Laryngeal trauma

Dr Henry Knipe et al.

Laryngeal trauma is uncommon in the setting of external blunt or penetrating trauma. The larynx may also be injured internally, for example during endotracheal intubation.

Symptoms include hoarseness, larygneal pain, dyspnoea, and/or dysphagia. Also stridor, haemoptysis, subcutaneous emphysema and tenderness/deformity of the larynx skeleton may be present. 

The following laryngeal structures may injured in isolation or combination 1,2

  • laryngeal oedema, haematoma and/or mucosal lacerations
  • thyroid and/or cricoid cartilage fracture
  • laryngeal rupture
  • cricotracheal separation
  • cervical tracheal injury

The hyoid bone, although technically not part of the larynx, can also be fractured.

Mechanism

The larynx may be injured in a number of ways 1,2:

  • external blunt: motor vehicle accidents, "clothesline" accidents, strangulation, falls, sporting injuries
  • external penetrating: stabbing, shooting
  • internal blunt: iatrogenic during endotracheal intubation or fibroendoscopic examination
Associations

Other injuries are common 1:

CT is the modality of choice. Review of airway obstruction includes evaluation of oedema, haematoma, foreign body or displaced fractures.

CT review for larynx function should also include close inspection for lacerations especially to the vocal cord and anterior commisure, and arytenoid cartilage dislocation or avulsion.

The key goals of management are:

  • maintaining airway: preserve life
  • restoring function to larynx: voice quality
  1. Patients who are uncooperative or unstable and may not be in the normal anatomical position on the CT scanner. Often useful to use a 3D workstation to facilitate proper review of soft tissue injuries to the true cord versus false cord, and position of the cricoid cartilages. 
  2. CT is advantageous over laryngoscopy and clinical exam for:
    • detection of cartilage fractures
    • evaluation of the subglottic and anterior commissure regions which are poorly visualized on endoscopy
  3. Do not forget to assess for associated cervical spine and vascular injuries.
  4. A key indirect sign of laryngeal injury is subcutaneous emphysema. If this is present look for subtle laryngeal and tracheal injury. There can be a ball-valve derangement that forces massive amounts of air into the neck and chest leading to tracheal displacement and pneumothorax. Thus, patients with laryngeal trauma should not have excessive mask ventilation.
  5. Look for tracheolaryngeal separation: should not have intubation, but require tracheostomy.
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Article Information

rID: 40995
Section: Pathology
Tag: trauma
Synonyms or Alternate Spellings:

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Cases and Figures

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    Case 1: left subglottic haemaoma
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    Case 2: laryngeal rupture
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    Case 3: thyroid cartilage fracture
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    Case 4
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    Case 5: cricoid cartilage fracture
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