The throat represents the internal and external body parts that descend from the tonsils down to the opening of trachea. It can be injured internally through swallowing something too big or sharp; it can also be injured externally, such as by a blow to the throat or a strangulation injury that damages the throat.
What is a Throat Injury?
A throat injury can be due to penetrating trauma to the throat or to a blunt trauma to the throat. Any throat injury that results in a break in the skin can do extensive damage because there are major arteries and veins that pass through the throat and can cause serious bleeding. A wound to the throat should be looked at carefully to see how deep it is so you can determine if there are any major vessels involved.
Blunt trauma to the throat can cause injury to the trachea, esophagus, spine or even the brain stem. If the person has had a severe blunt trauma to the throat, they should be asked the same questions as a person who may have had a concussion because there may actually be a brain injury with throat trauma.
Throat injury can damage the trachea and can cause difficulty breathing, swallowing or hoarseness of the throat. If the vocal cords are damaged, speaking will be difficult and there can be a hoarse throat or a complete lack of ability to speak if the vocal cords are more than just bruised.
Blunt trauma to the throat can affect the cervical spine. If there is any pain on moving the neck, the patient shouldn’t be moved until the cervical spine is cleared by x-ray.
You may have to immobilize the neck until the clearing x-rays can be done. Because of the number of important organs (the thyroid, vocal cords), blood vessels (carotid artery, jugular vein), and nerves (the spinal nerves of the cervical spine) involved in the throat, any kind of blunt or penetrating trauma can do a great deal of damage, even with a seemingly minor injury.
What are the Causes of a Throat Injury?
As mentioned, throat injuries can be blunt trauma injuries or penetrating trauma injuries, such as a gunshot wound. They are complicated by the fact that many delicate and important structures reside in the small space of the throat so that damage to some aspect of the throat is likely. Causes of throat injury can include:
- Automobile injuries, being struck by a blunt object or being cut by metal or glass.
- Sports-related injuries, such as being struck by another player’s extremities or helmet.
- Altercations, like being punched in the throat or kicked in the throat.
- Accidental falls, such as landing on a sharp or blunt object.
- Gunshot wounds, which can easily be fatal
- Knife wounds, which usually strike a vital part of the throat
The throat has no particular bony cage or protection so it is open to trauma in many different ways.
Symptoms of a Throat Injury
Some of the symptoms are the same as with any soft tissue trauma. Others are specific to the throat and the structures of the throat. There is the thyroid gland, major blood vessels and nerves, the trachea, the esophagus and the cervical spine to think about
- There can be signs and symptoms of a traumatic brain injury if the brainstem is affected.
- There can be shortness of breath and air escaping from a penetrating wound if the dome of the lungs is injured.
- There can be severe shortness of breath if the trachea has swollen or been penetrated and is bleeding. Air cannot get through to the lungs and the person begins to suffocate.
- There can be coughing up of blood in about 25 percent of cases.
- There can be severe bleeding that can exsanguinate the individual if the carotid artery or jugular veins are severed.
- The patient can have dysphonia due to damage to the vocal cords, either from blunt or penetrating trauma.
- Rapid breathing is a common phenomenon.
- In certain cases, there can be subcutaneous air, in which air from the lungs is dissected into the subcutaneous tissue. This feels like crackles under the skin. This can be seen in up to 85 percent of injuries to the tracheal area.
- Stridor, a pattern of noisy breathing, can be heard when the patient breathes and has had trauma to the upper airway.
- Coughing may be present if the trachea has been damaged.
- There may be a positive Hamman’s sign, which is crackling under the skin associated in time with the heartbeat.
In total, the symptoms can be any of the following:
- Difficulty swallowing
- A sensation of fullness in the throat
- Spitting up blood
- Subcutaneous air
- Visible throat swelling
- Loss of normal landmarks because of swelling
- Bleeding in the mouth or externally
- Labored breathing
Risk Factors for Throat Injury
More men than women are injured in a throat injury, in part because they engage in high risk behaviors. Many high risk behaviors include driving too fast, driving recklessly, engaging in high risk sports such as boxing and football, and being prone to altercations with people who might strike them with their fists, their feet or their weapon. People who practice martial arts are at higher risk of sustaining a throat injury.
