A Case of Neck Trauma with Hypopharyngeal and Epiglottic Laceration

A sixty-year-old male slipped down from a silkworm trellis to an iron pole. His front neck was injured at that accident. On his visit to a local doctor, the neck wound was sutured primarily. In a short time, his neck became swollen, so that the wound was reopened by a surgeon in a different clinic. When the patient was referred to our clinic by the surgeon, 4 hours had passed since the first treatment was done. Clinical examination revealed the partially defected epiglottis, the lacerated hypopharyngeal mucosa and the fractured hyoid bone. X-ray examination and CT revealed subcutaneous emphysema and tracheotomy was recommended. After tracheotomy was done under local anesthesia, the patient was operated on to repair the epiglottis and the hypopharynx. The left vocal cord was fixed for 3 months after surgery probably due to intubation for the general anesthesia. He was discharged after 44 days of hospitalization. This case suggest that the first 4 to 5 hours after injury with intensive observation of the patient are the critical period for successful treatment.