Management of acute blunt and penetrating external laryngeal trauma

Abstract

Acute external injury to the larynx is both life threatening and a potential long-term management challenge. Although a rare injury, sufficient experience now exists to recommend specific treatments, and to preserve voice and airway function.

Awake tracheal intubation for blunt airway trauma

“…Epidemiological data relating to airway trauma, and specifically laryngeal fracture, is highly heterogenous . However, existing data suggest that outside of specialist centres the acute management of blunt laryngeal trauma is unlikely to be a frequent event, particularly in cases of an isolated injury that is not accompanied by overwhelming respiratory distress .…”

“…Laryngeal fracture usually results from high‐energy mechanisms of injury and mortality can be as high as 3.8% . However, signs and symptoms are often non‐specific, provide a poor indicator of the site of injury and, apart from impending complete airway obstruction, correlate poorly with injury severity . The presence of airway compromise in blunt airway trauma suggests involvement of the cricoid cartilage and cricothyroid membrane in 50% of cases, and mechanisms of direct trauma will tend to involve the cricoid and thyroid cartilage .…”

Comminuted laryngeal fracture following blunt trauma: A need for strict legislation on roads!

“…Minor endolaryngeal lacerations and abrasions may be managed conservatively, whereas major endolaryngeal soft tissue injury (vocal ligament avulsion, epiglottis detachment, and arytenoid dislocation) is managed either through thyrotomy or endoscopically. [812] Laryngeal skeletal fractures require internal fixation. Nondisplaced fractures can be managed nonoperatively or better with internal fixation, but displaced fractures should always undergo ORIF with sutures or plates, as soon as possible.…”

“…Nondisplaced fractures can be managed nonoperatively or better with internal fixation, but displaced fractures should always undergo ORIF with sutures or plates, as soon as possible. [1234812] Butler et al . found better outcomes for voice and airway function with early treatment within 48 h, as compared to delayed treatment.…”

“…In these cases, the stent helps maintain the proper configuration of the commissure and prevent anterior glottic webs. [812] For stenting, various options are available, but soft materials are preferred for longer duration. [8] We used PVC endotracheal tube for only small time.…”