(0822) Management of Laryngeal Trauma at the University of New Mexico: A 19-Year Chart Review

Introduction: Laryngeal cartilage fractures are rare and their exact reported incidence varies between 1 in 5,000 and 1 in 137,000 ED visits. These injuries can be fatal if not managed appropriately. Securing the airway is the essential primary step in management of these injuries. Early intervention (within 24-48 hours of the inciting trauma) is important to optimize long-term outcomes for voice and swallowing.

Methods: We performed a retrospective chart review on all the patients who presented to UNMH with laryngeal trauma from 2003 to 2022. We classified their injuries based on the Schaefer-Furhman classification. We collected how patients' airway were managed based on injury stage, most specifically who required intubation or tracheostomy. We also collected data on surgical intervention based on injury stage.

Results: We reviewed 49 charts (male: 41, female: 8). The majority of patients presented with blunt trauma from assault (45%), MVC (19%), falls (12%), and strangulation (8%). Penetrating trauma were from GSW and stabbing (10% and 6%). The most common injury stage was stage II at 53% and stage III at 20%. Stage I was 16% and stage 4, 10%. No patients with stage I or II injury underwent any surgical reduction of their fractures. Most stage III and stage IV injuries underwent a tracheostomy and surgical reduction of their fractures. All surgical intervention were within 24 hours. Those who had a tracheostomy were eventually decannulated. Patients who did not have surgical intervention had no voice or swallowing symptoms at follow up. Only 3 patients had hoarseness post decannulation.

Conclusions: Laryngeal trauma can be fatal if not properly managed. Securing the airway is the most important first step and managing the fractures is important to prevent long lasting voice or swallowing consequences. The data recommends that patients with stage II injury and above should undergo surgical reduction; however, our data shows that the majority of patients with Stage II injury and some in stage III had excellent voice and swallowing outcome without surgical intervention. Surgical management should be evaluated on an individual basis.