Cricoid Cartilage Fracture Research Articles

Asphyxialdeath due to fracture of thyroid cartilage, cricoid cartilage and arytenoid cartilage as result of blunt trauma of neck in a motorcycle accident:An Autopsy report

Laryngeal fracture is rare but fatal traumatic injury which is mainly caused by severe blunt trauma from interpersonal violence, motor vehicle accident or sports injuries. Laryngeal fracture can lead to severe airway collapse and death.Mortality decreases to less than 5% once the airways made patent and laryngeal injuries are corrected.People must take motorcycle riding safety course to learn how to ride safely. Always follow traffic rules. The motor vehicle accident can be prevented largely through public awareness and education

ISOLATED CRICOID CARTILAGE FRACTURE AFTER BLUNT THORACOCERVICAL TRAUMA: A CASE REPORT

ABSTRACT
 İntroduction: Although cricoid cartilage fracture is rare because of the firm and stable structure of the cricoid cartilage, it can cause fatal complications. Prompt diagnosis and rapid airway safety are incredibly vital.
 Case Report: A 24-year-old male patient was admitted to the emergency department due to blunt trauma to the thoracocervical region. The computed tomography taken after the first interventions detected a displaced fracture of the cricoid cartilage. 
 Conclusion: In light of the patient's clinical findings, the patient was treated conservatively and non-surgically with close follow-up of the airway safety.
 Keywords: Cricoid fracture, subcutaneous emphysema, larynx trauma, thoracocervical blunt trauma, conservative treatment

Isolated comminuted fracture of the cricoid cartilage and narrowing of the airway after a traumatic blunt injury of the neck: a case report

BackgroundBlunt trauma to the anterior of the neck may compromise the vital structures like major blood vessels, trachea, larynx, pharynx, thyroid, spine, esophagus, and the cricoid. Laryngeal trauma is rare and accounts for 1% of all neck blunt traumas. Cricoid trauma is also very rare and accounts for half of the laryngeal traumas, and the diagnosis is frequently missed.Case presentationA 43-year-old man, with blunt neck trauma after being hardly hit by a crane lifting hook, was referred to the Shahid Beheshti Hospital. The patient complained of dysphonia (hoarseness) and dyspnea. The CT scans showed a comminuted fracture of the left anterior arch of the cricoid cartilage with left-sided mucosal thickening, inflammation, and edema which was extended to the glottis, causing a narrowing of the airway. Direct fiber-optic laryngoscopy revealed swelling and congestion in the epiglottis and swelling at the level of the left vocal cord.ConclusionThis case report highlights the conservative treatment of isolated cricoid cartilage fracture in the setting of low-energy blunt trauma. The patient was clinically stable and treated conservatively with oxygen therapy and silence therapy (complete silence).

Pattern of Death Due Hanging Special Emphasized on Neck cartilages

introduction: Commonest form of asphyxial death come across during autopsy in the country is Hanging. The present study was carried out to studying the pattern of fracture in hyoid bone and neck cartilage (thyroid cartilage and cricoids) in deaths due to hanging in the Department of Forensic Medicine, M. P. Shah Govt. Medical College, Jamnagar. We found that death due to compression of ligature seen maximum in the age group of 21-30 years (36.9%), males are accounted for 43% as compared to 57% in females. Ligature material used was dupatta in 43.68% of cases. In hanging ligature mark was oblique, above thyroid cartilage, going backward and laterally. In the majority cases, the ligature mark was above the thyroid cartilage (88% cases), followed by at and above the thyroid cartilage (10% cases) and only in 1 case the ligature mark was below the thyroid cartilage. In maximum cases, the position of the knot was present at the occipital region of the neck (49% cases), followed by the left mastoid region (30% cases). In the majority of cases, the ligature mark was prominent and discontinuous. Hyoid fracture was found in only 8.05% cases. There was only 1 case with thyroidcartilage fracture and no case of cricoidcartilage fracture.

