Larynx Fracture

Description

• Direct transfer of severe forces to the larynx
• Range from simple mucosal tears to fractured and comminuted cartilages to laryngotracheal separation:
  • Unpaired: Thyroid, cricoid, and epiglottic cartilages
  • Paired: Arytenoid, corniculate, and cuneiform cartilages
• Rare: 1/5,000–1/43,000 trauma patients
• <1% of all blunt trauma
• Recent data suggests it may be more common: CT may diagnose in almost 1% of neck trauma patients
• Mortality may be as high as 80% prehospital, but decreases to <5% after securing the airway

Etiology

• Blunt or penetrating trauma to the anterior neck associated with motor vehicle or motorcycle crash, assault, recreational activities, strangulation, and rarely vigorous coughing or sneezing
• Typical mechanism is hyperextension of neck with a direct blow to the exposed anterior neck
• “Clothesline” injury is a classic mechanism (victim struck in neck by cord, wire, or branch hung across path of travel)
• Iatrogenic injuries from intubation are becoming more common with an aging population

• Extended neck hits the bar, compressing structures between the bar and vertebral column