Cricoid cartilage fracture

Case contributed by Craig Hacking
Diagnosis certain

Presentation

Anterior neck injury during football game. Mild hoarseness.

Patient Data

Age: 30 years
Gender: Male
ct

Mildly displaced fracture of the posterior ring of the cricoid to the right of the midline is associated with adjacent subglottic hematoma and mild subglottic stenosis. Small left supraglottic hematoma. Mild supraglottic airway narrowing. Piriform sinuses are unremarkable.

No evidence of thyroid cartilage or hyoid fracture. Cricoarytenoid, cricothyroid alignment is maintained. Thyroid cartilage and hyoid alignment is maintained. No suspicion of dislocation.

No retropharyngeal hematoma. 

No surgical emphysema.

Impression

Fractured cricoid cartilage with mild subglottic stenosis. Small left supraglottic hematoma with mild supraglottic airway narrowing.

Case Discussion

Laryngeal injuries are uncommon and often missed or overlooked, especially in the multitrauma patient. Cricoid fractures make up less than half of patients with laryngeal fractures. They are generally considered life threatening as the cricoid cartilage is the only complete ring of the cartilages. Isolated cricoid fractures are very rare and due to a blow to the anterior neck. 

Three classic clinical features are described with laryngeal fractures, which are not always present:

  • hoarseness

  • subcutaneous emphysema

  • palpable fracture

Patients may also demonstrate poor tolerance in lying supine.

Treatment is often with surgical management of the airway.

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