56 A 50-year-old man is brought into the emergency department after a motor vehicle accident. A cricothyrotomy had been done emergently in the field. Examination shows significant anterior neck swelling with crepitus. Fiberoptic examination reveals a right fold only. The left true and false folds cannot be identified. The right fold is intact with minimal swelling. Individual thyroid cartilage fragments can be palpated on the left. He is judged to be stable, and imaging is obtained. 1. Resuscitative measures following the Advanced Trauma Life Support guidelines are implemented for all serious injuries. 2. Presenting symptoms of blunt laryngeal trauma include dyspnea, hoarseness, tenderness, cough, hemoptysis, and dysphagia. Signs of laryngeal trauma are edema, crepitance, subcutaneous emphysema, and flattening of the laryngeal prominence. Laryngotracheal separation can also manifest in this manner. 3. A grading system for laryngeal trauma and management of the acute airway is reviewed in Table 56.1. 4. A complete history of the mechanism of injury should be obtained, as well as any preexisting medical conditions. A thorough physical examination includes both palpation of the neck and a flexible fiberoptic laryngoscopy to evaluate endolaryngeal trauma. 5. Concomitant injuries. Cervical spine injuries have been reported in up to 50% of patients with blunt laryngeal trauma. Recurrent laryngeal nerve palsies suggest a possible cricoid crush fracture. Pharyngoesophageal tears must also be evaluated. Cervical spine and chest radiograph are clear. Neck computed tomography reveals a vertical thyroid cartilage fracture just lateral to mid-line, extending from the thyroid notch to the inferior edge of the thyroid cartilage. The right side of the cartilage appears to be in the proper place, but multiple pieces of the left cartilage appear to be posteriorly displaced. Significant subcutaneous emphysema is also noted. There are no other injuries of the airway. Facial CT reveals no fractures. Grade 4 blunt laryngeal fracture
Laryngeal Trauma
History
Differential Diagnosis—Key Points
Test Interpretation
Test Interpretation
Diagnosis
Group | Features | Management |
1 | Minimal or no airway compromise; minor endolaryngeal hematomas or lacerations | Conservative: humidified oxygen, 24-hour observation |
2 |
