Nguyen Helen Hieu, Tong Jane, Varone Andrew, Fransman Ryan B, Stein Deborah M, Guardiani Elizabeth, Snow Grace E
School of Medicine, University of Maryland, Baltimore, Maryland, USA.
Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Laryngoscope. 2025 Oct;135(10):3774-3782. doi: 10.1002/lary.32306. Epub 2025 Jun 7.
Thyroid and cricoid cartilage fractures that are displaced or have multiple fracture lines are traditionally managed with open reduction and internal fixation (ORIF). In practice, patients with penetrating laryngeal trauma may have small fragments of cartilage that are difficult to reduce and fixate. This study examines outcomes in patients managed with and without ORIF.
A retrospective review was conducted of patients aged 18 years and older with penetrating laryngeal trauma who were treated at a single Level I trauma center affiliated with a tertiary-level teaching hospital between 2012 and 2022. Demographics, injury characteristics, and fracture management were recorded. The primary outcome was tracheostomy dependence at the last follow-up. Secondary outcomes included time to laryngeal stent removal, time to tracheostomy decannulation, time to feeding tube removal, voice functionality, and hospital length of stay.
Thirty-two patients were included. Thirty-one (97%) were men. Mean age was 35 years. The mean injury severity score (ISS) was 19 (range: 5-59). Twenty-six (81%) patients suffered gunshot wound(s), and six (19%) stab wound(s). Twenty-two (69%) patients had Schaefer-Fuhrman group 3 or higher injury. Of 22 (69%) patients requiring tracheostomy, 20 (91%) underwent tracheostomy decannulation and resumed an oral diet. Only five (17%) patients underwent ORIF. All surviving patients had functional voices at the time of the last follow-up, except for two patients unable to voice for neurological reasons.
Patients with penetrating laryngeal trauma with a Schaefer-Fuhrman Group 3 or higher injury who were managed without ORIF had good recovery from an airway, voice, and swallowing perspective.
对于移位或有多条骨折线的甲状腺和环状软骨骨折，传统上采用切开复位内固定术（ORIF）进行治疗。在实际操作中，穿透性喉外伤患者可能有难以复位和固定的小软骨碎片。本研究探讨了接受和未接受ORIF治疗的患者的预后情况。
对2012年至2022年期间在一家隶属于三级教学医院的一级创伤中心接受治疗的18岁及以上穿透性喉外伤患者进行回顾性研究。记录患者的人口统计学资料、损伤特征和骨折处理情况。主要结局是最后一次随访时对气管切开的依赖情况。次要结局包括喉支架取出时间、气管切开拔管时间、鼻饲管拔除时间、声音功能和住院时间。
纳入32例患者。其中31例（97%）为男性。平均年龄为35岁。平均损伤严重程度评分（ISS）为19分（范围：5 - 59分）。26例（81%）患者遭受枪伤，6例（19%）患者遭受刺伤。22例（69%）患者的损伤为Schaefer - Fuhrman 3级或更高。在22例（69%）需要气管切开的患者中，20例（91%）进行了气管切开拔管并恢复经口饮食。只有5例（17%）患者接受了ORIF。除2例因神经原因无法发声的患者外，所有存活患者在最后一次随访时声音功能均正常。
对于Schaefer - Fuhrman 3级或更高损伤的穿透性喉外伤患者，未接受ORIF治疗的患者在气道、声音和吞咽方面恢复良好。
