Laryngeal Trauma

Traumatic laryngeal fractures are rare but potentially fatal injuries. Successful management lies with early recognition of critical airway signs and symptoms. Radiographic imaging, usually with CT, may identify occult injuries or characterize the extent of laryngeal skeleton injury. Examination of the aerodigestive structures with bedside flexible laryngoscopy is crucial to fully delineate the extent of injury. Establishing a safe airway is the primary goal of acute management of severe laryngeal trauma. This can be done by intubation in the operating room, awake tracheostomy, or if absolutely necessary, careful cricothyroidotomy with conversion to tracheostomy. An experienced provider can perform intubation outside of the operating room if the endolarynx can be visualized and there is no distortion of anatomy. In severe injuries with impending airway obstruction, or if the extent of the injury is unknown, awake tracheostomy is favored due to its greater safety in cases of laryngotracheal separation. Stage Ito II injuries can often be managed conservatively but Stage III to V injuries typically require surgical intervention. Patients with extensive endolaryngeal mucosal injury may require laceration repair via midline thyrotomy, and an endolaryngeal stent may provide benefit in select cases. Early intervention results in best phonation, airway, and swallowing outcomes, and most patients requiring tracheostomy are eventually decannulated.