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Photo of Justin Stigent

The sun was setting over another dusty Texas night when it happened: Justin Stigent steered his horse through a darkened gauntlet of trees and galloped neck-first into a dead branch. The limb pierced Justin’s throat and clawed its way into his tissue. And then, it got worse. As Justin slid off his horse, it kicked him, crushing his larynx and breaking his neck in two places.

Justin’s wife, Mary, rushed him to a San Antonio hospital. Doctors performed an emergency tracheotomy enabling Justin to breathe, but they said he might never talk, eat or breathe on his own again. Then they remembered Blake Simpson, M.D.

Dr. Simpson is a laryngologist at the Health Science Center. "He didn’t just save my life, he made my life," Justin said.

School of Medicine
Back in the Saddle Again

By Amanda Gallagher

Photo of Justin Stigent on horseback
“The pain was relative…the worst part was not being able to breathe and not being able to talk.”

Justin Stigent is the real man every Marlboro model longed to portray. He’s got rugged good looks, weathered Western wear and the horsemanship of a seasoned rodeo rider. "I used to ride in rodeos, but work got in the way," Justin said. With 40 years experience on a horse, Justin knows accidents come with the territory. His sister died in a riding accident when she was only 17, and Justin has had his share of horse-related injuries. So when he was impaled last June, he wasn’t surprised. In fact, after he hit the tree he took matters into his own hands.

"I was sitting on the ground after being impaled and kicked. I pulled the stick out of my throat, took off my shirt, rolled it into a bandage and put it around my head," Justin said.

Mary, a nurse at the Health Science Center, was at the stables when she thought she heard something in the pasture. She reached Justin as he was climbing to his feet.

"I saw all the blood on his neck and I knew, because I’m a nurse, he had a stridor (a sign of respiratory obstruction). When he tried to talk, I knew his airway was in trouble and I knew how fast it would swell," Mary said. She rushed Justin to a local hospital. They got there in the nick of time.

"The pain was relative. You can block out pain," Justin said. "The worst part was not being able to breathe and not being able to talk. I was at the hospital when I got to that point."

Doctors performed a lifesaving tracheotomy but didn’t offer much hope for a full recovery. "They showed me a CAT scan and said his larynx was crushed. They had a very grim prognosis," Mary said. "But they did say there was only one person in this part of the United States who could help us. They said his name was Blake Simpson, and they said he was at the Health Science Center."

Dr. Simpson is a laryngologist — the only fellowship-trained laryngologist in Texas. The super-specialty concentrates on voice disorders and laryngeal injuries. The larynx houses the vocal chords and plays a major role in breathing and airway protection. Although it is made of cartilage, it can still fracture like a bone.

Illustration of rare throat surgery

"Justin had a fracture that went up and down the entire length of his Adam’s apple cartilage. His cricoid cartilage also was fractured and pushing into his airway," Dr. Simpson said. "When the cartilage fractures, your vocal cords are not lined up. You also have a high risk of scarring and permanent damage. If you don’t do something quickly, your chances of success are low. Time is critical."

Justin transferred to University Hospital two days after his accident. He arrived at 11 p.m.; Dr. Simpson and his team were ready and waiting. "They immediately assessed him and came up with a plan. They saw what kind of titanium plates and gadgets and screws and nuts and bolts they were going to need to piece this thing back together. They had to use all sorts of stuff they don’t use every day," Mary said.

That’s because trauma-related laryngeal injuries aren’t that common. Dr. Simpson sees only two or three cases each year. He described Justin’s injury as the "classic case," but that doesn’t mean it was easy to fix.

"The real problem in younger men is the cartilage in the Adam’s apple hasn’t hardened. It is like a Tootsie Roll. The challenge is putting it back together again," Dr. Simpson said.

At 6 o’clock the next morning he rolled Justin into surgery. Eight screws, two titanium plates and a few hours later, Justin was on the road to recovery. Dr. Simpson placed a plate at the top and bottom of the larynx and crocheted a "reinforcing system" of sutures to hold the cricoid cartilage together.

Justin’s tissue was extremely bruised and swollen. Dr. Simpson predicted he would need a tube to breathe and eat for about four weeks. "But I didn’t think I could get that guy to stay in the hospital for more than a week," he admits.

Sure enough, Justin, with the help of Mary, recovered quickly. He was talking and eating on his own within two weeks.

Today, his only sign of trauma is the miniscule tracheotomy scar in his neck and a deeper, slightly gravelly voice that would make Johnny Cash proud — and maybe Dr. Simpson. As a laryngologist, he not only treats upper airway disorders, vocal chord growths and vocal chord paralysis, he also is one of the few doctors trained to treat voice disorders on a professional level. His patients include a host of Grammy award-winning musicians and well-known disc jockeys. "I’ve always been a musician, and I thought it would be neat to work with singers and mix my hobby with my vocation," Dr. Simpson said.

While he worked wonders for the Stigents, he never promised any miracles. "He said Justin’s voice might not be the same as it was. He said he’s never going to be an opera singer," Mary laughed. "But then again, Justin never was."

And that’s okay with Justin. The Texas cowboy is much more at home on his range.

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