666 Rugby Tackle: A Cause of Delayed Onset Laryngeal Oedema. (19th August 2022)

• Record Type: Journal Article
• Authors: Dhar, P; Brimioulle, M; Nair, D
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 6
• Publication Date: 2022-08-19
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac269.146
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Case Presentation: A 14-year-old boy presented to the emergency department with facial and neck swelling, hoarseness and dysphagia. The symptom onset was 24 hours after a rugby tackle to the neck and shoulder. Examination found significant bilateral lower facial and neck swelling. Blood results and observations were normal. Fibreoptic nasendoscopy (FNE) revealed diffuse oedema of arytenoids and soft tissue around the larynx. Computed Tomography (CT) neck with contrast demonstrated diffuse inflammatory changes in the submental and submandibular regions extending to the suprasternal notch, the aetiology for this was indeterminate. He responded to medical treatment with regular intravenous dexamethasone, intravenous antibiotics and as required, adrenaline nebulisers. He was discharged after two days and was able to return to school the following week. Discussion: Laryngeal oedema is an ear, nose and throat emergency which can result in airway obstruction. It is commonly caused by bacterial infection. However, rarely other precipitants including blunt trauma are reported. This is the first case reported in the literature of delayed laryngeal oedema from a common sporting injury. It is important to recognise and consider trauma as a cause in patients with delayed laryngeal oedema, especially when no other obvious underlying cause is present. This case highlights the importance of thorough history taking to detect trauma. After ensuring a secure airway, systemic steroids are effective against trauma-induced laryngeal oedema and prophylactic antibiotics should be considered to avoid oropharyngeal contamination. FNE, CT and a minimum 24-hour observation period with specialist involvement are essential for neck trauma management.