The larynx is a complex structure located in the anterior neck that plays a role in breathing, swallowing, and speaking. While not composed of hard bone, the larynx is formed by a framework of cartilages, ligaments, and membranes. This cartilaginous structure can be fractured or broken, an injury medically termed laryngeal trauma or laryngeal fracture. This injury is serious due to the larynx’s function as a gateway to the trachea and lungs.
Mechanisms of Laryngeal Trauma
A laryngeal fracture occurs when significant external force is applied directly to the anterior neck, compressing the cartilaginous framework against the cervical spine. Blunt force trauma is the most common cause, often resulting from high-speed impacts. Motor vehicle accidents, where the neck strikes a steering wheel or dashboard, were historically frequent causes, though incidence has decreased with modern safety features like airbags.
Direct blows to the neck during sports, such as an elbow or a fall onto a hard object, are also common culprits. Compression injuries, like those sustained during strangulation or hanging, can cause multiple fractures. The thyroid cartilage, which forms the prominent “Adam’s apple,” is the most frequently fractured structure, typically breaking vertically at or near the midline.
Recognizing the Critical Symptoms
The symptoms of a laryngeal fracture are often immediate and can indicate a life-threatening compromise of the airway. Difficulty breathing (dyspnea) is a primary concern, frequently accompanied by noisy breathing called stridor. Stridor is a high-pitched, harsh sound that signals a blockage or narrowing of the airway due to internal swelling or structural displacement.
Voice changes are another hallmark of this injury, ranging from hoarseness (dysphonia) to a complete inability to speak (aphonia). The patient may also experience pain localized to the throat, especially when swallowing (odynophagia). Subcutaneous emphysema, which is air trapped under the skin of the neck, feels like a crackling sensation when touched. Coughing up blood (hemoptysis) is another potential indicator of a mucosal tear inside the larynx.
Emergency Medical Steps and Diagnosis
A suspected laryngeal fracture requires immediate medical attention, as airway obstruction can rapidly worsen. Medical professionals prioritize securing a stable airway first, which may involve observation or, in severe cases, performing a tracheostomy to bypass the injured larynx. Diagnostic evaluation proceeds once the patient’s airway is stabilized.
A physical examination includes careful palpation of the neck to check for tenderness, loss of the normal thyroid cartilage contour, or subcutaneous emphysema. Imaging is then used to confirm and grade the injury’s severity. High-resolution Computed Tomography (CT) scans are the imaging modality of choice, providing detailed visualization of the cartilage fractures and internal soft tissue damage. Specialized procedures like flexible fiberoptic laryngoscopy allow direct visualization of the vocal cords and the extent of the mucosal injury, guiding the treatment plan.
Treatment and Long-Term Outlook
Treatment for a laryngeal fracture is determined by the injury’s severity. Minor, stable injuries with minimal internal damage or non-displaced fractures may be managed conservatively. This non-surgical approach involves strict voice rest, humidified air, and close observation for the first 24 to 48 hours to monitor for delayed airway swelling.
More severe injuries, such as displaced fractures or those with significant internal mucosal tears, require surgical intervention. The goal of surgery is to realign the fractured cartilage (open reduction) and internally fixate the fragments to restore the structural scaffold of the larynx. After surgical repair, an internal stent may be temporarily placed to maintain the laryngeal lumen’s shape during healing. Long-term recovery often involves speech therapy to address potential issues with voice quality or swallowing function, and timely diagnosis and treatment are associated with a better prognosis.