clothes-line

1
??? ???? ?? ??? ???? ????...
2
?????? ????? ? ???
3
????? ?????? ?????

• -?????1
• clothes-line
• Crushing
• Strangulation
• ????2
• Gunshots
• low-velocity
• High-velocity
  
• knife
• Inhalation3
• Caustic ingestion4

4
??????? ????? ?? ?????? ?????

• ?????? (?????? ???-?????? ??????????????-????????
  ?? ??????-????? ????? ??? ???? ? ???? ????-?????
  ???? ??? ???? ??????? ??? ??? )
• ??????? ?????? ????? ??? ?? ?????
• ????? ??? (?????? ?? ???? ---??????
  ????? ????????? )
• ????? ?????? ???? ???? ?? ???? ???
  ?.? ?? ??????? ????
• ?????????????? -----???? ???? ?? Breathy
• ????? ????? ???? ??? ????? ?????? ????????????
  ?? ??? ?? ???
• ??????????
  

5
??????? ??? ?????? ?????? ?????

• ????? ??? ?????
• ?????? ??????????? (??????????? ??? ?????? ??
  ????????? )
• ?????? ????? ?? ???? 1-?????? 2-?????
  ?????????3-?????? ???? 4-?????? ?????? ???
• ?? ?? ???? ??? ????? ?? ??????? ????? ??
  ?????????? ????? ??????
• ????? ?? ????? ?????? ?????????? ????????????
  ????? ????? ?????
• ?? ??? ?? ?????? ????? ??????????? ?????? ????
  ???? ?????? ?? ??????????? ?????? ?? ????

6
????? ????? ?????? ?????

• ????? ??? ?????
• ????? ????? ?? ??? ?????
• ?? ???? ?????? ???? ???? ????? ??????? ??????
  (???? ????? )
• ?? ?????? ???? ??? ????????? ??????? ??
  ??????????
• ?? ???? ???? ??? ? ??? ???? ?? ????? -----?????
  ???? ?? ????? ??????????? ?? ??? ???

7
(No Transcript)
8
??????? ??? ????? ?? ?????? ?????

• ??? ?? ?????? ? ??????? ?????? ????? ???????
  ???? ??? ?? ?????
• ????? ?????? ?? ???????
• Stable
• ????????? ?????? ????? ???? ?????? ????? ?????
• ?????? ???? ? ????? ???? ? ?????? ???? ?????
  ???????
• ??????? ??????
• ???????? ????
• ???? ???? ?? ?? ???
• ??????? ???????? ?? ???? ????? ???????

9
??????? ????? ?? ????? ?? ?????? ?????

• ?????????? ????? ???
• involving the anterior commissure,
• having exposed cartilage,
• having multiple or displaced fractures of the
  thyroid cartilage
• involving multiple fractures of the cricoid
  cartilage,
• causing vocal fold paralysis or airway compromise
  sufficient to require intubation or tracheotomy,
• associated with an injury to another area of the
  neck that requires surgical intervention

10
????? ?? ?????? ?????

• ???? ?? ??? ???? ?? ??????
• ?????? ??????? ? ???? ??????? ???? ??? ???? ?????
  ??? ????? ??????????? awake
• ?????????? ??????????? ?? ????? ??? ???? ?????
  ??? ?? ????? ???? ????
• ??? ?? ??????????? ?????? ???? ? ?????? ????????
  ????
• -1-????? (????? ??????-??????
  ????????? ??????? ?????
  ?????? ???? )
• 2-??? ???? (???????? ????? )
• 3-???????????? ????? ???? ??
  ????? ???
• ???? ????? ?????????
• ?????? ????? ?? ????? ????? (3-5 ??? ??? )

11
????? ??? ????? ????? ????? ?? ?????? ?????

• surgical exploration subplatysmal apron flap
• The strap muscles are divided in the midline and
  retracted laterally
• A midline thyrotomy is used to enter the larynx
• Laryngeal skeletal fractures are repaired using
  wire or nonabsorbable suture.
• Simple nondisplaced fractures can be repaired by
  suturing the outer perichondrium with
  nonabsorbable sutures.
• An alternative to wire is internal fixation using
  absorbable or nonabsorbable plates
• lacerations are meticulously repaired using fine
  absorbable sutures
• A dislocated arytenoid is reduced
• In military weapons ----the loss of tissue is
  large, regional mucosal flaps or skin grafts

12
(No Transcript)
13
(No Transcript)
14
?????????? ? ????? ?????? ?????

• ??????????
• involving the anterior commissure,
• comminuted fractures of the thyroid cartilage
• cases in which the architecture of the larynx is
  not maintained by open fixation of the fractures.
  
• ?????
• decreased web formation at the anterior
  commissure
• better support of the laryngeal architecture
  during healing.
• useful in light of the movement of the larynx
  with phonation and swallowing during the healing
  process.

15
????? ???? ?? ???? ??????? ?? ????? ??

• ??????? ?? ?? ????? ??????????? ?? ??????? ?????
  ? ???????????????? ?? ??? ???? ????? ???
• ??? ?? ????? ???? ??? ?? 10-14 ??? ????
• ??? ???? ?? ???? ??? ??? ????? ????? ????
• ?? ????? ???? ????? ????? ???? ????? ?? 53?????
  ??? FVC
• ???? ???? ?? ?? ????? ?? ???????? ???? ???
• ?????? ?????? ???? ????? ????? ???? ??????????
  ??? ?????? ??? ?? ???????? ????? ? ????
• TVC,FVC

16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
???? ???? ???? ???? ????? ????? ?? ????? ??
?????? ?????

