NYMC Faculty Publications

Management of Acute Blunt and Penetrating External Laryngeal Trauma

Author Type(s)

Faculty

DOI

10.1002/lary.24068

Journal Title

The Laryngoscope

First Page

233

Last Page

244

Document Type

Article

Publication Date

1-1-2014

Department

Otolaryngology

Keywords

Algorithms, Humans, Larynx, Wounds, Nonpenetrating, Wounds, Penetrating

Disciplines

Medicine and Health Sciences

Abstract

OBJECTIVES/HYPOTHESIS: Improve the care of acute external laryngeal trauma by reviewing controversies and the evolution of treatment.

DATA SOURCE: Internet-based search engines, civilian and military databases, and manual search of references from these sources over the past 90 years.

REVIEW METHODS: Utilizing the above-mentioned sources, electronic and manual searches of primary topics such as laryngeal trauma or injury, emergency tracheotomy, airway trauma, intubation versus tracheotomy, cricothyrotomy, esophageal trauma, and emergent management of airway injuries in civilian and combat zones. Citations were reviewed, selected reports analyzed, and the most relevant articles referenced.

RESULTS: Optimal treatment of acute laryngeal trauma includes early identification of injuries utilizing a directed history and physical examination. Timely management of the wounded airway is essential. The choice of intubation, tracheotomy, or cricothyrotomy must be individualized. Computed tomography (CT) may assist in differentiating patients who can be observed versus those who require surgical exploration. In selected patients, laryngeal electromyography and stroboscopy may also be useful. Surgery should begin with direct laryngoscopy and rigid esophagoscopy to evaluate the hard and soft tissues of the larynx, and to visualize the pharynx and esophagus. Minor endolaryngeal lacerations and abrasions may be observed, whereas more significant injuries require primary closure via a thyrotomy. Laryngeal skeletal fractures should be reduced and fixated. Endolaryngeal stenting is reversed for massive mucosal trauma, comminuted fractures, and traumatic anterior commissure disruption.

CONCLUSIONS: Acute external injury to the larynx is both life threatening and a potential long-term management challenge. Although a rare injury, sufficient experience now exists to recommend specific treatments, and to preserve voice and airway function.

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