External laryngeal trauma: A management dilemma

Abstract

External laryngeal trauma though uncommon but it is a life threatening ENT emergency. Early diagnosis, prompt establishment of a secure airway is the key for good outcome. Here we present a series of three cases of external laryngeal injury with significant trauma managed conservatively with good recovery to discuss the present concepts in management of external laryngeal trauma. The first case was presented with neck swelling and inability to speak after suicidal attempt. CT scan showed fracture of thyroid cartilage and hyoid bone. Second patient following trauma had change in voice and pain in neck with extensive injury clinically and on CT scan showed gross emphysema in soft tissue planes extending from skull base to mediastinum with comminuted fracture of anterior thyroid cartilage. The third patient presented with change in voice and respiratory distress. CT scan showed cricoid fracture at subglottic level. All these three patients were managed conservatively with systemic steroids, antibiotics and nebulization without any surgical intervention. All three patients showed complete recovery. Conclusion: External Laryngeal trauma can be managed conservatively without active surgical intervention with good voice airway.