II. Epidemiology

  1. Common cause of death in blunt head and neck Trauma (second only to Intracranial Hemorrhage)
  2. Rare overall
    1. Incidence: 1 in 30,000 Emergency Department encounters
    2. Found in 0.5% of overall blunt Trauma patients

III. Causes

  1. Head and Neck Trauma
  2. Rare overall and especially rare in children (elastic necks)
  3. Sports Injury
    1. Football
    2. Soccer

V. Signs

  1. Stridor
  2. Cyanosis
  3. Subcutaneous Emphysema (typically massive)
    1. Persistent air leak despite Chest Tube
  4. Laryngeal palpation with crepitation
  5. Tracheal tenderness

VI. Precautions

  1. Easily unrecognized in multisystem Trauma patients
  2. Airway compromise can develop quickly
    1. May be delayed if airway obstruction is due to soft tissue edema and bleeding

VII. Imaging

  1. CT Soft Tissue Neck
    1. Evaluate Larynx as well as esophagus and vascular structures
  2. CT Cervical Spine
    1. Evaluate for concurrent Cervical Spine Injury as indicated
  3. Other diagnostics
    1. Flexible fiberoptic Laryngoscopy
    2. Flexible bronchoscopy

VIII. Grading: Schaefer Classification System of Laryngeal Injury

  1. Grade 1
    1. Minor endolaryngeal hematoma
    2. No detectable Fracture
  2. Grade 2
    1. Edema, hematoma or mucosal disruption
    2. Nondisplaced Fractures
    3. No exposed cartilage
  3. Grade 3
    1. Massive Edema
    2. Mucosal disruption
    3. Displaced Fracture
    4. Exposed cartilage
    5. Vocal Cord Immobility
  4. Grade 4
    1. Includes Grade III criteria AND
    2. Two or more Fracture lines OR Massive Trauma to laryngeal mucosa
  5. Grade 5
    1. Complete laryngotracheal separation

IX. Management: Complete airway obstruction or severe respiratory distress

  1. Emergent Surgical Consultation
  2. Endotracheal Intubation
    1. Video Laryngoscopy or
    2. Flexible Endoscopic Intubation
  3. Cricothyrotomy for failed intubation (Airway double set-up)
    1. May also exacerbate Laryngeal Trauma

X. Management: Airway Initially Stable

  1. Emergent surgical Consultation with otolaryngology or maxillofacial surgery in all cases (regardless of grade)
    1. Grade 1-2 Laryngeal Injuries are medically managed in many cases
    2. Grade 3-5 Laryngeal Injuries are managed surgically
  2. Elevate head of bed
  3. Ice region
  4. Encourage vocal rest
  5. Humidified air
  6. Antibiotics indicated for exposed laryngeal cartilage
  7. Monitor for worsening (secure airway for changes)
    1. Agitation
    2. Altered Level of Consciousness
    3. Oxygen Saturation
    4. Cyanosis, retractions or Stridor
    5. Snoring or unable to speak

XI. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21
  2. Phillips (2021) Crit Dec Emerg Med 35(8): 14-5

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Related Studies

Ontology: Fracture of larynx (C0238229)

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