Analysis of compression injuries over neck: One-year prospective study

In compression of neck cases with faint or absent ligature mark on the neck and with minimal internal findings it may be difficult to opine about the cause and manner of death. Many times, in forensic practice, cases occur where there is allegation from maternal side of married woman particularly in cases of dowry deaths, where relatives claim that it is a case of post-mortem hanging. In such cases there is importance of clubbing the gross findings. These findings may be helpful in arriving at conclusions in such unsolved and doubtful cases. The present study was conducted in Department of Forensic Medicine and Toxicology of a Government Medical College and Hospital in year 2017. Total 2781 postmortem examinations were conducted in 2017. Out of that total 2781 cases, 176 compression of neck cases came for postmortem and amongst these 105 cases were studied in detail as per inclusion criteria. Out of 105 cases of compression around neck, which were studied, there were 93 cases of hanging, 10 cases of ligature strangulation, 01 case of manual strangulation and 01 case of accidental strangulation studied. Out of total 105 cases, 66 were males and 39 were females. In this study maximum cases of neck compression were observed in 21 to 30 years age group (30 cases). Intimal tear of carotid artery was observed in 11 cases of hanging and no carotid artery intimal tear was found in case of strangulation. In the present study, fracture of hyoid bone alone was found in total 11 cases of which 06 cases were in hanging, 05 cases were in strangulation. Fracture of thyroid cartilage was found in 03 cases of which 02 cases were of strangulation and 01 case of throttling. No case of cricoid cartilage fracture either alone or in combination to fracture of throat skeleton was observed in the present study.

CT-based assessment of laryngeal fracture patterns and associated soft tissue abnormality.

Acute traumatic injuries to the larynx, including fractures of the hyoid bone, cricoid, and thyroid cartilage, are uncommon injuries. The purpose of this study was to assess fracture and soft tissue patterns associated with laryngeal trauma. This was a retrospective review of patients with laryngeal fractures who presented to two level I trauma centers and underwent CT imaging. Imaging findings, including fractures of the cartilaginous structures of the larynx and hyoid bone, and soft tissue abnormalities including focal hematoma, edema with non-focal hemorrhage, and additional penetrating injuries were recorded. Frequencies of fracture patterns were recorded. Thyroid cartilage fractures were most frequently observed occurring in 45/55 patients, followed by cricoid fractures in 13/55 patients. Hyoid fractures were encountered in 8/55 patients. Multi-site fractures were observed in 12/55 patients with thyroid-cricoid fractures occurring in 8/12 patients, followed by thyroid-hyoid fractures in 2/12 patients. Most multi-site fractures occurred in association with focal supraglottic hematomas (10/12), supraglottic edema and non-focal hemorrhage (11/12), and focal subglottic hematoma (5/12). All 13 cricoid fractures occurred with either focal supraglottic hematoma (7), focal subglottic hematoma (4), or edema with non-focal hemorrhage (13). Thyroid cartilage fractures were the most frequently encountered fracture, followed by cricoid cartilage fractures. Cricoid fractures always occurred with soft tissue abnormalities. Recognition of fracture patterns in the setting of laryngeal trauma and associated patterns of soft tissue injury is important for practicing radiologists for early diagnosis of these conditions and reduction of associated morbidity. • Acute fractures to the larynx may be isolated fractures or occur as multi-focal fractures. • Thyroid cartilage fractures are the most frequent fractures followed by cricoid cartilage fractures. • Cricoid cartilage fractures always occurred in association with soft tissue abnormalities.

Management of major airway obstruction: cricoid cartilage fracture with laryngeal hematoma

Management of major airway obstruction: cricoid cartilage fracture with laryngeal hematoma

Application of sengstaken-blakemore tube in laryngeal trauma patient with fracture of cricoid cartilage: a case report

Application of sengstaken-blakemore tube in laryngeal trauma patient with fracture of cricoid cartilage: a case report

Cricoid Fracture and Paralaryngeal Space Hematoma Due to Blunt Trauma to the Neck

Blunt and penetrating trauma to the neck can cause life-threatening injuries that requires immediate attention of the physicians. Many important structures such as spinal cord, esophagus, larynx, trachea, jugular veins, cranial nerves and carotid arteries can be injured by trauma to this region. Injuries of these structures might cause different symptoms and the physician should be alert for patient’s complaints. We present a case of cricoid cartilage fracture and paralaryngeal space hematoma and evaluate the effect of late admission on management of severe blunt trauma to neck.

