1 C J Mieny, U Mennen: Principles of Surgical Patient Care - Volume ...

Table 5.4.2. Symptoms and Signs of Laryngo-Tracheal Trauma- Dyspnoea- Hoarseness- Aphonia- Haemoptysis- Pain- Dysphagia/odinophagia- Aspiration- Endolaryngeal oedema- Local tenderness- Crepitus- External swelling- External bruising- Submucosal haemorrhage- Subcutaneous emphysema- Overt bleeding- Loss of laryngeal contour- Prolapse of arytenoid cartilage- Flaccidity or immobility of vocal cordA subtle presentation may be misleading and lead to gross cicatrization due to lateintervention.Diagnosis and Special InvestigationsA careful and methodical physical examination is the mainstay of the diagnosis.Indirect laryngoscopy should be attempted, but may be difficult to execute. Immobilizationof the neck to protect the cervical spine in case of instability should precede any attempts atexamination.The use of direct fibre-optic laryngoscopy is becoming more popular and does notrequire extension of the neck to perform. It can be done transnasally if necessary which willbe convenient i cases with concomitant mandibular fractures. Plain radiographs of the neckwill give valuable information and are quick and easy to perform.Computerized tomography is imperative, but should not be attempted in the acutephase. It is particularly helpful in deciding between conservative and surgical intervention.Contrast studies of the oesophagus will indicate the integrity of this vulnerable organ.Laryngograms and laryngeal polytomography are not as informative as computerizedtomography, and can be omitted if the later is available.The diagnostic work-up is outlined in table 5.4.3.51