Laryngeal Fracture

Aka: Laryngeal Fracture, Laryngeal Trauma, Larynx Injury

1. Causes
   1. Head and Neck Trauma
   2. Rare overall and especially rare in children (elastic necks)
   3. Sports Injury
      1. Football
      2. Soccer
2. Signs
   1. Dyspnea
   2. Hoarseness
   3. Subcutaneous Emphysema
   4. Laryngeal palpation with crepitation
3. Precautions
   1. Airway compromise can develop quickly
      1. May be delayed if obstruction due to soft tissue edema and bleeding
4. 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
5. Management: Complete airway obstruction or severe respiratory distress
   1. Emergent Surgical Consultation
   2. Intubation
      1. Video Laryngoscopy or
      2. Flexible Endoscopic Intubation
   3. Cricothyrotomy for failed intubation (Airway double set-up)
      1. May also exacerbate Laryngeal Trauma
6. Management: Airway Initially Stable
   1. Emergent surgical Consultation
   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
7. References
   1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21