The Adam’s apple is a noticeable bump on the front of the throat, more prominent in some individuals than others. It is a protective component of the voice box, or larynx.
Anatomy and Function of the Larynx
The Adam’s apple is the common term for the laryngeal prominence, a part of the thyroid cartilage. This cartilage is the largest of the larynx, also known as the voice box. The larynx itself is a cartilaginous structure situated in the anterior neck, forming part of the respiratory tract. It contains a skeleton made of nine cartilages, including three unpaired ones—the thyroid, cricoid, and epiglottis—and three paired cartilages like the arytenoids. These cartilages are held together by ligaments and membranes, providing rigidity and stability to the larynx.
The larynx serves several important functions for the body. It allows air to pass from the throat to the windpipe and lungs, playing a direct role in breathing. Another key function is voice production, or phonation, which occurs as air passes through the vocal cords located within the larynx. Additionally, the larynx protects the lower respiratory tract by preventing food or liquids from entering the windpipe during swallowing. The epiglottis, a leaf-shaped cartilage, folds over the entrance to the larynx during swallowing to ensure this protection.
How the Larynx Can Be Injured
While commonly referred to as “breaking” the Adam’s apple, injuries to this area involve fractures or dislocations of the laryngeal cartilages. Such damage typically results from blunt force trauma to the neck, requiring significant force to occur. The thyroid cartilage, which forms the Adam’s apple, is the most frequently fractured laryngeal cartilage.
Common scenarios leading to laryngeal injuries include motor vehicle accidents, particularly from impact with a steering wheel or dashboard. Direct blows to the neck during sports activities or physical altercations can also cause such trauma. Other mechanisms include strangulation, attempted hanging, or “clothesline” injuries where a person’s neck impacts a fixed object. Less commonly, laryngeal injuries can occur from internal blunt trauma, such as during endotracheal intubation or other medical procedures. The severity of the injury can range from minor mucosal tears and swelling to displaced fractures or complete separation of the larynx from the trachea. Even seemingly minor external signs can mask severe internal damage.
Recognizing the Signs of Injury
Severe pain in the anterior neck is a common indicator, often worsening with swallowing or speaking. Difficulty breathing, known as dyspnea, is a serious sign, sometimes accompanied by noisy breathing or stridor, which is a high-pitched sound indicating airway obstruction. Changes in voice, such as hoarseness (dysphonia) or complete loss of voice (aphonia), are frequent symptoms due to damage to the vocal cords or surrounding structures. Swallowing can become painful or difficult (dysphagia or odynophagia). Visible signs may include swelling, bruising (ecchymosis), or tenderness to the touch in the neck area. A crackling sensation or sound under the skin, known as subcutaneous emphysema, indicates air has escaped into the tissues, which is a significant sign of laryngeal or tracheal injury. In some cases, there might be a noticeable change in the normal contour of the neck or loss of the thyroid cartilage prominence. These symptoms collectively suggest a medical emergency requiring immediate attention.
Immediate and Long-Term Medical Concerns
Laryngeal injuries can lead to severe complications, with acute airway obstruction being the most immediate and life-threatening concern. Swelling or displaced cartilages can rapidly block the airway, potentially causing asphyxia or death if not managed promptly. Even if the airway is initially stable, delayed swelling can lead to sudden obstruction hours after the trauma.
Permanent voice changes are a common long-term consequence, ranging from persistent hoarseness to complete loss of voice, due to vocal cord or nerve injury. Damage to the recurrent laryngeal nerve, which controls vocal cord movement, can impair voice or respiration. Chronic difficulty swallowing and increased aspiration risk (where food or liquid enters the lungs) can also result from laryngeal trauma. This can lead to recurrent pneumonia and nutritional deficiencies. Scar tissue within the larynx can further impair vocal cord movement and narrow the airway, potentially requiring long-term tracheostomy dependence.
Diagnosis and Medical Management
Laryngeal injuries are diagnosed through physical examination and imaging studies. Initial assessment involves neck palpation for tenderness, crepitus, or contour changes, and evaluation of voice and breathing. Flexible laryngoscopy, performed in a conscious patient, allows direct visualization of vocal cords and internal laryngeal structures to assess injury extent. Computed tomography (CT) scans are typically the imaging choice to assess laryngeal anatomy and identify fractures, displacements, or soft tissue swelling.
Once a laryngeal injury is suspected, securing the patient’s airway is the immediate priority. If severe respiratory distress or impending obstruction is present, emergency procedures like intubation, cricothyroidotomy, or tracheostomy may be performed. Treatment varies based on injury severity. Minor injuries with minimal swelling or small mucosal tears may be managed conservatively with observation, voice rest, humidified air, and corticosteroids to reduce inflammation. More severe injuries, including displaced fractures or significant mucosal lacerations, often require surgical repair. Surgical intervention aims to restore the laryngeal framework and mucosal lining, sometimes using stents to maintain airway patency and proper alignment during healing.