Diagnosing a Throat Injury
The diagnosis of a throat injury depends on a careful knowledge of the anatomy of the area of the throat. In such cases, the ABCs of diagnosis and first aid are followed. Is the patient’s airway patent? Is there stridor or a hoarse voice? Is there visible swelling in the area of the trachea? Is the patient pink or are they cyanotic? In such cases of evidence of respiratory distress, one can assume that there has been swelling, dislocation or bleeding of the trachea or other aspect of the airway.
If there is bleeding from a laceration or puncture wound, the doctor must make a determination of which major vessels, if any, are involved. If the patient is stable, an angiogram to assess the carotid artery and jugular veins integrity. An unstable patient will be assumed to have a major vessel injury and will be treated immediately with surgical intervention.
The cervical spine should be immobilized if there is any chance of cervical pain. When in the emergency department, a lateral cervical spine x-ray should be done in order to rule out a major cervical injury. Following that, the c-spine can be removed from immobilization and a complete cervical spine series should be performed.
Orthopedics can be involved if there is positive evidence of a cervical spine bony injury.
If the voice is hoarse, a tube with a camera (a laryngoscope) can be dropped into the oral cavity and the vocal cords can be visualized to see if the cords are fractured, dislocated or perhaps just swollen from direct trauma.
If there is the possibility of a hematoma or other structural problem that cannot be assessed from the outside evaluation, a CT examination or MRI exam need to be done to see the internal structures of the head and neck. This could help the surgical procedures done on the patient and can assess things like the patency of the trachea, the integrity of the esophagus and the structure of the thyroid gland.
Treatment of a Throat Injury
There is first aid treatment for a throat injury and definitive treatment at an emergency room or hospital.
First is the first aid management at the site of the injury.
- Contact 911 as these situations can go badly quite quickly.
- Keep the person sitting but semi-upright to keep blood flow to a minimum in the area.
- Tilt the head back. This will open the airway.
- If the victim stops breathing, do rescue breathing.
- Apply direct pressure to any bleeding areas.
- Check the person’s breathing periodically.
- Put ice on the sides of the neck. This will reduce the swelling.
- Immobilize the neck.
- If there are signs of shock, elevate the legs and keep the patient warm.
- If the victim vomits, roll him to one side and sweep the vomit out of his mouth so the airway won’t be compromised.
- Monitor the patient’s status continuously until help arrives.
When the patient arrives at the emergency room, they will need an IV to stabilize the blood pressure. Assessment and management of the area can involve intubation or possibly a cricothyrotomy, which is a hole placed in the neck to create an airway when the airway above it has occluded.
When the breathing is adequate, the doctor turns to the bleeding. Ice is applied to quell internal bleeding and direct pressure is applied to the bleeding wound until it can be evaluated and treated, possibly in the operating room.
Hematomas are evacuated in the emergency room and things like the vocal cords can be repaired by an ENT surgeon. If there is a cervical bony injury, the cervical spine needs to be immobilized, possibly with surgery to fuse the injured bony fragments. This would involve care by the orthopedic surgeon.
If the thyroid gland is damaged, as much of the gland should be spared as possible during surgery in the hope that the victim does not come down with post-injury hypothyroidism.
Complications of Throat Injuries
If the injury is minor and the medical care appropriate, the patient can suffer no ill effects from the traumatic injury.
Complications can include:
- Paralysis from a cervical spine fracture
- Permanent damage to the vocal cords with resultant dysphonia
- Brain injury from extended shock. This would happen if there was injury to the carotid arteries or jugular veins
- Stroke from injury to the carotid arteries
- Hypothyroidism from permanent damage to the thyroid gland
- Tracheal abnormalities
The throat is an extremely vulnerable place to be injured and many of the injuries, if not treated promptly and correctly, can lead to life-threatening sequelae and permanent injury. Unfortunately most of these injuries happen in young people who have many potentially good years ahead of them.
- What are the symptoms of a throat injury?
- What are the causes of a throat injury?
- What are the risk factors of a throat injury?
- Diagnosing a throat injury
- What is the treatment of a throat injury?
- What are the complications of a throat injury?
If you or a loved one has suffered a throat injury due to another's negligence and would like to discuss your legal options, contact me online or call me at 916.921.6400 to set up a FREE consultation with an experienced Injury Lawyer