Closed laryngeal trauma refers to laryngeal injuries caused by blunt force impact or compression without an open wound on the skin of the neck. It is also known as laryngeal contusion and may occur in conjunction with closed tracheal injuries.
Etiology
The condition often results from external blunt trauma, such as being struck, punched, or hit with a blunt object, as well as self-inflicted strangulation or manual strangulation by others. Injuries may involve laryngeal cartilage fractures, mucosal tears, vocal cord rupture, or dislocation of the cricoarytenoid joint.
Clinical Manifestations
Laryngeal Pain
Pain and tenderness in the laryngeal region are present.
Hoarseness
The voice may become hoarse or aphonic (loss of voice).
Hemoptysis
Minor hemoptysis may occur if the laryngeal mucosa is damaged. Severe hemoptysis may result from cartilage fractures causing vascular injury.
Cervical Subcutaneous Emphysema
Subcutaneous emphysema in the neck may occur if the laryngeal mucosa is damaged and cartilage fractures are present. In severe cases, the emphysema may extend to the face, chest, or mediastinum.
Respiratory Distress
Severe mucosal swelling, hematoma formation, displaced fractures of the cricoid arch, or bilateral recurrent laryngeal nerve injury can lead to respiratory distress and potentially asphyxiation.
Examinations
Swelling and bruising may be observed on the neck. If the laryngeal mucosa is torn and cartilage fractures are present, air can leak through the damaged mucosa and fracture gaps into the subcutaneous tissue, leading to subcutaneous emphysema. Palpation of the neck may reveal crepitus, and severe emphysema can extend to the submandibular region, face, chest, and waist. Tenderness in the neck may also be observed, and in some cases, fragments of cartilage may be palpated.
Indirect laryngoscopy or fiberoptic laryngoscopy may reveal swelling or hematoma of the laryngeal mucosa, vocal fold deformity, vocal cord rupture, or impaired vocal cord mobility.
CT imaging of the larynx can demonstrate the presence of laryngeal cartilage fractures or misalignment, mucosal tears, submucosal hematomas, and airway obstruction caused by the trauma.
Diagnosis
The diagnosis of laryngeal contusion is generally straightforward and is based on the patient's medical history and examination findings.
Treatment
In cases without respiratory distress, anti-inflammatory and pain-relieving medications may be administered, with careful monitoring of the patient's breathing and subcutaneous emphysema progression. If no cartilage fracture, cricoarytenoid joint injury, or vocal cord rupture is present, most patients recover without the need for specific treatment.
Respiratory distress requires tracheotomy.
In cases of laryngeal cartilage fracture—particularly cricoid cartilage fracture, severe mucosal laceration, vocal cord rupture, or cricoarytenoid joint dislocation—treatment involves reduction of the cartilage fracture, suturing of torn laryngeal mucosa, and reduction of the cricoarytenoid joint. Placement of a laryngeal stent postoperatively may be necessary to prevent laryngeal stenosis. Early repair is crucial for preventing later development of laryngeal stenosis and for restoring laryngeal function.
During the first 7–10 days after injury, nasogastric feeding is recommended to minimize laryngeal movement and promote healing of the injured region