Management of laryngeal fractures--a 10-year experience

Objectives: Laryngeal fracture patients can present with a spectrum of clinical findings ranging from normal to airway collapse and death. We will therefore examine and emphasize clinical presentation, an algorithm for appropriate diagnosis and acute airway management, and radiological or physical examination findings and demonstrate the appropriate surgical approach for optimum clinical outcome in cases of blunt and penetrating laryngeal injury. Herein, we present one of the largest series of management of laryngeal and tracheal fractures from a tertiary care level I trauma center.

Study design: A retrospective chart review from 1998 to 2008.

Methods: A retrospective chart analysis on patients presenting to the head and neck trauma service. Institutional review board approval was obtained before the start of the research.

Results: Our series consisted of 11 men and one woman with a mean age of 41.8 years presenting with laryngeal fractures caused by blunt (n=10) or penetrating (n=2) trauma. One patient presented with complete laryngotracheal separation, which was successfully managed by immediate tracheotomy and early surgical intervention. The other 11 patients had a combination of conservative (n=6) and surgical (n=5) management. All patients who required a tracheotomy (n=7) were decannulated.

Conclusions: Early suspicion and diagnosis of acute laryngeal and tracheal injuries are crucial. The airway must be secured via tracheotomy when possible. Computed tomography scans play a central role in diagnosis. Proper restoration of the laryngeal framework with appropriately timed open reduction and internal fixation is critical for optimal recovery of the airway, voice, and swallowing.