Laryngeal Trauma (2024)

Laryngeal trauma is injury to the voice box, or larynx, the upper portion of the airway where the vocal cords are located.

Blunt trauma to the airway is rather common, but happens less frequently in children than in adults. In pediatric cases, the trauma is usually caused by a fall or blow to the neck, or other throat injury.

The damage can range from minor vocal cord weakness to fractures of the cartilage structures of the larynx or trachea. These fractures can cause air to escape into the neck and chest, leading to significant respiratory compromise and even death if not diagnosed and treated quickly.

In childhood, the larynx and trachea have a soft cartilage structure and small size. Therefore, pediatric fractures occur less often. Even the largest hospitals only see a small number of real laryngotracheal fracture cases.

Trauma to the larynx may not be obvious right away.If there is any suspicion thata child'slarynx was injured in a fall or other incident, it is important that the childbe examined by a doctor. Signs and symptoms of laryngeal trauma include:

• Difficulty speaking or making sounds
• Change in voice (hoarseness)
• Noisy breathing (stridor)
• Respiratory distress
• Complaints of neck pain or pain when swallowing or coughing
• Bruising on the neck
• Coughing blood
• Neck swelling

Laryngeal trauma as seen during an endoscopic exam If trauma to the larynx is suspected, the doctor will do a few things to confirm the diagnosis.

• The doctor will assess the degree of respiratory distress and the nature of the injury.
• In cases of soft blunt trauma to the neck, the neckwillbeexamined, specifically by touch. The doctor will feel forgrating, crackling or popping sounds and sensations under the skin (calledcrepitus).
• If the child'svoice is hoarse then a flexible laryngoscopy can be used in the emergency room to visualize the vocal cords for hematomas or disruption.
• If the child's condition is stable, they may havea CT scan of the neck and chest.
• Amicrolaryngoscopy and bronchoscopy with repair of the airway may be necessary.

When our doctors diagnose laryngeal trauma, the first priority is securing the airway.A rigid laryngoscopewill beused toexpose the injury, and we may take photo and video documentation of the procedureto determine the extent of thedamage to the larynx. If it issafe, your child will beintubated. In emergency situations, a tracheostomy may be performed to provide a safe airway while the damage is surgically repaired.

An open, surgicalrepair of the fracture and/or internal lacerations should be performed as soon as possible. This can usually be done as a single-stage laryngotracheal reconstruction without tracheotomy, where the patient is intubated for the surgical repair forfive to sevendays. The patient will undergo another microlaryngoscopy and bronchoscopy to reassess the healingprocess before extubation.

A speech and swallowing evaluation must beperformed after theairway has healed. Frequently, the child must also undergo voice rest and have speech therapy.