The forensic medical characteristics and assessment of the neck injuries resulting from intubation

The objective of the present study was to detect injuries to the sublungual bone, larynx, and trachea resulting from intubation in the patients including those with the blunt neck trauma and to determine their character and localization. Another objective was the forensic medical evaluation of these injuries from the standpoint of harm to human health. A total of 80 cases of death from neck injuries were available for the analysis. These subjects underwent tracheal intubation prior to death that was performed either by an ambulance crew or in a hospital setting. Forty of these patients had the blunt neck trauma inflicted in the preceding period. It was shown that tracheal intubation leads in 60% of the patients to isolated or combined fractures of the sublingual bone, laryngeal and tracheal cartilages in the form of the injuries to the greater horns of the hyoid bone and the inferior horns of the thyroid cartilage, fissures in the arch of the cricoid cartilage, sometimes cracks and complete fractures of the tracheal cartilages, and breaks of the connections between the hyoid bone body and its greater horns. The scope of the injuries in the neck region is larger and their severity higher when intubation is performed in the patients with the blunt neck trauma compared with the subjects undergoing intubation in the absence of previous external injurious impacts. It is concluded that forensic medical expertise and examination of the corpses of the subjects who had undergone tracheal intubation prior to death coming should include the removal of the entire complex of the neck organs together with the unopened larynx and the cervical portion of the trachea. Differential diagnostics of the injuries inflicted by tracheal intubation following the blunt neck trauma should be performed only by means of the comprehensive assessment of the external defects and the fractures of the constituents of the hyoid-laryngeal-tracheal complex using the graphical and vector methods of analysis.

Management of laryngeal trauma: Case reports and literature review

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.

Surgical management for isolated cricoid fracture causing arytenoid immobility

Cricoid cartilage fractures usually occur concurrently with disorders of laryngeal function. In, particular, displaced cricoid lamina fractures can affect arytenoid movement. However, functional, recovery may require proper repositioning of the cricoid lamina, which is associated with a high rate of, complications. Here we present a case in which an isolated cricoid cartilage fracture with arytenoid, immobility due to displacement of the fracture in the cricoarytenoid joint space was successfully, treated. Our findings suggest that a combination of external approaches with temporary, cricothyrotomy and wide suturing of the entire cricoid framework has the potential to improve, arytenoid movement and prevent associated complications.

Cricoid and Thyroid Cartilage Fracture, Cricothyroid Joint Dislocation, Pseudofracture Appearance of the Hyoid Bone: CT, MRI and Laryngoscopic Findings

Laryngeal trauma is extremely rare and usually occurs as a result of blunt trauma. The most common cause of the blunt laryngeal trauma is a motor vehicle accident but it can also occur as a result of relatively minor insults to the anterior neck that cause posterior compression of the larynx against the spine. Injury to the larynx may range from simple mucosal tears to laryngeal cartilage fracture and dislocation. It may be associated with hyoid fractures, epiglottic injury, cervical spine fractures and esophageal or vascular injuries. As it may lead to life-threatening airway obstruction, rapid and accurate diagnosis is essential for proper treatment. We report computed tomography (CT), magnetic resonance imaging (MRI) and serial endoscopic findings of a patient with cricoid and thyroid cartilage fracture and cricothyroid joint dislocation after blunt neck trauma. Case Report

Successful cricoid fracture reduction using a balloon dilator

The traditional treatment of cricoid cartilage fractures concurrent with subglottic stenosis in pediatric patients usually requires an open approach with a high rate of complications and morbidity. We present here a case report of a successful treatment of a cricoid cartilage fracture concurrent with a subglottic stenosis in an adolescent patient using balloon dilation. The mentioned procedure reduced the fracture and allowed us to prevent a tracheostomy and its complications.

Cadaveric position of unilateral vocal cord: a case of cricoid fracture with ipsilateral arytenoid dislocation

We report a case of cricoid cartilage fracture with unilateral arytenoid dislocation following a motorcycle accident. This 25 year old male sustained blunt injury to the head, face and neck. He presented late to the hospital with one week history of dysphonia. Laryngoscopy revealed cadaveric position of the non-functioning left vocal cord. CT and MRI showed laterally displaced left vocal cord. Displaced fractures were noted in the cricoid at the junction of lamina with the anterior arch on the left side and at the right side of the anterior arch, along with dislocated left arytenoid resulting in ipsilateral vocal cord palsy. Medialization thyroplasty was performed to improve his phonation. Laryngeal trauma warrants close monitoring because of the risk of airway compromise. Radiologists play a crucial role in early diagnosis and should always have high index of suspicion. Recognition of laryngeal injury is important for initial resuscitation as well as for long term airway and vocal function.

Conservative approach to the isolated cricoid cartilage fracture

Isolated cricoid fracture is encountered rarely during the clinical follow-up. A 71-year-old female patient was referred to emergency service with complaints of fall from height, and urgent tracheotomy was performed due to dyspnea. During the examination, isolated fractures of the cricoid cartilage were identified. With the conservative approach, the patient remained symptom-free and was discharged after decannulation.

