The larynx, commonly known as the voice box, is a complex structure of cartilage, muscle, and soft tissue located in the front of the neck. Its primary functions are to ensure air passage to the lungs, protect the trachea from aspiration during swallowing, and produce sound. It is possible for the cartilaginous framework of the larynx to sustain a fracture, though this injury is rare. A laryngeal fracture is a serious medical event because of the immediate threat it poses to the airway and the long-term risk of permanent voice and breathing difficulties.
Understanding the Larynx and Injury Mechanisms
The laryngeal structure is composed of several cartilages. The thyroid cartilage forms the prominent “Adam’s apple,” is shield-shaped, and protects the vocal cords. Below it, the cricoid cartilage is the only complete ring of cartilage in the airway, connecting the larynx to the trachea. The thyroid and cricoid cartilages are the most susceptible to fracture from external trauma.
Laryngeal fractures almost always involve significant blunt force trauma directed at the neck. Common causes include high-impact motor vehicle accidents where the neck strikes the dashboard or steering wheel. Direct, forceful blows, often seen in contact sports or altercations, can also cause this injury. Compression injuries, such as manual strangulation, can crush or fracture the delicate cartilages. Because the larynx is partially shielded by the jawbone and the sternum, it takes considerable force to cause structural damage. When the injury occurs, the impact can fracture the thyroid or cricoid cartilage, potentially displacing fragments and disrupting internal soft tissues.
Recognizing the Signs of Laryngeal Trauma
The symptoms of a laryngeal fracture can appear immediately and may progress rapidly. A person who has experienced trauma to the front of the neck will often report severe, localized pain and tenderness over the laryngeal area. A change in voice is a common sign, ranging from hoarseness (dysphonia) to a complete inability to speak (aphonia) due to damage to the vocal cords or their supporting structures.
Difficulty breathing, medically termed stridor, is the most dangerous symptom. Stridor is characterized by a high-pitched, harsh sound during inhalation, indicating significant airway obstruction or narrowing. Another specific sign is subcutaneous emphysema, which is air trapped under the skin of the neck, producing a crackling sensation when touched.
Additional indicators include hemoptysis, or coughing up blood, which signals laceration to the mucosal lining of the airway. Physical examination may also reveal a loss of the normal prominence of the thyroid cartilage or visible bruising (ecchymosis) on the neck. The presence of these signs following neck trauma warrants immediate emergency medical attention.
Immediate Medical Response and Diagnostic Procedures
The immediate priority for anyone suspected of having a laryngeal fracture is to secure and maintain a patent airway, as breathing can fail quickly. Emergency medical services must be called immediately, and movement of the patient’s neck should be strictly avoided until medical professionals can assess for associated spinal injuries. If the patient is struggling to breathe, a surgical airway, such as an emergency tracheotomy or cricothyrotomy, may be necessary to bypass the obstructed larynx.
Once the patient is stabilized, medical professionals use specific diagnostic tools to determine the extent of the damage. Flexible laryngoscopy is often performed first, involving a thin, flexible tube with a camera passed through the nose to visualize the internal structures of the larynx. This allows for the assessment of vocal cord movement, internal swelling, and mucosal tears.
The gold standard for assessing the cartilaginous framework is a high-resolution Computed Tomography (CT) scan of the neck. The CT scan provides detailed, cross-sectional images that clearly show the location, severity, and displacement of any thyroid or cricoid cartilage fractures. Early, accurate diagnosis using these tools is essential to guide the subsequent treatment plan.
Treatment Pathways and Recovery Outlook
The chosen treatment for a laryngeal fracture depends heavily on the injury’s severity, particularly whether the airway is compromised and if the fracture is displaced. For minor injuries, such as non-displaced fractures without significant airway obstruction, a conservative management approach is adopted. This includes strict voice rest, close observation in a hospital setting, and administration of corticosteroids to reduce internal swelling.
More severe injuries, including unstable fractures or those causing significant airway compromise, require prompt surgical intervention. This procedure, known as open reduction and internal fixation, involves surgically opening the neck to realign the fractured cartilage segments and secure them using small plates or wires. If extensive mucosal damage exists, a specialized stent may be temporarily placed inside the larynx to maintain its shape during the initial healing process.
The long-term recovery outlook varies, but the primary goals are to restore normal breathing and voice function. Even after surgical repair, patients often experience some degree of long-term voice change (dysphonia) due to scar tissue formation or residual vocal cord dysfunction. Post-operative care includes follow-up with a speech pathologist to maximize voice quality and swallowing function through specialized therapy.