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Laryngeal Fracture
Aka: Laryngeal Fracture, Laryngeal Trauma, Larynx Injury, Laryngotracheal Trauma
- See Also
- Tracheal Laceration
- Epidemiology
- Common cause of death in blunt head and neck Trauma (second only to Intracranial Hemorrhage)
- Rare overall
- Incidence: 1 in 30,000 Emergency Department encounters
- Found in 0.5% of overall blunt Trauma patients
- Causes
- Head and Neck Trauma
- Rare overall and especially rare in children (elastic necks)
- Sports Injury
- Football
- Soccer
- Symptoms
- Dyspnea
- Dysphagia
- Hemoptysis
- Hoarseness or Dysphonia
- Neck Pain
- Signs
- Stridor
- Cyanosis
- Subcutaneous Emphysema (typically massive)
- Persistent air leak despite Chest Tube
- Laryngeal palpation with crepitation
- Tracheal tenderness
- 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
- 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
- Grading: Schaefer Classification System of Laryngeal Injury
- Grade 1
- Minor endolaryngeal Hematoma
- No detectable Fracture
- Grade 2
- Edema, Hematoma or mucosal disruption
- Nondisplaced Fractures
- No exposed cartilage
- Grade 3
- Massive Edema
- Mucosal disruption
- Displaced Fracture
- Exposed cartilage
- Vocal Cord Immobility
- Grade 4
- Includes Grade III criteria AND
- Two or more Fracture lines OR Massive Trauma to laryngeal mucosa
- Grade 5
- Complete laryngotracheal separation
- 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
- 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
- References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21
- Phillips (2021) Crit Dec Emerg Med 35(8): 14-5