Upper part: ventricular ligament

Lower part - elastic cone of larynx: vocal ligament, cricothyroid membrane

Open the glottis: posterior cricoarytenoid muscle (the only abductor muscle; also tenses the vocal cords)

Close the glottis: cricoarytenoid muscles, arytenoid muscles

Ten/relax the vocal cords: cricothyroid muscle, thyroarytenoid musle

Activate the epiglottis: aryepiglottic muscle, thyroepiglottic muscle

Labored breathing, hoarseness, asthma, weak crying/loss of voice in children

Laryngoscope: web-like protrusions, light red in color

Imaging: plays a certain role in determining the thickness of laryngeal webs, especially subglottic and rare double laryngeal webs.

Poor breathing, holding of breath/wheezing/intermittent crying when feeding young children; laryngeal air sacs generally have no clinical symptoms

Ultrasound: the test of choice

Laryngoscopy (use a hollow needle to aspirate if there is liquid/gas to confirm the diagnosis), imaging

Characteristics - laryngeal stridor: caused by extremely loose supraglottic soft tissue falling into the laryngeal entrance; it is the most common cause of congenital laryngeal stridor in infants; it only occurs during inhalation, and can be aggravated by activities and crying, and can be caused by prone positioning. alleviate

laryngoscope

Imaging: Helps in diagnosis and differential diagnosis

Pain: noticeable in the throat and neck, often with obvious tenderness; aggravated by speaking, swallowing, chewing, and coughing, and can radiate to the ears

hoarseness, loss of voice

Cough, hemoptysis

Difficulty breathing: suffocation may occur in severe cases

subcutaneous emphysema

shock

Physical examination: The neck is swollen and deformed, the skin is flaky and cord-like with ecchymoses, the throat is obviously tender, and the friction sound of laryngeal cartilage fragments can be palpated; in patients with subcutaneous emphysema, crepitus can be palpated.

Laryngoscopy, imaging

Sedation, neck immobilization, reduction of swallowing movements, airway humidification, antibiotics, corticosteroids, analgesics

Closely observe changes in the wound and be prepared for tracheotomy

Obvious inspiratory dyspnea: tracheotomy; in extremely critical cases, intralaryngeal intubation/cricothyrotomy can be performed first

Laryngeal cartilage fixation under direct laryngoscope: This method is used to reposition the laryngeal cartilage after tracheotomy; when fixation is difficult, a laryngeal mold can be used, but follow-up is required after the laryngeal mold is taken out 4 to 8 weeks after surgery, and if there is a tendency of stenosis, be processed

Pay attention to the active use of antibiotics and glucocorticoids after surgery to prevent infection and reduce scar hyperplasia.

Bleeding: more violent, prone to hemorrhagic shock

Dyspnea: Dyspnea, bleeding, and shock are the three critical phenomena of open laryngeal trauma

hoarseness

hard to swallow

subcutaneous emphysema

Routinely check vital signs

Wound condition: If there is saliva flowing out from the wound, it indicates that the wound is connected to the inside of the throat; note that blood clots and foreign bodies in the wound cannot be easily removed to avoid heavy bleeding.

Dyspnea: Suck out the blood/saliva from the throat, inhale oxygen, and remove foreign objects at the same time; in an emergency, cricothyroidotomy is possible, and then conventional tracheotomy can be performed after the dyspnea is relieved.

Control bleeding: Find the bleeding blood vessel and ligate it; if it cannot be found, use gauze to pack it to stop bleeding; note that wounds that have penetrated the laryngeal cavity cannot be bandaged (to prevent laryngeal edema and aggravate cerebral edema); common carotid artery/internal carotid artery Only use sterilization as a last resort

(Hemorrhagic) shock: rehydration, cardiotonic

Others: Application of hemostatic drugs, injection of tetanus antitoxin

Superficial throat injuries: If the wound is short and not contaminated, it can be sutured in one stage; if there is contamination, it can be sutured in one stage.

Throat incisions and penetrating injuries: Preserve the laryngeal cartilage and laryngeal mucosa as much as possible; use non-invasive sutures according to the anatomical relationship to leave no wounds as much as possible; fix with a laryngeal mold

foreign body removal surgery

Postoperative management: nutritional support, antibiotics, and corticosteroids

The damage is at and above the glottis; manifested by hoarseness, sore throat, increased salivation, dry throat, cough with excessive phlegm, and difficulty swallowing; congestion, swelling, blisters, ulcers, bleeding, and pseudomembrane formation of the nasal/mouth/pharyngeal/laryngeal mucosa.

The injury is above the tracheal carina; in addition to the above symptoms, inspiratory dyspnea and suffocation may occur; laryngeal mucosa edema and erosion, rough breath sounds, rales and wheezing may occur

Damage to the bronchi and below; in addition to the above symptoms, lower respiratory tract mucosal edema, erosion, ulcers, and necrosis may occur; shortness of breath, severe coughing, and coughing up pus and bloody sputum; in severe cases, obstructive atelectasis, bronchopneumonia, and Edema, respiratory failure

Early treatment: For burns caused by hot fluids, take ice cubes in your mouth/gargle with cold water; for those burned by strong acid or alkali, rinse the oropharynx immediately with water and use neutralization therapy

Systemic treatment: rehydration, maintenance of water and electrolyte balance, oxygen inhalation, antibiotics, glucocorticoids; emergency tracheal intubation in severe cases

Tracheal intubation, tracheotomy, edema incision, drainage and decompression, antispasmodic drugs, aerosol inhalation

In the early stage, intravenous nutrition is mainly used; gastric tube can be inserted when allowed

Large foreign body: Immediate loss of voice, severe coughing, difficulty breathing, cyanosis, and death from suffocation in severe cases

Small foreign bodies: hoarseness, laryngeal stridor, paroxysmal severe cough; sharp objects may cause sore throat and dysphagia.

Laryngoscope: Supraglottic foreign bodies are easy to detect

Auscultation: Wheezing in the larynx during inspiration

Videography