Blunt trauma to the airway is rather common, but happens less frequently in children than in adults. In pediatric cases, the trauma is usually caused by a fall or blow to the neck. The damage can range from minor vocal cord weakness to fractures of the cartilage structures of the larynx or trachea.
These fractures can cause air to escape into the neck and chest, leading to significant respiratory compromise and even death if not diagnosed and treated quickly.
Fractures of the pediatric larynx and trachea are rare due to their soft cartilage structure and small size. Even the largest hospitals only see a small number of real laryngotracheal fracture cases.
Trauma to the larynx may not be obvious immediately after the injury. If there is any suspicion that a child's larynx was injured in a fall or other incident, it is important that the child be examined by a doctor. Signs and symptoms of laryngeal trauma include:
Laryngeal trauma as seen during an endoscopic exam.
If trauma to the larynx is suspected, the doctor will do a few things to confirm the diagnosis.
When the trauma has been diagnosed, securing the airway is the priority. A rigid laryngoscope will be used to expose the injury, and we may take photo and video documentation of the procedure to determine the extent of the damage to the larynx. If it is safe, the child will be intubated. In emergency situations, a tracheostomy may be performed to provide a safe airway while the damage is surgically repaired.
An open, surgical repair of the fracture and/or internal lacerations should be performed as soon as possible. This can usually be done as a single-stage laryngotracheal reconstruction without tracheotomy, where the patient is intubated for the surgical repair for five to seven days. The patient will undergo another microlaryngoscopy and bronchoscopy to reassess the healing process before extubation.
A speech and swallowing evaluation must be performed after the airway has healed. Frequently, the child must also undergo voice rest and have speech therapy.