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 [1] [2].

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 [3] [4].

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 [5]. Airway injury or obstruction, crepitus over bony structures and loss of palpable landmarks in the neck may also be seen in these individuals.

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 [6] [7]. 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 [8]. Other common studies that may be performed include bronchoscopy, esophagoscopy, cervical arteriography and certain histological tests.

The treatment of a laryngeal fracture depends on the severity of the injury. Mild fractures may be managed conservatively with voice rest, pain management, and close monitoring. More severe cases may require surgical intervention to realign and stabilize the fractured structures. In all cases, protecting the airway is a priority, and in some instances, a temporary tracheostomy (a surgical opening in the neck to aid breathing) may be necessary.

The prognosis for a laryngeal fracture varies based on the severity of the injury and the timeliness of treatment. With prompt and appropriate management, many patients recover well, regaining normal voice and breathing function. However, severe fractures or delayed treatment can lead to complications such as permanent voice changes or airway obstruction.

Laryngeal fractures are typically caused by blunt trauma to the neck. Common causes include motor vehicle accidents, sports injuries, physical assaults, or falls. Less commonly, they can result from penetrating injuries or iatrogenic causes, such as complications from medical procedures involving the neck.

Laryngeal fractures are relatively rare, accounting for a small percentage of all traumatic injuries. They are more common in males, likely due to higher exposure to risk factors such as contact sports and physical altercations. The incidence can vary based on geographic and demographic factors.

The larynx is composed of cartilage, muscles, and ligaments, all of which can be damaged in a fracture. The primary concern is the potential for airway obstruction, as swelling or displacement of structures can block airflow. Additionally, damage to the vocal cords or surrounding tissues can affect voice production and swallowing.

Preventing laryngeal fractures involves minimizing risk factors for neck trauma. This includes wearing seat belts in vehicles, using protective gear in contact sports, and avoiding high-risk activities. Awareness and education about the risks of neck injuries can also play a role in prevention.

Laryngeal fractures are serious injuries that require prompt medical attention. They can significantly impact breathing and voice, necessitating a careful and comprehensive approach to diagnosis and treatment. While rare, understanding the causes, symptoms, and management options is crucial for effective care and recovery.

If you suspect a laryngeal fracture, it is important to seek medical evaluation immediately. Symptoms such as difficulty breathing, voice changes, and neck pain should not be ignored. Early diagnosis and treatment are key to preventing complications and ensuring a good outcome. Always use protective measures to reduce the risk of neck injuries in daily activities.

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