OPEN LARYNGEAL FRACTURE: A CASE REPORT AND REVIEW OF THE LITERATURE

Abstract

Laryngeal fracture is a rare and life threatening entity which is caused by blunt or penetrating neck trauma. Majority of laryngeal fractures are closed type and caused by blunt neck trauma. They frequently left underdiagnosed due to their closed nature and accompanying multisystem trauma. Besides, open laryngeal fracture is exceptional and seen particularly in penetrating neck traumas like gunshot injuries. We describe an unusual case of open laryngeal fracture in which the patient was totally breathing from the wound as if a coniotomy had done. A 23-year-old male presented to the emergency department after getting involved in a motorcycle accident resulting with a blunt injury to the neck. The patient was breathing from a horizontal open neck wound below the level of the thyroid cartilage. Computed tomography revealed a laryngeal fracture involving thyroid, cricoid and the first ring of trachea. Given the extent of the injury, a laryngeal reconstruction was done. 6 weeks after surgery he had no stridor, with evidence of full vocal cord mobility on both sides. Early diagnosis is indispensable because it may cause acute airway compromise or significant long term squeal like dysphonia, aspiration, airway stenosis and tracheoesophageal fistula. In laryngeal fracture cases trans-oral intubation may lead irremediable results especially in comminuted fractures or if there’s arytenoid dislocation. Thus, in suspicion of laryngeal fracture associated with airway compromise one should always discuss tracheotomy rather than trans-oral intubation.