Laryngeal Fractures - Diagnosis and Management

Objective:

To review the various presentations of laryngeal fractures and the treatment planning process used for their management.

Background:

Laryngeal fractures are rare injuries that may present in a variety of ways. When laryngeal fractures do occur, they are often the result of blunt trauma to the neck. Diagnosis can be challenging, as laryngeal fracture patients' presenting signs and symptoms have been found to poorly correlate with the severity of injury (with the exception of impending loss of the airway). Thus the practitioner must exercise a high level of suspicion when evaluating the head and neck trauma patient. Once the correct diagnosis has been made, an appropriate course of treatment may then be decided upon. Indications for operative intervention are various and may include the presence of an impending airway obstruction, endolaryngeal injury, and cartilagenous disruption.

Cases:

We present two laryngeal fracture patients. The first is a 30-year-old male who was involved in an MVC. He presented to the emergency department via EMS and exhibited an obviously compromised airway. This patient's laryngeal fracture was diagnosed on initial trauma evaluation. The second case is a 25-year-old male who sustained a strangulation-type injury. He was triaged in the emergency department immediately following his injury, however, the laryngeal fracture was a missed diagnosis. He was referred to our clinic for follow-up regarding a possible orbital fracture, at which time the laryngeal fracture was diagnosed. Both cases were treated with open reduction and internal fixation of the involved thyroid cartilage. Case one has developed persistent post-operative hoarseness, while case two is doing well and asymptomatic.

Conclusion:

These cases demonstrate both the diagnostic challenge that may be posed by a blunt force laryngeal injury, as well as the treatment planning process used for the management of an accurately diagnosed laryngeal fracture. A high degree of suspicion must be exercised during evaluation of the patient who has sustained a blunt force neck injury. A complete diagnostic work up (ie clinical examination, direct laryngoscopy, computed tomography) must be acquired in order to decide upon the most appropriate course of treatment.

References:

Schaefer N, Griffin A, Gerhardy B, Gochee P: Early recognition and management of laryngeal fracture: A case report. The Ochsner Journal 14:264-265, 2014

Schaefer S: The acute management of external laryngeal trauma, A 27 year Experience. Arch Otolaryngol Head Neck Surg 118:598-604, 1992

Schaefer S: Management of acute blunt and penetrating external laryngeal trauma. Laryngoscope 124:233-244, 2014