2017-18 HSC Section 3 Green Book
J.E.
Strychowsky
et al.
/ International
Journal
of Pediatric Otorhinolaryngology 79
(2015)
959–964
reported
delay.
Interestingly,
Quesnel
and
Hartnick
without
3.2.
Literature
review
a
case of VF
avulsion
secondary
to
traumatic
intubation
described
case
reports
[5–10]
of
pediatric
vocal
fold
avulsion
female
that was successfully repaired 12 days after
in a 6-week-old
Seven
to external
trauma
( Table 1 ) and eight
cases
[4,7,11,12]
initial
injury due
to
the
associated posterior
tracheal wall
tear
secondary secondary literature
the [7] .
to
internal
trauma were
identified
through search of
the
Harris
et
al.
reported
the
successful
repair
of
a
right
vocal
( Table
2 ).
avulsion
2
years
after
injury
in
a
16-year-old
female
[4] .
process
cases
of
external
laryngeal
trauma
presented
in
male Three
injected botulinum
toxin
to
the
left
thyroarytenoid
All
Abraham et al.
and
ranged
in
age
from
5
to
15
years
[5–10] .
to reduce VF
patients
muscle after endoscopic repair of bilateral VF avulsion
[5,6,9] and
four had unilateral
in
the
postoperative
period
to
allow
for
adequate
patients had bilateral TVF avulsions
movement
(two
left-sided
[7,8]
and
two
right-sided
[8,10] ).
Six
[6] .
avulsions patients avulsion
healing
had
total
avulsions patients
[5–9] ;
one
patient
had
a
partial
reports of
internal
laryngeal
trauma were all
secondary
to
Case
[10] .
Four
underwent
tracheotomy
[5,7,8,10] ;
[4,7,11,12] .
Two
patients
presented
acutely
after
intubation traumatic
for an open surgical approach and
intubations
[7,11] whereas
the
remaining
six
patients
these were associated with need
significant
injuries
including
comminuted
thyroid
cartilage
ranging
from 5 months
to 13 years after
more
had delayed presentations
and
fractures
nearly
resulting
in
a
laryngofissure.
All
intubation
injury
[4,12] , most
in
the neonatal
fracture patients
suspected prolonged
were
successfully
decannulated
in
the
postoperative patients; when
[12] .
Of
the
patients who management
presented
acutely,
Quesnel
and and
period
quality
returned
to normal
for most
reported
that
included
tracheotomy
period. Voice
Hartnick delayed tracheal
follow-up
ranged
from
1 month
to
2
years.
open
laryngoplasty
given
the
concomitant
posterior newborn;
reported,
repair
was
achieved
in
three
patients
[6,9,10] ,
wall
tear
[7] .
The
second
case
occurred
in
a
Endoscopic
in one patient but was unsuccessful and converted
to an
the avulsed
tissue back
into place and placed an
attempted
Wohl manipulated
procedure
[7] ,
and
repaired with
an
open
laryngofissure
in
tube
as
a
stent
for
3
days
[11] . voice
This healed well and VF movement
and
open
endotracheal the patient is
[5,8] . Time
to
surgical
repair
ranged
from
immediate
reported
to have normal
at
two patients
2
years.
All
cases
of
external
laryngeal
trauma were
repaired
of
age.
Of
patients with
delayed
presentation,
Harris
to
18 months
Table 1 External
laryngeal
trauma.
Author,
year
Age/Gender
Mechanism
of
injury
Injury
Management
Outcome
Right avulsion (midmembranous), mucosal laceration and exposed cartilage right paraglottic TVF
Endoscopic repair, reapproximation with
Normal
study,
5yo/M Fall
onto metal
bar
of
voice
quality
at
4m
Present
equipment
5-0
2015
fitness
suture;
ETT
kept
in
place
vicryl
space
2
days
then
extubated
for
et
al.
from
bull,
laryngeal anterior
fracture
4.5m
after
Decannulated
Shires
14yo/M Thrown
Comminuted
Tracheotomy, neck exploration, laryngofissure; open repair with resuspension of TVFs and miniplate with screws for cartilage fractures; postoperative removal of granulation tissue with CO 2 laser
(2011)
subsequently
with
injury;
[5]
gored
injury
to
excellent
voice
at
and
avulsion
of
anterior
glottis web
commissure
12m;
TVFs
from
anterior
both
present
commissure
Normal
Endoscopic repair, reapproximation with
et
al.
(2010)
[6]
13yo/M Clothesline
injury,
neck
fractures
voice
quality
at
5m,
Bilateral vocal process
Abraham
a
tree
branch while
avulsion
of
bilateral
TVFs
5-0
left-sided
atrophy
and
struck riding
and
slight phase
all-terrain
vehicle
suture;
botulinum
toxin
asymmetry
vicryl 2.5 u
to
left
TA muscle;
POD1 repair
discharged Endoscopic
Decannulated after injury; near-normal voice 1m after injury 16d
15yo/M Skate
and Hartnick
board
struck
right
TVF
avulsion
from
vocal
attempted
Quesnel
Left
[7]
performing
a
tear with
unsuccessful;
open
repair
(2009)
neck while
process, mucosal
but
of
paraglottic
space
laryngofissure;
trick
exposure
with
tracheotomy Emergent completion
14yo/M MVA
Deannulated; weak
Wootten
et
al.
Right
arytenoid
rotation with
tracheotomy;
voice
[8]
avulsion
from
vocal
laryngofissure with
right
TVF
paralysis;
no
(2009)
TVF
with
vertical fracture
thyroid
pexy
of
right over
TVF
and
process; cartilage
suture
aspiration/dysphagia; adequate airway
creating
repair
Aboulker
mucosal
fracture;
suture fixation
of
cricoid
laryngofissure; cricoid
stent;
tear
repair
of
pharynx
and
pharyngeal
fracture;
cricothyroid membrane
5yo/M Fall
into
table while playing
Left
TVF
sheared edema
off
vocal
NR
NR
of
arytenoids,
process;
subglottis
FVFs,
10yo/M Clothesline
et
al.
injury,
neck
the
leading anterior
repair with
voice
and
larynx
2y
Normal
Bilateral avulsion of
Bloom
Endoscopic placement
[9]
chain while
riding
of
TVFs
from
the
of
internal
and
(2001)
struck bicycle
edge
down
a
hill
at
full
ethibond
sutures;
commissure
external external
suture
tied
over
a
speed
sterile
button
at
the
skin;
ETT
in
place
for
4
days
then
kept
extubated
15yo/M Slip
Knapp
et
al.
and
fall
onto
log while
Partial
avulsion
of
right
TVF
under
local
POD5;
voice
Decannulated outcomes NR
Tracheotomy anesthesia;
[10]
arytenoid
cartilage,
endoscopic
repair
(2000)
walking
from
of
thyroid
cartilage
avulsion with
6-0
chromic
fracture
of
suture;
open
approach cartilage
for
gut
of
thyroid
repair
fracture with
prolene
sutures
tube; FVF,
false vocal
fold; M, male; m, month; MVA, motor vehicle accident; NR, not reported; POD, post-operative day; TA,
thyroarytenoid; TVF,
true vocal
ETT, endotracheal
fold;
yo,
year
old.
38
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