Laryngotracheal trauma: its management and sequelae

Abstract

Objective: Laryngotracheal trauma is a rare but clinically important injury. Complications are frequent. Early recognition, accurate evaluation and proper treatment is vital. In order to learn from our past experience and refine our management, we reviewed our cases

Methods: Fifteen patients with external laryngotracheal injuries were analyzed retrospectively. The outcome was assessed both in terms of voice and airway, on short term and long term basis.

Results: Commonest cause of injury was cut throat injuries followed by road traffic accidents. The main presenting symptoms and signs were hoarseness, haemoptysis, odynophagia and stridor. Major laryngeal injuries (10 cases) outnumbered minor injuries (5 cases). A good association exists between the symptoms of haemoptysis and stridor at presentation and severity of the injury. Sites of laryngeal injury included; thyroid cartilage, mixed soft tissue and cartilaginous injuries, thyrohyoid membrane, aryepiglottic fold and cricothyroid membrane. Ten patients presented within 24 hours of the injury. Out come (airway and voice) was good in 12 patients whereas it was poor in 3 patients. Poor results were seen in patients who had delayed surgical intervention.

Conclusion: The presence of stridor and haemoptysis are suggestive of major injury. Early surgical intervention is recommended for all major injuries to ensure a good outcome.