as bilateral abductor paralysis<br />Peudolaryngeal paralysis<br />Dr. Naim Manhas<br />42<br />
  43. 43. Sequelae of prolonged intubation<br />Dr. Naim Manhas<br />43<br />
  44. 44. Sequelae of prolonged intubation<br />Dr. Naim Manhas<br />44<br />
  45. 45. Prevention of postintubation injuries <br />Dr. Naim Manhas<br />45<br />
  46. 46. Prevention of postintubation injuries <br />Time of intubation<br />More than 10 days and less than 10 days<br />Dr. Naim Manhas<br />46<br />
  47. 47. Prevention of postintubation injuries <br />Dr. Naim Manhas<br />47<br />
  48. 48. Prevention of postintubation injuries <br />Dr. Naim Manhas<br />48<br />
  49. 49. Prevention of postintubation injuries <br />Dr. Naim Manhas<br />49<br />
  50. 50. Result of recent studies done at university hospital Vall”Hebron-spain<br />Dr. Naim Manhas<br />50<br />
  51. 51. Result of serial laryngeal examinations<br />Dr. Naim Manhas<br />51<br />
  52. 52. conclusion<br />Intubation injury to the larynx is relatively common and all types of injury have been reported . In patients intubated for prolonged period ,certain types of injury can be expected. The surgeon asked to evaluate a patient for intubation injury should have a clear idea of the type of injury that may be encountered as well as through knowledge of the best methods of prevention and intervention.<br />Dr. Naim Manhas<br />52<br />
  53. 53. conclusion<br />In many cases, the injury will resolve without incident, while in others the injury is irreversible. Frequently the process can be corrected with good results if the proper treatment is instituted.<br />THANK YOU <br />Dr. Naim Manhas<br />53<br />

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