Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-09T06:07:52.260Z Has data issue: false hasContentIssue false

In vitro study investigating post neck surgery haematoma airway obstruction

Published online by Cambridge University Press:  02 September 2008

E R M Carr*
Affiliation:
Department of Ear, Nose & Throat Surgery, Derbyshire Royal Infirmary, Derby, UK
E Benjamin
Affiliation:
Department of Ear, Nose & Throat Surgery, Charing Cross Hospital, London, UK
*
Address for correspondence: Mr ERM Carr, Amber Mill Furniture Cottage, Oakerthorpe DE55 7LL, UK. Fax: 01899 830 482 E-mail: [email protected]

Abstract

Objectives:

To investigate whether the possible pressure produced by a haematoma in the neck would be sufficient to directly compress the trachea to the point of airway obstruction.

Study design:

In vitro study.

Methods:

Varying pressures were applied over the second and third cartilaginous rings of 10 pig tracheas in vitro and the anterior–posterior compression was measured.

Results:

At pressures of 257 mmHg, equivalent to the maximum possible pressure in the neck (i.e. systolic blood pressure), there was an average compression of 20.8 per cent of the original anterior–posterior tracheal diameter.

Conclusions:

This study suggests that the pressures in haematomas observed after neck surgery would not be sufficient to cause airway obstruction due to direct pressure on the trachea. Therefore, the most likely cause of airway obstruction would be supraglottic oedema secondary to venous obstruction.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented as a poster at the Joint ENT UK/Royal Society of Medicine meeting, 6–7 September 2007, London, UK.

References

1 Lahey, FH, Hoover, WB. Tracheostomy after thyroidectomy. Ann Surg 1951;133:6576Google Scholar
2 Wade, JS. Respiratory obstruction in thyroid surgery. Ann R Coll Surg Engl 1980;62:1524Google Scholar
3 Drobnic, M, Mars, T, Alibegovic, A, Bole, V, Balazic, J, Grubic, Z et al. Viability of human chondrocytes in an ex vivo model in relation to temperature and cartilage depth. Folia Biol Praha 2005;51:103–8Google Scholar
4 Jiang, JJ, Raviv, JR, Hanson, DG. Comparison of the phonation related structures among pig, dog, white-tailed deer and human larynges. Ann Otol Rhinol Laryngol 2001;110:1120–5Google Scholar
5 Gill, GA, Buda, A, Moorghen, M, Dettmar, PW, Pignatelli, M. Characterisation of adherens and tight junctional molecules in normal animal larynx; determining a suitable model for studying molecular abnormalities in human laryngopharyngeal reflux. J Clin Pathol 2005;58;1265–70CrossRefGoogle ScholarPubMed
6 Stennert, E, Siefer, O, Zheng, M, Walger, M, Mickenhagen, A. In vitro culturing of porcine tracheal mucosa as an ideal model for investigating the influence of drugs on human respiratory mucosa. Eur Arch Otorhinolaryngol 2008, PMID: 18458926 DOI 10.1007/s00405-008-0661-5CrossRefGoogle ScholarPubMed
7 Gorti, G, Birchall, M, Haverson, K, Macchiarini, P, Bailey, M. A preclinical model for laryngeal transplantation: anatomy and mucosal immunology of the porcine larynx. Transplantation 1999;15;68(11):1638–42CrossRefGoogle Scholar
8 Randestad, A, Lindholm, CE, Fabian, P. Dimensions of the cricoid cartilage and the trachea. Laryngoscope 2000;110:1957–61CrossRefGoogle ScholarPubMed
9 Shaha, A, Jaffe, B. Practical management of post-thyroidectomy hematoma. J Surg Onc 1994;57:235–8Google Scholar
10 Savargaonkar, A. Post thyroidectomy haematoma causing total airway obstruction – a case report. Indian Journal of Anaesthesia 2004;48:483–5Google Scholar
11 McGuirt, WF, McCabe, BF. Bilateral radical neck dissections. Arch Otolaryngol 1980;106:427–9Google Scholar
12 Frazell, EL, Moore, OS. Bilateral radical neck dissection performed in stages. Experience with 467 patients. Am J Surg 1961;102:809–14CrossRefGoogle ScholarPubMed
13 Maier, W, Malatskey, S, Fradis, M, Krebs, A. Diagnostic and therapeutic management of bilateral carotid artery occlusion caused by near-suicidal hanging. Ann Otol Rhinol Laryngol 1999;108:189–99Google Scholar
14 Nikolic, S, Micic, J, Atanasijevic, T, Djokic, V, Djonic, D. Analysis of neck injuries in hanging. Am J Forensic Med Pathol 2003;24:179–82Google Scholar
15 Feigin, G. Frequency of neck organ fractures in hanging. Am J Forensic Med Pathol 1999;20:128–30Google Scholar
16 Kuriloff, DB, Pincus, RL. Delayed airway obstruction and neck abscess following manual strangulation injury. Ann Otol Rhinol Laryngol 1989;98:824–7Google Scholar