Larinksin Travmatik ve İyatrojenik Hastalıkları
Özet
Larinks; solunum, fonasyon ve alt havayolunun korunması gibi hayati fonksiyonları üstlenen, kompleks nöromusküler kontrole sahip biyolojik bir sfinkter düzeneğidir. Laringeal travmalar; sesin kötü kullanımı, iyatrojenik müdahaleler (entübasyon, cerrahi), korozif madde maruziyeti ve eksternal mekanik etkiler gibi geniş bir etiyolojik spektrumda karşımıza çıkmaktadır. Klinik pratikte en sık sesin kötü kullanımına bağlı vokal nodül, polip ve Reinke ödemi izlenirken; internal travmalarda endotrakeal entübasyona bağlı gelişen posterior komissür nekrozları ve laringotrakeal stenozlar ön plana çıkmaktadır. Eksternal travmalar ise nadir görülmekle birlikte, akut havayolu obstrüksiyonu riski nedeniyle acil yaklaşım gerektirir. Bu vakalarda, laringeal mukozayı korumak ve anatomik distorsiyonu derinleştirmemek adına endotrakeal entübasyon yerine trakeotomi tercih edilmelidir. Laringeal yaralanmaların yönetiminde Schaefer sınıflaması gibi objektif değerlendirme sistemlerinin kullanımı ve multidisipliner bir yaklaşım esastır. Tanı ve tedavideki gecikmeler; kalıcı disfoni, kronik aspirasyon ve ilerleyici stenoz gibi yüksek morbiditeye sahip sekellere yol açmaktadır. Sonuç olarak, akut dönemde havayolu güvenliğinin sağlanması ve erken müdahale, organın fonksiyonel bütünlüğünün korunmasında kritik öneme sahiptir.
The larynx is a specialized organ complex functioning as a biological sphincter at the junction of the aerodigestive tract, performing vital functions such as respiration, phonation, and airway protection. Laryngeal traumas encompass a broad etiological spectrum, including vocal abuse (phonotrauma), iatrogenic interventions (intubation, surgery), corrosive substance exposure, and external mechanical impacts. While benign lesions such as vocal nodules, polyps, and Reinke’s edema are frequently observed in clinical practice due to vocal misuse, internal traumas are primarily characterized by posterior commissure necrosis and laryngotracheal stenosis following endotracheal intubation. Although external traumas are rare, they necessitate urgent intervention due to the risk of acute airway obstruction. In such cases, tracheotomy is preferred over endotracheal intubation to prevent further mucosal damage and to manage anatomical distortion effectively. The management of laryngeal injuries relies on objective assessment systems like the Schaefer classification and a multidisciplinary approach. Delays in diagnosis and treatment lead to high-morbidity sequelae, including permanent dysphonia, chronic aspiration, and progressive stenosis. Consequently, ensuring airway safety during the acute phase and implementing early intervention are critical for preserving the functional integrity of the larynx.
Referanslar
Negus V., Keith A. The Comparative Anatomy and Physiology of the Larynx. London: Heinemann; 1949.; 1949. Accessed October 24, 2023.
Lynch M. Repair of the traumatized larynx. Laryngoscope. 1951;61(1):51-65. doi:10.1288/00005537-195101000-00003
Nahum AM. Immediate care of acute blunt laryngeal trauma. J Trauma. 1969;9(2):112-125. doi:10.1097/00005373-196902000-00003
Trone TH, Schaefer SD, Carder HM. Blunt and penetrating laryngeal trauma: a 13-year review. Otolaryngol Head Neck Surg (1979). 1980;88(3):257-261. doi:10.1177/019459988008800313
Fuhrman GM, Stieg FH, Buerk CA. Blunt laryngeal trauma: classification and management protocol. J Trauma 1990;30(1):87–92.
