Laryngeal trauma is injury to the voice box, or larynx, the upper portion of the airway where the vocal cords are located.
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, or other throat injury.
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.
In childhood, the larynx and trachea have a soft cartilage structure and small size. Therefore, pediatric fractures occur less often. Even the largest hospitals only see a small number of real laryngotracheal fracture cases.
Trauma to the larynx may not be obvious right away. 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:
- Difficulty speaking or making sounds
- Change in voice (hoarseness)
- Noisy breathing (stridor)
- Respiratory distress
- Complaints of neck pain or pain when swallowing or coughing
- Bruising on the neck
- Coughing blood
- Neck swelling
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.
- The doctor will assess the degree of respiratory distress and the nature of the injury.
- In cases of soft blunt trauma to the neck, the neck will be examined, specifically by touch. The doctor will feel for grating, crackling or popping sounds and sensations under the skin (called crepitus).
- If the child's voice is hoarse then a flexible laryngoscopy can be used in the emergency room to visualize the vocal cords for hematomas or disruption.
- If the child's condition is stable, they may have a CT scan of the neck and chest.
- A microlaryngoscopy and bronchoscopy with repair of the airway may be necessary.
When our doctors diagnose laryngeal trauma, the first priority is securing the airway. 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, your 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.