Larynx Trauma - Types and Management

Introduction

Blunt or penetrating wounds of the larynx can occur. Protection from accidental or wanted injury to the larynx is done by protection from the sternum and the jaw. Neck injuries in the anterior region are checked before a major injury. It is of utmost importance to maintain the airway properly. For the proper trauma assessment, various diagnostic assessments are done, and the necessary treatment is given.

What Are the Causes of Larynx Trauma?

• Road traffic accidents, penetrating trauma, assaults, near-hanging, and attempted strangulation-type injuries are the primary causes of laryngeal trauma.

• Blunt trauma is usually prevented with the help of the mandible and sternum. But they can be caused due to a hard blow in the neck region.

What Are the Classifications of Larynx Trauma?

Larynx trauma can be classified based on the following factors.

• Minor hematoma (a solid swelling of blood or blood clot in the internal organs).

• Extreme hematoma or edema.

• Extensive edema (swelling due to accumulation of fluid in the tissues).

• Interruption of the anterior larynx, fracture lines, and severe mucosal trauma.

How Can Larynx Trauma Be Assessed?

The first priority is to set up a secure airway in an emergency condition. Orotracheal intubation or intubation is necessary. After the patient is stabilized, the cervical spine and the airway are secured, and a CT (computed tomography) scan is performed to check for laryngeal damage.

• Flexible Laryngoscopy: The appearance of an intact airway in the patient is the best way to evaluate. This method evaluates the internal laryngeal tissues after the primary and secondary trauma assessments. Edema, lacerations, mucosal tears, hematomas, and others can lead to further complications. Serious mucosal wounds can also be assessed. Additional investigation is necessary to look for concerns of vocal fold paresis. A routine laryngeal examination is necessary, such as a bronchoscopy performed during the surgery if the clinical condition and the way of damage concern any hidden injury. Symptomatic patients with laryngeal examinations may not require tracheostomy or intubation.

• Computed Tomography: Imaging should only be used to affect management strategy positively under secure conditions. Not all patients are benefited from imaging. Patients with positive history, routine review, clinical picture, and laryngoscopy do not need imaging. Computer tomography scans may be useful in patience with an opposite assessment of clinical suspicion of undiscovered harm and steady airway.

• Esophagram: Laryngeal fractures can also result in esophageal damage. Suspected chronic damage can be revealed and evaluated through this method. Esophagoscopy laryngoscopy is the procedure included if there is a doubt of esophageal damage in case of laryngeal injury.

• Chest X-ray: A portable roentgenogram is typically used in a patient with a secured airway. An X-ray can help in visualizing internal fractures.

What Is the Management for Larynx Trauma?

The primary step in managing larynx trauma is to recognize an interruption in the airway and stabilize it. If the patient has a normal talking ability, the airway is at least patent but cannot be steady.

Crackling sounds on palpitation, neck wound, surgical emphysema, and pain can be seen in a clinical condition.

Severe conditions such as hematoma, breathlessness, severe soreness of throat, strider, and severe hemorrhage are the symptoms that show the necessity for intubation.

For a patient with evident larynx fracture, tracheostomy and cricothyrotomy are the immediate surgical treatment.

Impending Airway Obstruction:

• Tracheostomy, cricothyrotomy or intubation can be led by competent airway therapy. After this procedure, esophageal scooping or direct laryngoscopy can be performed on every patient.

• Depending on the type of injury, treatment modalities are made.

• Normal fracture of the larynx and mild trauma to the mucosa was first managed by monitoring the patient.

• Fractures to the thyroid cricoid and uninjured larynx can be treated by open reduction and internal fixation of larynx fractures with plating.

• Major lacerations of the mucosa and fractures are treated by open reduction and inter-fixation of the fractures, along with correcting the mucosal lacerations and placing the stent.

Stable Airway:

Laryngoscopy and computer tomography of the neck, along with laryngeal electromyography, should be employed. The results of these examinations help in the formulation of the treatment.

Medical Management:

Close monitoring of the patient will be sufficient in cases of mild injuries. Edema is treated by administering Dexamethasone intravenously along with steroids. For the first day after the injury, flexible laryngoscopy and airway monitoring, along with pulse oximetry, are performed. In cases where there is the presence of a near-normal mucosal layer and any chance of unfavorable laryngeal scarring, all the above-mentioned treatment procedures can be followed.

Surgical Treatment:

All the other clinical conditions require surgery along with esophageal and laryngeal examinations with direct endoscopy and laryngoscopy. Endoscopic repair can be tried in cases of mild to moderate mucosal lacerations. Unstable or displaced fractures and major mucosal lacerations will provide an open neck examination and necessitate the thyrotomy for treatment. Covering to prevent webbing or scarring is done by mending the mucosa first. Esophageal injuries are addressed first, along with fractures of the larynx. Soft tissue and skin repair are scheduled to the last. A stent is also placed essentially if there is the presence of extensive intralaryngeal mucosal lesions.

Post-operative and Rehabilitation Care:

All laryngeal injuries need the patient to be hospitalized. Head elevation, analgesics, steroids, and proper diet can do conservative treatment of certain laryngeal injuries. Such conservative treatment is done for injuries like hematomas, non-displaced fractures, and minor mucosal injuries. Restoration of voice and swallowing system can be done through long-term therapy to regain speech and swallowing system.

What Are the Associated Complications of Larynx Trauma?

The severity of the complication can be very minor to huge or catastrophic. As intralaryngeal mucosa healing occurs, granulation tissue can be present.

• The best defense against cicatrix formation, a terrible consequence, is rapid healing of the mucous membrane along with avoiding laryngeal muscle or exposed cartilage.

• Wound healing complications which include recurrent fistula formation, although very uncommon, can also occur.

• Reliance on long-term tracheostomy can also occur.

• Unrecognized esophageal damage is a fatal complication that can occur due to trauma of the larynx.

• Dysphonia (impaired voice production) and aspiration.

Conclusion

Larynx trauma, though rarely occurs as it is protected by the lower jaw and sternum bone, is fatal. Larynx is a part of the body helping with breathing, speech, and swallowing. Any injury to that region can cause alteration in the function, which can lead to death as breathing is hampered. Various management approaches, along with complications, are explained in this article. Larynx trauma is an emergency condition that requires immediate treatment.