Laryngotracheal trauma

Trauma: Laryngotracheal Injury

High-Yield Clinical Management for Board Review & PG Entrance Examinations

Laryngotracheal trauma is a surgical emergency requiring rapid assessment of the airway. Because the larynx is protected by the mandible above and the sternum below, injuries often result from “clothesline” accidents or direct blunt force.

1. Clinical Presentation (The “Red Flags”)

• Signs of Injury: Subcutaneous emphysema (crepitus), neck tenderness, hoarseness/aphonia, and stridor.
• Schaefer’s Signs:
  • Minor: Endolaryngeal hematoma or mucosal tears (manage conservatively).
  • Major: Exposed cartilage, massive edema, or airway disruption (requires urgent surgical repair).
• Caution: Avoid blind intubation if a laryngeal fracture is suspected; it can convert an incomplete tear into a complete airway disruption.

2. Diagnostic Workup

• Initial Assessment: Secure the airway (awake fiberoptic intubation or tracheostomy if anatomy is distorted).
• Gold Standard Imaging: CT scan of the neck with thin cuts is the definitive diagnostic modality for evaluating skeletal integrity and cartilage fractures.
• Direct Laryngoscopy/Bronchoscopy: Often performed in the OR to define the extent of internal mucosal injury.

3. Management Principles

• Conservative: Minor hematomas, linear undisplaced fractures, or non-obstructive mucosal tears. Includes voice rest, humidification, and head elevation.
• Surgical: Indicated for displaced cartilage fractures, vocal cord paralysis, or airway instability.
  • Goal: Restore airway patency and laryngeal framework support (often using internal stenting).

4. High-Yield Board Exam Facts