Trauma lalring dan trakeaNanang M, dr., SpTHT-KL

Relatif jarangTerapi tepat selamatkan hidup / jalan

nafas / suaraJenis : trauma tumpul / tajamTrauma tumpul:

Sebab: KLL, perkelahian, olahragaMandibula & sternum: proteksi (fleksi)Bila terjadi hiperekstensi laring terjepit

antara obyek - vertebrae

Kelainan yang timbul:Robekan mukosa endolaringEdemaHemaatomaFraktur kartilagoRobekan ligamen laringSubluksasi / dislokasi aritenoid fixasi vocal

cordcricoarytenoid joint injuries Unilateral injury

to the recurrent laryngeal nerve

clothesline injury: tali/ kawat/ kabel dllkecepatan tinggi gaya >> , area <<crushes the laryngeal cartilages commonly causes cricotracheal separation Bilateral injury to the recurrent laryngeal nerve

Associated structures injured:Fractures of the hyoid bone epiglottic injuries Laserasi mukosa hipofaring kornu mayor /

minor kartilago thyroid

airway obstruction

strangulation or hanging-type injuries: gaya statis dg kecepatan rendah multiple cartilaginous fractures without immediate mucosal laceration,

submucosal hematoma, or marked displacement of the fractures

Trauma tajam:Pisau / tembakanKerusakan: laserasi hingga kerusakan berat

pada: cartilage, mucosa, soft tissue, nerves, adjacent

structuresTingkat injury berbanding lurus dengan

kecepatanKematian ok :

complete disruption of the larynx, massive soft tissue edema, associated neurovascular injuries.

Diagnosis

AnamnesisTrauma leher depan airway trauma

Pemeriksaan fisik:Singkirkan trauma vertebrae/ spinal cordPerdarahan/hematom/ Bruits / nadi kecil cedera

vaskulerStridor :

Inspiratory partial supraglottic airway obstruction, Expiratory lower-airway abnormality (tracheal injury) Combined inspiratory and expiratory partial obstruction

at the level of the glottisslight soft tissue emphysema to massive

pneumomediastinumtension pneumothorax

Laringoskopi indirekta : sering tidak mungkinLaringoskopi direkta/ Esofagoskopi rigid : bila

trauma vertebra (-)Laringoskopi direkta dg serat optik : paling

aman

Pemeriksaan penunjang : CT scan

Diagnosis trauma laring

Penatalaksanaan

EMERGENCY CARE LARYNGEAL TRAUMA

TREATMENT LARYNGEAL TRAUMA

MRS untuk obseervasi : min 24 jam Medical

   Voice rest   Systemic steroids   Elevate head   Humidified air   Antibiotics   Antireflux measures NGT : tdk perlutrauma posterior laring

Surgical   Tracheotomy   Endoscopy   Exploration   Thyrotomy   Closure of lacerations   Insertion of stents for disrupted anterior commissure   Grafting for severe mucosal loss only   Fixation of fractures Gastrostomy bila tdp robekan pada hipofaring

Fracture of thyroid cartilage

Laceration of true vocal fold and hematoma of false vocal fold

Repair of lacerations

Resorbable plate fixation of laryngeal fracture

Fixation of endolaryngeal stent by using nonabsorbable sutures

COMPLICATIONS LARYNGEAL TRAUMAManifested as failure to decannulate and inadequate

voice.Granulation tissue

   Prevent by covering all exposed cartilage   Avoid stents when possible   Careful excisionLaryngeal stenosis   Excision with mucosal coverage   Stenting selected cases   Laryngotracheoplasty   Tracheal resection with reanastomosisVocal-fold immobility   Observe   Vocal-fold injection   Thyroplasty-type vocal-fold medialization   Arytenoidectomy and vocal-fold lateralization for bilateral paralysis

INJURY GROUPSGroup 1: Minor endolaryngeal

hematoma/lacerations without detectable fractureGroup 2: Edema, hematoma, minor mucosal disruption without exposed cartilage; nondisplaced fractures on computed tomography scanGroup 3: Massive edema, mucosal tears, exposed cartilage, vocal-cord immobility, displaced fracturesGroup 4: Group 3 plus three or more fractures and massive mucosal damage requiring stentingGroup 5: Laryngotracheal separation

Thank you