Laryngeal Trauma

Doddy Sumardhika

Dept. of Otorhinolaryngology Head & Neck Surgery

Faculty of Medicine Universitas Padjadjaran
Hasan Sadikin Hospital Bandung
2010
 Introduction
• Laryngeal trauma is a relatively uncommon event,
and therefore most otolaryngologists will not have
the opportunity to gain extensive experience in the
diagnosis and treatment thereof

• Timely, proper management of injury to the larynx is

essential to preserve the patient's life, airway, and
voice

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 Pathophysiology
Blunt Trauma
• Caused mainly by motor vehicle accidents,
personal assaults, or sports injuries
• The neck can be hyperextended during the
trauma
• Moderate blow to the larynx, the momentum
of the vocal folds causes a shearing effect
between the vocalis muscle and the internal
perichondrium
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 Pathophysiology
• This results in injuries such as
endolaryngeal mucosal tears, edema, or
hematoma. More severe trauma produces
fractures of the laryngeal cartilages and
disruption of the laryngeal ligaments

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 Pathophysiology
• Women are considered more likely to incur
supraglottic injuries than are men because
they have long, thin necks
• Elderly persons have been described as
being at higher risk of sustaining
comminuted laryngeal fractures have more
calcification of the larynx

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 Pathophysiology
• The larynx in children is situated higher in
the neck and is better protected by the
mandible than it is in adults. Laryngeal
fractures are less common in children, and
the injuries tend to be less severe

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 Pathophysiology
• Manual strangulation or hanging-type
injuries produce different patterns of
laryngeal injury because the applied force is
fairly static and of low velocity
• This can cause multiple cartilaginous
fractures without immediate mucosal
laceration, submucosal hematoma, or
marked displacement of the fractures

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 Pathophysiology
Penetrating Trauma
• Knife and gunshot wounds are primarily
responsible for penetrating trauma
• Gunshot wounds are more likely than knife
wounds to be associated with severe tissue
damage
• Death is caused by complete disruption of
the larynx, massive soft tissue edema, or
associated neurovascular injuries
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 Diagnosis and Evaluation
History
• Any patient with anterior neck trauma is
considered to have an upper-airway injury
• The classic symptoms of laryngeal trauma
include hoarseness, laryngeal pain,
dyspnea, and dysphagia

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 DIAGNOSIS LARYNGEAL TRAUMA

Symptoms Signs
• Hoarseness • Stridor
• Pain • Hemoptysis
• Dyspnea • Subcutaneous emphysema
• Dysphagia • Laryngeal tenderness
• Loss of thyroid cartilag
Radiology
prominence
• Computed tomography • Vocal-fold immobility
• Arteriography • Laryngeal hematoma
• Cervical spine • Laryngeal edema
radiography • Laryngeal lacerations
• Contrast esophagography LR-DD 10
 Physical Examination
• After trauma, a thorough physical
examination of the neck is needed to
identify associated neurovascular injuries
• Cervical spinal injuries must be ruled out for
all patients with neck trauma. Active
bleeding, expanding hematoma, bruits, and
the loss of pulses are signs of vascular
injury

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 Physical Examination
• Inspiratory stridor typically indicates partial
supraglottic airway obstruction, as might
occur from edema, hematoma, foreign body,
soft tissue injury, or cartilaginous fractures
• Expiratory stridor may portend a lower-
airway abnormality caused by a tracheal
injury
• Combined inspiratory and expiratory stridor
suggests partial obstruction at the level of
the glottis LR-DD 12
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