II. Epidemiology
- Common cause of death in blunt head and neck Trauma (second only to Intracranial Hemorrhage)
- Rare overall
III. Causes
- Head and Neck Trauma
- Rare overall and especially rare in children (elastic necks)
-
Sports Injury
- Football
- Soccer
IV. Symptoms
V. Signs
- Stridor
- Cyanosis
- Subcutaneous Emphysema (typically massive)
- Persistent air leak despite Chest Tube
- Laryngeal palpation with crepitation
- Tracheal tenderness
VI. Precautions
- Easily unrecognized in multisystem Trauma patients
- Airway compromise can develop quickly
- May be delayed if airway obstruction is due to soft tissue edema and bleeding
VII. Imaging
- CT Soft Tissue Neck
- Evaluate Larynx as well as esophagus and vascular structures
- CT Cervical Spine
- Evaluate for concurrent Cervical Spine Injury as indicated
- Other diagnostics
- Flexible fiberoptic Laryngoscopy
- Flexible bronchoscopy
VIII. Grading: Schaefer Classification System of Laryngeal Injury
- Grade 1
- Minor endolaryngeal hematoma
- No detectable Fracture
- Grade 2
- Grade 3
- Grade 4
- Grade 5
- Complete laryngotracheal separation
IX. Management: Complete airway obstruction or severe respiratory distress
- Emergent Surgical Consultation
-
Endotracheal Intubation
- Video Laryngoscopy or
- Flexible Endoscopic Intubation
-
Cricothyrotomy for failed intubation (Airway double set-up)
- May also exacerbate Laryngeal Trauma
X. Management: Airway Initially Stable
- Emergent surgical Consultation with otolaryngology or maxillofacial surgery in all cases (regardless of grade)
- Grade 1-2 Laryngeal Injuries are medically managed in many cases
- Grade 3-5 Laryngeal Injuries are managed surgically
- Elevate head of bed
- Ice region
- Encourage vocal rest
- Humidified air
- Antibiotics indicated for exposed laryngeal cartilage
- Monitor for worsening (secure airway for changes)
- Agitation
- Altered Level of Consciousness
- Oxygen Saturation
- Cyanosis, retractions or Stridor
- Snoring or unable to speak
XI. References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21
- Phillips (2021) Crit Dec Emerg Med 35(8): 14-5
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 32497008, 269317004 |
| English | Fracture laryngeal structure, Fracture of larynx, larynx fracture, fracture of larynx, Fracture of larynx (diagnosis), fracture larynx, Fracture of laryngeal structure, Fracture of larynx (disorder), fracture; larynx, larynx; fracture, Fracture of larynx, NOS, #Larynx |
| Spanish | fractura de la laringe, fractura de estructura laríngea (trastorno), fractura de una estructura laríngea (trastorno), fractura de una estructura laríngea, fractura de laringe, fractura de estructura laríngea, fractura laríngea |
| Dutch | fractuur; larynx, larynx; fractuur |
Ontology: Injury of larynx (C0339881)
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 125588009 |
| Italian | Traumatismo della laringe |
| Japanese | 喉頭損傷, ｺｳﾄｳｿﾝｼｮｳ |
| English | injury of larynx, injury of larynx (diagnosis), laryngeal trauma, laryngeal injury, Laryngeal injury, Injury of larynx, Laryngeal trauma, Injury of larynx (disorder), injury; larynx, larynx; injury, Laryngeal Injury, Laryngeal Trauma |
| Czech | Poranění laryngu |
| Hungarian | Gégesérülés |
| Dutch | larynx; letsel, letsel; larynx, strottenhoofdletsel |
| Spanish | injuria de la laringe, lesión traumática de la laringe (trastorno), lesión traumática de la laringe, traumatismo laríngeo, traumatismo leríngeo, Lesión laríngea |
| Portuguese | Lesão da laringe |
| French | Lésion laryngée |
| German | Kehlkopfverletzung |
