Wednesday, September 30, 2009

Laryngeal Crush


Stafon Johnson, a running back for the USC Trojans, suffered a severe crush injury to his larynx this week when he dropped a barbell on his throat while bench pressing. Apparently his spotter allowed the bar to slip through his hands at the end of a set of repetitions and the full brunt force of the weight slammed into Johnson's neck. Johnson was rushed to the nearest trauma center where he underwent 7 hours of emergency surgery to stabilize and repair the injuries. It sounds like he had to have a tracheostomy placed and a feeding tube, suggesting severe injuries to his larynx and possibly the esophagus.

Laryngeal trauma is a scary entity. The larynx (voicebox) is a complex musculo-cartilaginous structure located in the upper cervical portion of the trachea. Any direct trauma to the larynx can compromise passage of air and the ability to breath or speak. Because the neck is a closed space, inflammatory swelling and/or hematoma formation secondary to trauma can compress the trachea and cause airway compromise even in the absence of major laryngeal injury.

It sounds like this kid got lucky. He was able to maintain his own airway (with difficulty according to reports) by using the accessory breathing muscles of the neck. This bought him enough time to get to the hospital where I assume they rushed to the OR for an emergency tracheostomy and whatever else.

Besides the tracheal/laryngeal injury you also have to evaluate for any esophageal or vascular injuries. Presumably some sort of angiography was performed to assess the carotid artery and jugular veins. I suspect that once a secure airway was established, the surgeons also directly explored the esophagus and endoscopically inspected the mucosa. Repair of complex laryngeal injuries is beyond my expertise but you can read about it here.

Long term, the kid should be ok. You worry about stricturing of the repair and possible permanent voice changes from a recurrent laryngeal nerve injury but these are things that can be managed. The kid easily could have died. Nice work by the trauma team at California Hospital Medical Center. The next time I find myself bench pressing 300-400 pounds I will certainly make sure I have at least two spotters....

4 comments:

Doctor D said...

Ouch! Poor guy! I had heard "weightlifing accident and assumed it was a limb injury.

I bet Pete Carroll is going to have the spotter running windsprints the rest of his college career for that one.

Great blog by the way. I just discovered it.

rlbates said...

I bet no one uses his "spotter" ever again. Hope he heals quickly and without problems.

Frank Drackman said...

Man's got to know his limitations...
I bench without a spotter all the time, hey my daughters have lives too...
"Accessory breathing muscles of the Neck"??? WHAT Neck?????
Should be able to do 140lbs pretty soon...

Trader Bob said...

A good friend of mine broke his jaw in college. He played wide receiver at Ohio University. He was lifting weights while home on Christmas break. He was bench pressing at a community center in Canton, Ohio. The equipment was dilapidated and the weight bar rolled off the bench and landed right on his nose. You don't see those bench presses any more where the bar holders are 90 degrees with a slight lip. Now the bench presses all angle upward at a 45 degree angle. He had 225 pounds on the bar and was lucky he wasn't killed. My buddy broke his nose and jaw if memory serves me corect. He was always in great physical shape and recovered quickly. Hopefully Stafon Johnson from USC recovers and makes some NFL money.