Pediatric laryngeal trauma: A case series at a tertiary children's hospital

Background Pediatric blunt or sharp laryngotracheal injuries are infrequent because of the softer cartilages and the protection of the prominent mandible. These injuries usually occur secondary to striking furniture or via the “clothesline” injury. Methods We present five cases of pediatric laryngotracheal injury (thyroid cartilage, true vocal cords, cricoid cartilage, cricotracheal junction, and posterior tracheal wall). Results We examined the need for intubation, need for tracheostomy, length of intubation, length of hospital stay, interval until direct laryngoscopy, use of steroids, post-injury swallowing, and post-injury phonation. Discussion Three of the five patients were intubated either prior to arrival or upon arrival to the emergency department. Two of the patients underwent direct laryngoscopy on the day of arrival. Three patients received steroids. CT (computed tomography) was not helpful in diagnosis or decision regarding treatment. The patients with thyroid cartilage fracture, cricoid cartilage fracture, cricotracheal separation, and posterior tracheal wall tear required open repair. The tracheal wall injury, cricoid fracture, and cricotracheal separation were repaired with sutures and the thyroid cartilage fracture with a plate and screws. One tracheal stent was placed. Two open repairs were performed within 24 h of injury. The patient with posterior tracheal wall injury experienced persistent dysphagia and dysphonia, which may have been secondary to intraoperative dissection. Conclusion Dyspnea was not necessarily indicative of the severity of injury in our patients. CT added little information about the integrity of the larynx not already known by physical examination. Open repair was usually indicated for the blunt neck injuries in our series. Oral intubation proved less difficult than tracheostomy in our patient with cricoid cartilage fracture.

A Case of Isolated Multiple Cricoid Fracture Associated with Neck Trauma

Received February 22, 2011 Revised April 4, 2011 Accepted April 8, 2011 Address for correspondence Seung Hoon Woo, MD Department of Otolaryngology, Gyeongsang National University College of Medicine, 79 Gangnam-ro, Jinju 660-702, Korea Tel +82-55-750-8173 Fax +82-55-759-0613 E-mail lesaby@hanmail.net Laryngeal trauma is relatively uncommon but can be possibly life-threatenning. An isolated cricoids fracture associated with neck trauma is rare. We report a case of an isolated multiple fragmented cricoid cartilage fracture that was developed in a 30-year-old man after a neck trauma. It was diagnosed by computed tomography and treated successfully. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:634-7 Key WordsZZLarynx ᆞFracture ᆞCartilage ᆞComputed tomography.

A pilot study of balloon dilation in an animal model resulting in cricoid cartilage fracture: Implications for the stenotic pediatric airway

Endoscopic balloon dilation is increasingly popular as primary therapy for infants with subglottic stenosis. We aim to determine the maximum balloon diameter and pressure where no fracture of the cricoid would occur, minimum balloon size and pressures where a gross fracture of the cricoid occurs, and location of these fractures. We tested these objectives by performing balloon dilation in laryngotracheal complexes of eight euthanized adult male New Zealand white rabbits, with airway characteristics similar to a 3- to 9-month-old infant. Subglottic airway diameter of each specimen was determined using endotracheal tubes (Cotton-Myer grading system). Preexistent subglottic disease was excluded by rigid endoscopy. Serial dilation with balloon catheters was performed, employing incremental balloon sizes and pressures, to determine balloon size and pressure, which resulted in a cricoid fracture. Locations of gross fractures were validated by two independent observers. Airway diameter of all specimens was 5.4 mm (size 4.0 endotracheal tube). Four of the seven cricoid cartilages exhibited gross fractures. Dilation with balloon diameters less than 6.0 mm failed to induce a fracture despite maximal inflation to 16.0 atmospheres. The minimum balloon size required to create a fracture was 7.0 mm, at a pressure of 6.0 atmospheres. All fractures occurred at the anterior lamina of cricoid ring. No fractures occurred when balloon dilation was performed with a balloon 0.6 mm or smaller than the measured subglottic diameter. Fractures of the cricoid occurred when balloon dilation was performed with a balloon 1.6 mm or larger than the subglottic diameter.

Isolated Multiple Fragmented Cricoid Fracture Associated with External Blunt Neck Trauma: A Case Report

Blunt laryngeal trauma is a relatively uncommon but possibly life-threatening injury. An isolated cricoid fracture associated with blunt trauma is rare. We report a case of an isolated multiple fragmented cricoid cartilage fracture that developed in a 20-year-old man after a blunt neck trauma that occurred during a baseball game and was diagnosed by 64-slice multidetector computed tomography (MDCT).