[Tardive endolaryngeal oedema from blunt laryngeal trauma]

Mild to moderate blunt laryngeal injuries are frequent. Under the present management regimens patients are hospitalized for 24h observation due to the potential risk of developing endolaryngeal oedema. This group of patients is poorly described in the literature, and the aim of this study was to estimate the incidence of acute and especially tardive endolaryngeal oedema as well as the association between type of injury, symptoms and findings to improve existing evaluation criteria and treatment regimens.

A retrospective analysis of 130 cases exposed to mild to moderate laryngeal injury was performed. The mechanism of injury, symptoms, findings and treatment were registered.

Strangulation was the most common type of injury which was seen in 43% of cases, while stranglehold, fall and blow were observed in 29, 14 and 14%, respectively. Dysphagia was reported by 55%, while hoarseness was observed in 17% and stridor in 5%. Fibreoptically, 33% had endolaryngeal pathology. Twenty cases received treatment, 110 were observed. Immediate intubation was performed in 2.3% of the cases. In the observation-group, more patients were exposed to self-inflicted strangulation (p = 0.01). Fall and blow accidents were more frequent in the treatment than in the non-treatment group (p = 0.03). More patients in the treatment group had dyspnoea (p < 0.001), stridor (p = 0.001), hoarseness (p = 0.007) and endolaryngeal pathology (p < 0.001) than in the non-treatment group.

In general, mild to moderate blunt external laryngeal injuries seem rather harmless and should need no further treatment. Nevertheless, any injury against the paediatric larynx and injuries related to fall-accidents or genuine hangings are associated with an increased risk of a respiratory threat. No patients in this study developed tardive laryngeal oedema.