Diagnosis and therapy for acute laryngeal and tracheal trauma.

A laryngeal fracture should be suspected when there is hemoptysis and subcutaneous emphysema following blunt injury to the neck. Computed tomography of the neck should be used to define the extent of the injury. Cervical vertebral fractures and dislocations, perforation of the pharynx and esophagus, and vascular injuries must be excluded. Establishment of a secure airway by tracheotomy, avoidance of flexion or extension of the neck until cervical vertebral injuries are excluded, and evaluation for recurrent laryngeal paralysis are of great importance. The repair of the fractured larynx requires prompt repair of lacerations of the mucous membrane, reduction of cartilaginous fractures, and internal splinting for six weeks. Anastomosis of the transected trachea is carried out prior to repair of the recurrent laryngeal nerve injury. Although suturing of the transected nerve is controversial, there is general agreement that implantation of the avulsed recurrent laryngeal nerve in the posterior cricoarytenoid muscle is appropriate.