Laryngeal trauma and its complications

Abstract

1. 1. A review of eighty-two patients who sustained external trauma to the larynx shows the commonest cause to be automobile and other vehicular accidents (forty-three cases). Other vehicular accidents involved streetcars, buses, trains, airplanes, a tractor, bicycle and sled. In the automobile accidents the laryngeal injury was usually one of multiple injuries and it occurred as frequently in females as in males. 2. 2. Next in frequency as a cause of laryngeal trauma is physical violence (twenty-nine cases), i.e. garroting, “strong arm,” blow by edge of hand, gunshot, cutthroat, boxing and being struck by a baseball or golf ball. Twenty-seven of this group were males, only two females. 3. 3. Ten patients, all men, received their laryngeal injuries in industrial accidents, being struck in the neck by a “two by four,” striking projecting machinery or falling while carrying a heavy object and striking an edge of it in the fall. Three men had put their heads through open windows or horizontal elevator doors, the doors or windows closing on the neck. 4. 4. Minimal injuries cause hoarseness, dysphonia and aphonia. The pathologic conditions included hematomas, lacerations of the cords or other soft tissues, and dislocations or fractures of laryngeal cartilages. Respiratory obstruction is evidence of more severe injury and may vary in degree from slight respiratory embarrassment to total atresia and asphyxia. 5. 5. Diagnosis is established by palpation, mirror and direct laryngoscopic examinations of the larynx and x-ray films of the neck, particularly the lateral view. 6. 6. Treatment of minimal injuries consists of hot packs, voice rest (silence) and steam inhalations, with voice rehabilitation to help restore this important laryngeal function after the acute manifestations have subsided. 7. 7. Severe injuries to the larynx require low tracheotomy to establish the airway. Then, as soon as the patient's general condition will permit, broken cartilages must be replaced and held in position by an intralaryngeal splint or mold to insure an adequate airway. If manipulation perorally cannot be accomplished because of an associated fractured jaw, this must be performed through the tracheostomy or by external, open reduction. 8. 8. Failure or inadequate early management results in chronic laryngeal stenosis and the need of a permanent tracheostomy. Treatment of this complication requires reconstruction of the laryngeal lumen through the removal of scar and deformed cartilage and the lining of the interior of the larynx with a split thickness skin graft. This long and tedious process can be avoided by early reduction and fixation of the laryngeal fractures.