Verschueren DS, Bell RB, Bagheri SC, Dierks EJ, Potter BE. Management of laryngo-tracheal injuries associated with craniomaxillofacial trauma. J Oral Maxillofac Surg. 2006;64(2):203-214. doi:10.1016/j.joms.2005.10.034
Juutilainen M, Vintturi J, Robinson S, Bäck L, Lehtonen H, Mäkitie AA. Laryngeal fractures: clinical findings and considerations on suboptimal outcome. Acta Otolaryngol. 2008;128(2):213-218. doi:10.1080/00016480701477636
Bhojani RA, Rosenbaum DH, Dikmen E, et al. Contemporary assessment of laryngotracheal trauma. J Thorac Cardiovasc Surg. 2005;130(2):426-432. doi:10.1016/j.jtcvs.2004.12.020
Kleinsasser NH, Priemer FG, Schulze W, Kleinsasser OF. External trauma to the larynx: classification, diagnosis, therapy. Eur Arch Otorhinolaryngol. 2000;257(8):439-444. doi:10.1007/s004050000263
Willems-Bloemer LH, Vreeburg GC, Brummer R. Treatment of reflux-related and non-reflux-related dysphonia with profound gastric acid inhibition. Folia Phoniatr Logop. 2000;52(6):289-294. doi:10.1159/000021546
Lin PT, Stern )C, Gould Wj. The risk factors and management of vocal cord haemorrhages: An experience with 44 cases. J Voice 1991;5:74-77.
Feder RJ. Varix of the vocal cord in the professional voice user. Otolaryngol Head Neck Surg. 1983;91(4):435-436. doi:10.1177/019459988309100417
Heidegger T, Starzyk L, Villiger CR, et al. Fiberoptic intubation and laryngeal morbidity: a randomized controlled trial. Anesthesiology. 2007;107(4):585-590. doi:10.1097/01.anes.0000281925.61143.b5
Esteller-Moré E, Ibañez J, Matiñó E, Ademà JM, Nolla M, Quer IM. Prognostic factors in laryngotracheal injury following intubation and/or tracheotomy in ICU patients. Eur Arch Otorhinolaryngol. 2005;262(11):880-883. doi:10.1007/s00405-005-0929-y
Leung R, Berkowitz RG. Incidence of severe acquired subglottic stenosis in newborns. Int J Pediatr Otorhinolaryngol. 2007;71(5):763-768. doi:10.1016/j.ijporl.2007.01.014
Nouraei SA, Ma E, Patel A, Howard DJ, Sandhu GS. Estimating the population incidence of adult post-intubation laryngotracheal stenosis. Clin Otolaryngol. 2007;32(5):411-412. doi:10.1111/j.1749-4486.2007.01484.x
Vila J, Bosque MD, García M, Palomar M, Quesada P, Ramis B. Endoscopic evolution of laryngeal injuries caused by translaryngeal intubation. Eur Arch Otorhinolaryngol. 1997;254 Suppl 1:S97-S100. doi:10.1007/BF02439735
Zimmert M, Zwirner P, Kruse E, Braun U. Effects on vocal function and incidence of laryngeal disorder when using a laryngeal mask airway in comparison with an endotracheal tube. Eur J Anaesthesiol. 1999;16(8):511-515. doi:10.1046/j.1365-2346.1999.00525.x
Erdoğan E, Eroğlu E, Tekant G, et al. Management of esophagogastric corrosive injuries in children. Eur J Pediatr Surg. 2003;13(5):289-293. doi:10.1055/s-2003-43581
Arévalo-Silva C, Eliashar R, Wohlgelernter J, Elidan J, Gross M. Ingestion of caustic substances: a 15-year experience. Laryngoscope. 2006;116(8):1422-1426. doi:10.1097/01.mlg.0000225376.83670.4d
Brosch S, Johannsen HS. Clinical course of acute laryngeal trauma and associated effects on phonation. J Laryngol Otol. 1999;113(1):58-61. doi:10.1017/s0022215100143154
Havas TE, Priestley J, Lowinger DS. A management strategy for vocal process granulomas. Laryngoscope. 1999;109(2 Pt 1):301-306. doi:10.1097/00005537-199902000-00023
Jewett BS, Shockley WW, Rutledge R. External laryngeal trauma analysis of 392 patients. Arch Otolaryngol Head Neck Surg. 1999;125(8):877-880. doi:10.1001/archotol.125.8.877
Zátopková L, Janík M, Urbanová P, Mottlová J, Hejna P. Laryngohyoid fractures in suicidal hanging: A prospective autopsy study with an updated review and critical appraisal. Forensic Sci Int. 2018;290:70-84. doi:10.1016/j.forsciint.2018.05.043
Granholm T, Farmer DL. The surgical airway. Respir Care Clin N Am. 2001;7(1):13-23. doi:10.1016/s1078-5337(05)70020-4
