The laryngotracheal complex can be injured when the usually protective mandible is raised leaving the LT complex venerable to injury. Fractures occur in patterns according to the point of impact, particularly when the larynx is calcified (Calcification usually begins at age 21 years). Midline and paramedian fractures of the thyroid cartilage are the most common, but other fractures can involve the hyoid bone and cricoid cartilage which is the only complete ring in the larygotracheal complex supplying support. Blunt trauma to the anterior neck can result in laryngeal injury by 3 methods: compression over the spine, static lateral force and laryngotracheal separation which is the most serious injury resulting in airway compromise.
2 basic types of weapons – low and high velocity. As shown by formula, velocity is more important than mass in the amount of energy carried by a weapon.
First divided into zones in a paper from Monson et al Cook County Hospital 1969 Zone I clavicles to cricoid – Zone II – cricoid to angle of the mandible Zone III – angle of the mandible to the base of the skull
This is an endoscopic view of a patient with mild trauma. One can see small bilateral hematomas on Vc edema. This is an exam of a patient with more significant trauma. One can see blood in the airway and exposed cartilage.
When trauma is extensive there is no question that surgical treatment is necessary. The real question is ‘How minimal of a laryngeal injury detected by CT scan requires surgical treatment?” It has been shown by Hirano and Stanley and colleagues that voice is greatly improved with repair of displaced fractures of 1mm and therefore our protocol is repair non displaced fractures involving the median and paramedian thyroid ala in order to stablized the AP dimension of the thyroid cartilage
Bailey’s atlas p607
Bailey’s atlas p607
Displaced fracture of the R thyroid ala caused by blunt trauma. Used a Vitallium H type place (1.3mm) the suture was placed at the thyroid notch to stabilize the fracture during plating.
![Introduction ,[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)