Resident Manual of Trauma to the Face, Head and Neck

All exposed cartilage should be covered either primarily or with local mucosal advancement flaps. Displaced or subluxed arytenoid cartilages should also be carefully repositioned. C. Endolaryngeal Edema Patients with significant laryngeal edema, particularly if it appears to be progressing, should undergo awake tracheotomy to prevent airway loss. After tracheotomy, the patient with significant laryngeal edema should be evaluated with direct laryngoscopy and esophagoscopy to uncover subtle injuries that may be masked by the edema and missed in initial flexible fiberoptic laryngoscopy. Adjunctive measures, such as head-of- bed elevation, corticosteroids, anti-reflux medications, and humidifica- Patients with endolaryngeal hematomas should be admitted to the hospital for close airway observation, as even small hematomas may progress. Small, nonprogressing hematomas with intact mucosal coverage are likely to resolve spontaneously without significant sequelae. Adjunctive therapies, such as steroids, anti-reflux medication, humidification, and head-of-bed elevation are helpful. Large or expand- ing hematomas may lead to airway obstruction and necessitate placement of a tracheotomy. E. Recurrent Laryngeal Nerve Injury Recurrent laryngeal nerve injury may occur after blunt or penetrating laryngeal injury. Recurrent laryngeal nerve injury after blunt laryngeal trauma may be due to either stretching of the nerve or nerve compres- sion near the cricoarytenoid joint. y y If a vocal cord is persistently immobile after blunt trauma, the vocal fold should be observed for as long as one year to await the possible spontaneous regeneration of recurrent laryngeal nerve function. y y If a recurrent laryngeal nerve is severed, primary repair should be attempted. While vocal fold mobility will not be regained after even a successful repair due to the mixture of abductor and adductor fibers in the nerve, neural regeneration may prevent muscle atrophy, resulting in improved vocal cord tone and vocal strength in the long term. y y If primary re-anastamosis of the severed nerve is not possible, the ansa hypoglossi may be redirected and sutured to the distal stump of the recurrent laryngeal nerve to improve vocal cord muscle tone. tion should be strongly considered. D. Endolaryngeal Hematomas

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