• ?? ???? ???? ????? ????? ??? ???? ???? ????? ??
  ?? ?? ?? ???? ?????? ??? ???? ??????? ??? (???
  ??? ??? ????????? ? ??? ???? ????? )
• ???? ???????? ?? ????? ???? ?? ????
• ????? ?? ??? ????? ???????? ? ????? ?? ??????? ??
  ????? ???????????? ??????? ??? ??
• ?? ??? ???? ?? ?? ??? ????? ????? ??????? ?? ???
  ???? --------gt?? ???? ??? ????? ??? ?????
• ?? ???? ???? ???? ??? ?????? ------gt????????
  ???????
• ?? ???? ??? ??? ??????? ????? ?? ????? (??? ?)
  ---gt?????????? ?????? ?? ?????

20
????????? ??? ?? ???

• ???? ?????? ------gt 5-7???
• ????? ???? ------gt ???? ???
• ???????? ?? ?? ?????
• ???? ????? ---gt ??? ?? 10-14 ???
• ?????? ----gt?? ??? ?? ??? (??????? ?? ?? ??-???
  ???? )
• ??? ???? ???? ????? ?????? ??? ?? ??? (????
  ?????? ? ???? ????? )

21
?????

• ????? ???? ????
• ?? ????? ?? ???? ????
  ???? ???? ????
• ?? ????? ?? ???? ??????
  ??? ?????
• ????? ????
• ????? ???
• ???? ??? ?????? ????????------gt ????? ????? 6???
  
• ???? ??? ???? -------gt ????? ????? 6-12??? ---gt
  ??????-???????????
• ????? ??? 1???? ???? ???? ????????????
• ????? ??? 2???? ???? ???? ?????????????? ??
  ?????????
• ???? ??? ???? ???? ?? ????? ------gt

22
????? ?????? ?????? ?????

• ????? ??? ????? ? ???? ?? 4 ????
• 1-????? ????? ???? ???? ?? ?????
• 2-???? ?? ??????????? ? ????????? ???? ???????
• 3-?????? ??? ????? ?????? ???
• 4-?????? ????????? ?? ??? ? ?????

23
?????? ????????? ????? 1-?????? ???? ??
???????????

• ?? ????? ?? ?? ????-----gt ?????? ????? ???????
  ?? ????? ????? ?????
• ???? ??? ?? ?? ?? 7?? 10 ????? ??? ???????? ??
  ??????
• ????? ????? ???????????
• 1-????? ??? 2-??????? ?????????????? 3-????
  ??????? ???????? 4-???? ?? ??? ?????? ????????
  5-???? ?? ???? ????
• ?? ????? ???? ?????? ?????????? ---gt ?????
  ??????
• ?????? ??????? ???? ?????????????? ??
  ????????????????????????
• ????? ????????? ???----gt????????? ??????
• ?? ????? ??? ?? ????? ??? ???
  ????? ?? ?? 5-7???
• ??????? ????????????????? ???? ???? ??? ??
  ???????????---gt???????? ??????????
• ??????? ????? ???? ????? ---gt ????? ??????
• ??????????? ?????? ??? ------gt ??? ??? ?? 7-10
  ??? (?? ???? ???????? ?? ???? ?????

24
????? ????? ??? ?? ???????????

• ???? ?????? ? ????? ????? ??????????? ???????????
  
• ?????? ??? ?? ????? ???????(??????? ??????)
• ???? ????????
• ???? ?? ??? ??????
  ????????
• ?? ??????? ?? ????? ??????? ????? ??????? ?????
• ?? ????? ??? ?? ???? ???? ????? ??? ??????
  ?????? ?? ???? ??? ????? ???? ?? ???????? ???????

25
?????? ???

• ?????????? ??? ?? ?????? ????? ???? ????????
  ???? ????? ?? ??? ??????? ??????
• ?? ?????? ???? ?? ???? ?? ??? ?? ???????? 246/16
• ????? ??? ????? ?? ????? ???? ????????
• ????? 1-??? ??? ??????? ----gt ???? ????????
  ?????? ?? ?????? ????? ????? ???-????????? -
• ?? ?????? ???????? ??? ?????? ?????
• ???????????? ????? ?????? ??? ???? ?? ??????
  ??????

26
?????????? ???????????? ?????

• 1-??? ???? ???????? (????? ?? ???? ????? )
• 2-?????? ??? ?????
• 3-???? ????? ?????? ??? ??? ???? ?? ????? ????
  ??????

27
????? ?????? ???

• ?? ??? ???? ??? ??? ????? ?? ???????????? ????
  (???? ??? ????? )
• ????????? ???
• 1-???? ?? ??? ????
• 2-??? ????????
• ???? ??? ??? NPO
  3-
• NG-Tube 4-
• ?? ??? ???? ????????
• ?? ???? ????? ???? (???? ??
  ???? )???? ???? ???????
• ?? ???? ???? ??????? ??????
  ?????? ???????????????
• ?? ??? ????? ?????? ?? ????????? ????(??????? ??
  ????? ???? ??? ????? ???