Laryngeal Trauma

1. DR SHAFIQ AHMAD
ENT MMC MARDAN

2. AETIOLOGY
1.Automobile accidents.
2. Blow or kick on the neck.
3. Neck striking against a stretched wire
or cable.
4. Strangulation.
5. Penetrating injuries with sharp
instruments or gunshot wounds.

3. PATHOLOGY
•The degree and severity of damage will
vary from slight bruises externally or the tear
and laceration of mucosa internally to a
comminuted fracture of the laryngeal
framework.
• Laryngeal fractures are common after 40
years of age because of calcification of the
laryngeal framework. In children, cartilages are
more resilient and escape injury.

4. Pathological changes in laryngeal trauma are:
1. Haematoma and oedema of supraglottic or
subglottic region.
2.Subcutaneous emphysema.
3. Dislocation of cricoarytenoid joints.
4. Dislocation of cricothyroid joint. This may
cause recurrent laryngeal nerve paralysis, which
traverses just behind this joint.
5. Fractures of the hyoid bone.

5. 6.Fractures of thyroid cartilage.
 Vertical
 Transverse.
Fracture Of Upper Part Of Thyroid Cartilage :
Result In Avulsion Of Epiglottis And One Or
Both False Cords.
Fractures Of Lower Part Of Thyroid Cartilage
May Displace Or Disrupt The True Vocal
Cords.

6. 7. Fractures of cricoid cartilage.
8. Fractures of upper tracheal rings.
9. Trachea may separate from the
cricoid cartilage and retract into
upper mediastinum.
Injury to recurrent laryngeal nerve is
often associated with laryngotracheal
separation.

7. CLINICAL FEATURES
Symptoms :
1. Respiratory distress.
2. Change in voice.
Hoarseness or aphonia.
3. Painful and difficult swallowing. This is
accompanied by aspiration of food.
4. Local pain in the larynx.
5. Hemoptysis.

8. External signs include:
1. Bruises or abrasions over the skin.
2. Palpation of the laryngeal area is painful.
3. Subcutaneous emphysema due to mucosal
tears. It may increase on coughing.
4. Flattening of thyroid prominence and
contour of anterior cervical region. Thyroid
notch may not be palpable.

9. External signs include:
5. Fracture displacements of thyroid or cricoid
cartilage or hyoid bone. Gap may be felt
between the fractured fragments.
6. Bony crepitus between fragments of hyoid
bone, thyroid or cricoid cartilages may
sometimes be elicited.
7. Separation of cricoid cartilage from larynx or
trachea

10. DIAGNOSTIC EVALUVATION
 Indirect laryngoscopy or rigid endoscopy of the
larynx
 Flexible laryngoscopy through the nose
 CT of the larynx.
 Associated injuries. It is essential to examine
for other injuries like injury to head, cervical
spine, chest, abdomen and extremities.
X-ray chest for pneumothorax and gastrograffin
swallow for oesophageal tears may be required.

11. TREATMENT
CONSERVATIVE
1. Patient should be hospitalized and observed
for respiratory distress.
2. Voice rest is essential.
3. Humidification of inspired air is essential.
4. Steroid therapy should be started immediately and
in full dose.
5. Antibiotics are given to prevent perichondritis
& cartilage necrosis.

12. SURGICAL
1. Tracheostomy.
2. Open reduction.
(a) Fractures of hyoid bone, thyroid or cricoid cartilage can be wired and replaced in their
anatomic positions. Miniplates made of titanium can be used for immobilization of
cartilaginous fragments.
(b) Mucosal lacerations are repaired with catgut and any loose fragments of cartilage
removed.
(c) Epiglottis is anchored in its normal position and if already avulsed, may be excised.
(d) Arytenoid cartilages can be repositioned in their normal position or may be removed if
completely avulsed.
(e) In laryngotracheal separation, end-to-end anastomosis can be done.
(f) Internal splintage of laryngeal structures may be required. It is done with a laryngeal
stent, or sili- cone tube which may have to be left for 2–6 weeks on an average.
(g) Webbing of anterior commissure can be prevented by a silastic keel

13. COMPLICATIONS
Laryngeal stenosis:
supraglottic, glottic or subglottic.
Perichondritis
Laryngeal abscess.
Vocal cord paralysis.