Presentation
Anterior neck injury during football game. Mild hoarseness.
Patient Data
Mildly displaced fracture of the posterior ring of the cricoid to the right of the midline is associated with adjacent subglottic haematoma and mild subglottic stenosis. Small left supraglottic haematoma. 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 haematoma.
No surgical emphysema.
Impression
Fractured cricoid cartilage with mild subglottic stenosis. Small left supraglottic haematoma 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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