Analysis of Anterior Neck Injuries and their Intervention

INTRODUCTION: Laryngotracheal injuries are extremely uncommon, but they can be fatal. They are of major clinical significance because, if not treated timely and effectively, this will result in acute complications such as shock, sepsis, death, or, if the patient survives, the creation of fistula or voice dysfunction. ❖ Laryngotracheal structures area plays pivotal role in breathing, swallowing, and speaking. Traumatic damage to its complicated architecture can induce considerable acute dysfunction, posing a life-threatening situation. To reduce the risk of perioperative problems and long-term morbidity like dysphagia and dysphonia, proper assessment and appropriate surgical care are required. ❖ Neck trauma constitutes 75% of immediate mortality. Meticulous assessment and timely accurate surgical management are essential to reduce acute sequelae and improve post traumatic outcome. ❖ This is an observational study in a tertiary care centre hospital, Tamilnadu, India. In which the various patterns, modes, clinical presentations, survival rate and management status is studied for a study period of two years (2019 to 2020). AIM OF THE STUDY: To describe the causes, categorize the severity of injury and outcome of management of neck trauma based on time and depth of injury. MATERIALS AND METHODS: Setting: Emergency OPD and the department of ENT, Tirunelveli medical college hospital, Tirunelveli. Design of the study: Prospective Descriptive study. Period of the study: 2019 to 2021. Sample size: All patients who presented to emergency department with neck traumas during study period were included in this study. Inclusion criteria: All patients presented to emergency department with neck trauma. Exclusion criteria: Nil. STUDY METHOD: After obtaining institutional and ethical committee clearance all patients presenting to emergency department with neck injuries were examined. If the general condition of the patient was stable, detailed history and examination is carried out first and then managed accordingly, if patient is unstable, treatment was started first and later on history documented. ENT examination of the patients presented to emergency department of our hospital with neck trauma between 2019 to 2021 were examination of oral cavity, oropharynx, laryngopharynx examination and detailed neck examination. Patient demographics such as age, sex, mode of injury, site of injury, time taken to reach the tertiary care centre, clinical presentations were documented initially. Patient will be undergoing detailed clinical, endoscopic, radiological (if needed) examination and investigations. After obtaining consent patient is shifted to emergency operation theatre for airway management and exploration if needed. Post operatively patients were observed in ENT wards, tracheostomy decannulation was tried during the treatment period in the ward itself. Psychiatry opinion and counselling were given to all patients before discharge. These patients were followed up clinically on OPD basis for the assessment of complications and quality of life. CONCLUSION: ❖ Neck trauma with laryngeal framework injury is a rare yet life-threatening surgical emergency. Initial management of these patients established according to the ATLS criteria. ❖ In our study the incidence of neck injury is most common in middle aged men with risk taking behaviours like substance abuse and taking part in social disputes. ❖ Among the neck trauma, penetrating injuries are more common due to suicidal attempts, the most common type of injury is combined laryngotracheal framework injury. In isolated cartilaginous injuries thyroid cartilage is more commonly involved. ❖ Neck trauma cases due suicidal cut wounds are commonly associated with psychiatric illness. So, this will suggest all cases of neck trauma promptly evaluated and treated for psychiatric diseases. ❖ Arriving at the tertiary referral centre within the golden period of neck injury (First one hour) and getting timely surgical intervention is vital for better surgical outcome and prevention of future complications like fistula formation and subglottic stenosis