Core Curriculum Syllabus: Emergencies in Otolaryngology-Head and Neck Surgery
Laryngeal and Tracheal Injuries

A. General considerations - The respiratory skeleton is suspended from the base of the skull and mandible by the pharynx and strap muscles. Because of its mobility, resilience and relatively shielded anatomy, it usually escapes serious injuries; however, direct anterior blows, strangulation, and penetrating missiles can cause significant damage. Early diagnosis is the key to successful management. Unfortunately, these injuries are often overlooked initially in the multiply injured patient. Prompt diagnosis requires a vigilant approach.

B. Types of injuries

  • Laryngeal fracture
  • Tracheal fracture
  • Penetrating injuries
  • Arytenoid dislocation
  • Cricotracheal separation
  • Recurrent laryngeal nerve paralysis

C. Diagnosis

  • Symptoms
    • Pain
    • Hoarseness
    • Obstruction (can develop rapidly even if asymptomatic for several hours after the injury)
    • Hemoptysis
  • Signs
    • Ecchymosis
    • Subcutaneous emphysema
    • Loss of surface landmarks
    • Saliva or air exiting neck wound
    • Crepitus of larynx or trachea
  • Indirect laryngoscopy to search for lacerations and/or deformity
  • X-rays
    • Neck (soft tissue)
    • Chest
    • CT scan

D. Treatment

  • Maintain airway. Oral or nasal intubation is contraindicated. If intervention is required, proceed with tracheotomy. Try to avoid high tracheotomy in the presence of laryngeal injury.
  • Endoscopy evaluation is safe only after tracheotomy. Look for possible associated injuries of the esophagus or bronchi.
  • OPEN reduction of fractures and careful suturing of lacerations is imperative, as soon as possible after injury.

E. Late Complications: hoarseness, aspiration, and obstruction.

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©2001-2006 Baylor College of Medicine
Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery
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Phone: 713-798-5906
 E-mail: oto@bcm.edu

Last modified: Jan. 23, 2006