[Voice disorders, dyspnea, aspiration. A laryngeal injury can be the cause]

Injuries to the larynx may have extracorporeal (external), or endolaryngeal (internal), causes and are here classified on the basis of traumatic mechanisms. External trauma may be due to the action of blunt force or sharp objects--also including ruptures. Internal injuries may occur as a result of endotracheal intubation (also for anesthesia), long-term intubation and mechanical ventilation, ingestion of foreign bodies, surgical or nonsurgical interventions. In some cases, laryngeal injuries may be difficult to diagnose and evaluate. If the patient survives the primary traumatic event and his vital functions are preserved and stable, a careful laryngoscopic exploration--where indicated also such imaging procedure as high-resolution CT, direct microlaryngoscopy and laryngometry--should be applied to establish the diagnosis and decide on appropriate treatment.

External trauma to the larynx: classification, diagnosis, therapy

In contrast to internal trauma to the larynx caused by endolaryngeal procedures, trauma to the larynx caused by external forces is relatively rare. Nevertheless, the great variety of these external traumata warrants a thorough diagnosis and understanding of each case as well as a standardized and accepted method for classifying these injuries. These preconditions will facilitate successful therapy. At our three institutions cases of external trauma to the larynx, including the mechanisms of trauma, were reviewed and analyzed. Cases were classified according to the mechanisms and the sequelae of trauma. The three major categories were (a) external trauma due to the impact of blunt objects, (b) trauma after tearing of the neck and the larynx longitudinally, and (c) external trauma caused by sharp objects and gunshots. In the great majority of cases external trauma to the larynx was caused by blunt pressure and was most often due to strangulation in the course of (attempted) suicide or homicide. In a smaller number of cases sharp instruments caused external traumata. In patients surviving the immediate trauma a meticulous laryngological assessment is necessary. In addition to indirect laryngoscopy, we consider microlaryngoscopy as being indicated for investigating the soft tissues of the endolarynx. The status of the laryngeal skeleton can be determined more precisely via high-resolution computed tomography and ultrasound. Early diagnosis and appropriate therapy have a significant impact on the patient's condition later, especially as regards scar formation, ease of breathing, and voice quality.