Larynx Fracture
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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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