Larynx Fracture

Larynx Fracture is a topic covered in the 5-Minute Emergency Consult.

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Basics

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

Pediatric Considerations
Bicycle handlebars:
  • Extended neck hits the bar, compressing structures between the bar and vertebral column

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Basics

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

Pediatric Considerations
Bicycle handlebars:
  • Extended neck hits the bar, compressing structures between the bar and vertebral column

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