Management of laryngeal trauma: Case reports and literature review

Abstract

But de la presentation External laryngeal trauma is rare, accounting for less than 1 % of all trauma cases seen at major centers. We aim to report two clinical cases and to improve the care of acute laryngeal trauma by reviewing controversies and the evolution of treatment. Materiel et methodes We report two clinical cases along with images of videolaryngoscopy, CT scans and surgeries. We reviewed primary topics such as laryngeal trauma, laryngeal injury, and airway trauma through internet-based search engines and manual searches. Resultats Case report 1: a 76-year-old man without relevant medical history presented to our hospital after falling from a 3 meters wall. He experienced multiple injuries, including a laryngeal trauma. The primary signs and symptoms of his laryngeal trauma were hoarseness and dyspnea. Flexible endoscopy revealed laryngeal œdema and haematoma, bilateral vocal fold paralysis and dislocation of right aritnoid. Computed tomography (CT) showed cricoid cartilage fracture. The patient underwent immediate surgical exploration and tracheostomy. Postoperatively pain, dysphagia and food aspiration persisted. He had to undergo further surgeries to optimize laryngeal function. The patient was discharged with regained airway patency and with no food aspiration. Case report 2: a 40-year-old man with schizophrenia presented to our hospital after a 48-hour period of immobilization in a mental health institution. On arrival to the emergency department he was extremely agitated, febrile and had face and neck emphysema. Thoracic and neck CT scan were performed. Thyroid cartilage fracture was observed and other causes of emphysema were excluded. In the operating room we identified a minor laryngeal laceration, reduced the thyroid cartilage fracture and performed tracheostomy. The patient was discharged 12 days after surgery with normal swallowing, good voice quality and airway function. Laryngeal trauma is a rare injury and may result in lifelong complications or even death if diagnosis or treatment is delayed. Directed history, physical examination, laryngeal endoscopy and CT imaging help to delineate injuries and course of treatment. The choice of intubation, tracheotomy, cricothyrotomy and surgical repair must be individualized. Sufficient experience now exists to recommend specific treatments, and to preserve voice and airway function. Conclusion Acute laryngeal trauma caused by either blunt or penetrating injuries is a difficult airway management problem. The recognition and initial proper management of this injury is essential to a successful outcome.