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      Trauma laríngeo externo y fractura de cartílago tiroides: Revisión de la literatura Translated title: External laryngeal trauma and thyroid cartilage fracture: A literature review

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          Abstract

          RESUMEN El trauma laríngeo constituye un grupo de lesiones infrecuentes, pero de gran importancia clínica dada su alta morbimortalidad. Requiere un alto nivel de sospecha, puesto que muchas de estas lesiones pueden pasar desapercibidas en la evaluación inicial. Se debe sospechar en todo paciente que se presenta con traumatismo cervical y síntomas que van desde la disfonía y el dolor cervical anterior, a la disnea e incluso el compromiso respiratorio severo por obstrucción de la vía aérea. El abordaje de estos pacientes debe iniciar con la evaluación de la vía aérea y asegurar su estabilidad, para luego enfocarse en el diagnóstico y manejo específico de las lesiones. Presentamos a continuación una revisión bibliográfica en cuanto a los mecanismos de trauma, presentación clínica, diagnóstico, clasificación y manejo.

          Translated abstract

          ABSTRACT The laryngeal trauma constitutes a group of infrequent lesions, but with great clinical importance, given its high morbidity and mortality. It requires a high level of suspicion, since many of these injuries may go unnoticed at the initial evaluation. It should be suspected in every patient presenting with cervical trauma and symptoms ranging from dysphonia and anterior cervical pain, to dyspnea or even severe respiratory distress, due to obstruction of the airway. The approach of these patients should begin with the evaluation of the airway and ensure its stability, to then focus on the diagnosis and specific management of the lesions. We present an updated literature review regarding the mechanisms of trauma, clinical presentation, diagnosis, classification and management.

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          Most cited references35

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          Blunt tracheobronchial injuries: treatment and outcomes.

          Tracheobronchial injury is a recognized, yet uncommon, result of blunt trauma to the thorax. Often the diagnosis and treatment are delayed, resulting in attempted surgical repair months or even years after the injury. This report is an extensive review of the literature on tracheobronchial ruptures that examines outcomes and their association with the time from injury to diagnosis. We reviewed all patients with blunt tracheobronchial injuries published in the literature to determine the anatomic location of the injury, mechanism of the injury, time until diagnosis and treatment, and outcome. Only patients with blunt intrathoracic tracheobronchial traumas were included. We identified 265 patients reported between 1873 and 1996. Motor vehicle accidents were the most frequent mechanism of injury (59%). The overall mortality among reported patients has declined from 36% before 1950 to 9% since 1970. The injury occurred within 2 cm of the carina in 76% of patients, and 43% occurred within the first 2 cm of the right main bronchus. The proximity of the injury to the carina had no detectable effect on mortality. Injuries on the right side were treated sooner but were associated with a higher mortality than left-sided injuries. No association was detected between delay in treatment and successful repair of the injury; ninety percent of patients undergoing treatment more than 1 year after injury were repaired successfully. This review of patients with blunt tracheobronchial injuries represents the largest cohort studied to date. These data suggest an ability to repair tracheobronchial injuries successfully many months after they occur. We are also able to assess the mortality associated with the location and side of injury, examine the time from injury until diagnosis and treatment, and evaluate treatment outcome.
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            Management of acute blunt and penetrating external laryngeal trauma.

            Improve the care of acute external laryngeal trauma by reviewing controversies and the evolution of treatment.
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              Acute laryngeal trauma: a review of 77 patients.

              Acute laryngeal trauma is a rare injury. In the past 18 years, 77 patients with acute laryngeal trauma have been evaluated at our institution. Each patient's care was overseen by the senior author (E.S.P.). The 61 patients who were seen within 48 hours of their accident are compared with those treated after 48 hours. All patients are classified by both injury (groups 1 through 5) and treatment (types I through III). Results are reported for voice, airway, and swallowing. Our methods of evaluation and treatment are outlined, and controversial aspects of patient management are addressed. We conclude that conservative treatment of group 1 and 2 injuries is 100% effective, expeditious repair of laryngeal injuries greatly reduces poor outcome, and the type of injury can be used to roughly predict patient outcome. Further, with use of current methods of diagnosis and management, almost all patients will be decannulated (98%) with functional speech (100%) and normal deglutition (100%).
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                orl
                Revista de otorrinolaringología y cirugía de cabeza y cuello
                Rev. Otorrinolaringol. Cir. Cabeza Cuello
                Sociedad Chilena de Otorrinolaringología, Medicina y Cirugía de Cabeza y Cuello (Santiago, , Chile )
                0718-4816
                December 2019
                : 79
                : 4
                : 465-472
                Affiliations
                [3] Santiago orgnameUnidad de Otorrinolaringología orgdiv1Clínica Santa María Chile
                [1] Santiago orgnameHospital Clínico de la Universidad de Chile orgdiv1Servicio de Otorrinolaringología Chile
                [2] Santiago Santiago de Chile orgnameUniversidad de Chile orgdiv1Escuela de Medicina Chile
                Article
                S0718-48162019000400465 S0718-4816(19)07900400465
                2b81f9d2-14cf-4bb2-8174-f688572e7262

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 20 April 2019
                : 08 February 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 37, Pages: 8
                Product

                SciELO Chile

                Categories
                ARTÍCULOS DE REVISIÓN

                Laryngeal trauma,cartílago tiroides,cartílago laríngeo,fractura laríngea,Trauma laríngeo,thyroid cartilage,laryngeal cartilage,laryngeal fracture

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