The larynx, often called the voice box, is a complex structure in the neck, located above the trachea. It plays a role in breathing, protecting the airway during swallowing, and producing sound for speech. While uncommon due to its somewhat protected position, a laryngeal fracture is a serious injury that can compromise these functions.
Laryngeal Anatomy and Susceptibility
The larynx is primarily composed of several cartilages, not bone, which form its structural framework. The largest is the thyroid cartilage, known as the “Adam’s apple,” which partially shields the structures behind it. Below this is the cricoid cartilage, a complete ring forming the base of the larynx and connecting it to the trachea.
Two smaller, paired arytenoid cartilages sit atop the cricoid cartilage, aiding vocal cord movement. While flexible for breathing, speaking, and swallowing, these cartilages have limits. Direct, forceful impacts can cause fractures or dislocations. Their exposed position in the anterior neck makes them vulnerable to blunt force trauma.
Common Causes and Indicators
Laryngeal fractures result from direct blunt force trauma to the neck. Common causes include high-impact sports injuries, such as a direct blow, and motor vehicle accidents where the neck strikes the steering wheel or dashboard. Other causes include strangulation attempts or direct assaults to the throat.
Following such an injury, several immediate signs may indicate a laryngeal fracture. Hoarseness (dysphonia) is a common symptom, resulting from injury to the vocal cords or their supporting structures. Difficulty breathing (dyspnea) can occur if the airway narrows due to swelling or displaced cartilage. Pain upon swallowing (dysphagia) is another indicator, caused by trauma to the laryngeal tissues.
Other visible signs include neck swelling, bruising, or subcutaneous emphysema, which is air trapped under the skin, causing a crackling sensation. A sudden change in voice pitch, becoming lower or higher than normal, can also be a clue.
Medical Evaluation and Management
Prompt medical evaluation is important for a suspected laryngeal fracture due to potential airway compromise. Initial assessment involves a physical examination of the neck to check for tenderness, swelling, crepitus (a crackling sensation), and deformity. The medical team also assesses voice quality and breathing effort.
Imaging studies confirm the diagnosis and determine injury extent. A computed tomography (CT) scan of the neck is the preferred method, providing detailed views of cartilages, soft tissues, and potential airway narrowing. A direct or flexible laryngoscopy is also often performed. This involves inserting a thin, lighted tube with a camera through the nose or mouth to visualize the vocal cords and internal laryngeal structures, assessing mucosal integrity and vocal cord mobility.
Immediate medical management prioritizes securing an open airway, which may involve intubation or, in severe cases, an emergency tracheostomy if the airway is severely obstructed.
Treatment for the fracture varies based on severity. Minor, stable fractures with minimal displacement and no airway compromise may be managed conservatively with voice rest, humidified air, pain control, and close observation. More severe fractures, especially those involving significant cartilage displacement, vocal cord paralysis, or mucosal tears, often require surgical intervention. Surgical goals include realigning and stabilizing fractured cartilages, repairing torn mucous membranes, and restoring vocal cord function to prevent long-term complications.
Healing Process and Outcomes
The recovery period following a laryngeal fracture varies significantly based on injury severity and treatment. For minor fractures managed conservatively, healing may take several weeks to a few months, with strict voice rest and activity modification. More complex fractures requiring surgical repair involve a longer recovery, often several months of healing and rehabilitation. Follow-up imaging and endoscopic evaluations monitor healing and airway patency.
Potential short-term and long-term outcomes are diverse. Persistent voice changes, from chronic hoarseness to complete loss of voice (aphonia), are common and can result from vocal cord scarring, paralysis, or cartilage malunion. Ongoing breathing difficulties may occur if there is residual airway narrowing or scar tissue, potentially requiring further interventions. Swallowing issues (dysphagia) can also persist due to damage to muscles or nerves involved in swallowing. Speech therapy and swallowing rehabilitation are often recommended during recovery to optimize vocal quality, improve breathing, and restore safe swallowing function. These interventions are important for maximizing functional recovery and improving the patient’s quality of life.