Larynx Fracture

Basics

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

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

Pediatric Considerations
Bicycle handlebars:

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

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