The authors review 6 cases of laryngeal trauma and 2 cases of laryngotracheal rupture which were seen after road accidents. They note that increasingly, as a result of the intervention of emergency medical ambulance teams, such injured patients are intubated at the site of the accident. Closed laryngo-tracheal rupture corresponds completely with cases described in the literature, forming a clinical picture which is a source of grave error by virtue of its latent nature. The management at the time of admission of the patient obviously is altered if intubation has already been performed, since the tube should never be removed for the purposes of clinical assessment before tracheotomy has been performed. If the patient is not intubated, the presence of respiratory distress necessitating emergency therapy reflect major lesions which therefore require surgical exploration. Rather than primary tracheotomy, the authors prefer intubation using a rigid bronchoscope which facilitates subsequent tracheotomy.

Accidents, Traffic↗

PubMedDate not supplied

[Cervical esophagus injuries (author's transl)].

The authors report 16 cases of cervical esophagus injuries. In two patients, they followed a closed injury to the neck, in six cases, wounds from firearms or other weapons. In five cases, tracheal intubation, and in three cases, perforations of various origins. All patients required operative treatment, and in six cases surgery was performed between the 3rd and 25th day following the injury. Only one of the 8 patients operated upon within 12 hours following injury developed cervicomediastinal complications, while seven of the 8 cases operated upon after this period developed mediastinitis or a fistula. Radiological examination with an opaque medium and urgent operation combining drainage and suture are essential when injury to the esophagus is suspected, in order to obtain early diagnosis and good results.

Adult↗

PubMedDate not supplied

[New techniques in thoracic surgery. II].

The surgical approach to affections of the chest wall and pleura, still the predominant indications for thoracic surgery, has greatly changed since the advent of thoracoscopic procedures, and is emphasized in this second part of a two-part review, together with other indications for mediastinal tumours. Indicated after lung exeresis or emergency chest surgery, protective chest wall reconstruction with muscular flaps is no longer an exceptional operation. Inversely, thoracic surgery for infectious complications have become less frequent, unusually limited to well established procedures for tuberculosis surgery, treatment of bronchial fistula or mediastinal supperations. The chest cavity is well adapted to new techniques of thoracoscopy and video-assisted thoracic surgery both for diagnosis and treatment. Indications for pleuroscopy have taken on a completely new aspect since 1989. These techniques are used for pericardial fenestration, thoracic sympathectomy for dyshidrosis, vagotomy, splanchnicectomy, chylothorax, spinal affections, empyema and trauma surgery. These new techniques have also had an impact on treatment of spontaneous pneumothorax. For tumour surgery, thoracoscopy has made possible a more adapted strategy currently based on an initial needle biopsy, with limited thoracoscopic exeresis and ultimate treatment depending upon the pathology report. Immediate thoracoscopy without prior biopsy appears excessive. Video-assisted thoracosurgery is also used for most malignant mediastinal tumour which, due to advances in chemotherapy surgery have transformed the prognosis of a large number of mediastinal tumours.

Bronchial Fistula↗