The protection afforded by the maxilla and the sternum, coupled with the elastic nature of the cartilage makes laryngeal fractures relatively uncommon in occurrence. However, due to the risk of severe airway obstruction and impending multiorgan failure emanating from these fractures, proper and quick identification of this condition becomes necessary  .
Laryngeal fractures need to be suspected in all patients with trauma to the neck, as well as in patients presenting with respiratory distress, stridor, subcutaneous emphysema or hoarseness. Neck hematomas, hemoptysis, tenderness over the larynx and the loss of visible anatomical markers over the neck also constitute indications for a thorough clinical assessment, performed in view of a suspected laryngeal fracture  .
The most common symptoms encountered in a laryngeal fracture are odynophagia and pain at the site of trauma. Dysphasia, aphonia and dyspnea are also highly prevalent in such patients. Some individuals may suffer from subcutaneous emphysema or unconsciousness arising from these fractures.
The physical examination of such patients must begin with a complete assessment of the cervical spine. Acute fractures may present with tenderness over the larynx, whilst stridor, hematomas, ecchymosis and vocal cord abnormalities are some of the other clinical signs that may be seen in such patients . Airway injury or obstruction, crepitus over bony structures and loss of palpable landmarks in the neck may also be seen in these individuals.
Her physical examination was normal except subcutaneous emphysema, edema and tenderness in the cervical area, hoarseness, facial and extremity abrasions and ecchymoses. [ncbi.nlm.nih.gov]
People with these types of injuries tend to have pain in the neck, shortness of breath, hoarseness, pain on talking, an inability to speak and pain on swallowing. [autoaccident.com]
The athlete may have a hoarse voice or even lost their voice. They may be short of breath or coughing up frothy blood. There may be swelling at the front of the throat where the cartilage has been disrupted. [sportsinjuryclinic.net]
- Laryngeal Pain
Symptoms include hoarseness, laryngeal pain, dyspnea, and/or dysphagia. Also, stridor, hemoptysis, subcutaneous emphysema and tenderness/deformity of the larynx skeleton may be present. [radiopaedia.org]
Diagnosis is made based on clinical findings (for example, hoarseness, laryngeal pain, aphonia, asymmetry, bleeding and subcutaneous emphysema) in the laryngeal area. CT is recommended to evaluate the extent of laryngeal fractures . [jmedicalcasereports.biomedcentral.com]
- Difficulty Vocalizing
Vocal cord paralysis or vocal cord fixation Injury to the recurrent laryngeal nerve Granulation tissue formation (if antibiotics are not used) Subglottic stenosis (can be treated with laser excision or dilatation procedures) Sacramento Personal Injury [autoaccident.com]
Jaw & Teeth
Dysphasia, aphonia and dyspnea are also highly prevalent in such patients. Some individuals may suffer from subcutaneous emphysema or unconsciousness arising from these fractures. [symptoma.com]
Common presenting symptoms in patients with laryngeal trauma include hoarseness, neck pain, dyspnea, dysphonia, aphonia, dysphasia, odynophonia, and odynophagia; however, no single symptom correlates well with the severity of laryngeal injury. [oralmaxillo-facialsurgery.blogspot.com]
Before proceeding to any diagnostic tests, the Advanced Trauma Life Support (ATLS) protocol needs to be followed. Securing the airway and optimizing the cardiorespiratory status of the individual are of great importance. Other life-threatening injuries, if present, need to be managed accordingly.
Laryngeal fractures are suspected primarily based on the clinical findings. However, direct observation of the laryngeal anatomy helps in delineating the severity and extent of injury. For this purpose, transnasal fiberoptic laryngoscopy needs to be performed in these patients to identify any airway abnormalities. Dislocation of the laryngeal cartilages, avulsion of the vocal cords, edema, hematomas and other injuries can be visualized via this endoscopic technique. Indirect laryngoscopy is generally not employed, due to the sympathetic response of gagging and choking seen during the procedure.
Radiography of the chest and cervical spine must be performed to exclude any associated cervical or airway injuries.
The procedure of choice, in order to visualize the laryngeal anatomy, is a computerized tomography (CT) scan  . Laryngeal injuries have been classified based on CT scan and endoscopic findings. These imaging techniques can help to guide the management of laryngeal fractures and may prevent the need for excessive or unwanted surgery. Three-dimensional CT scanning has a higher sensitivity in terms of revealing minor fractures and is becoming more popular nowadays.
Magnetic resonance imaging (MRI) is not an optimal choice to assess laryngeal injuries . Other common studies that may be performed include bronchoscopy, esophagoscopy, cervical arteriography and certain histological tests.
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