Penetrating Laryngeal Trauma: Management of Severe Injuries Without Open Reduction Internal Fixation

Thyroid and cricoid cartilage fractures that are displaced or have multiple fracture lines are traditionally managed with open reduction and internal fixation (ORIF). In practice, patients with penetrating laryngeal trauma may have small fragments of cartilage that are difficult to reduce and fixate. This study examines outcomes in patients managed with and without ORIF.

A retrospective review was conducted of patients aged 18 years and older with penetrating laryngeal trauma who were treated at a single Level I trauma center affiliated with a tertiary-level teaching hospital between 2012 and 2022. Demographics, injury characteristics, and fracture management were recorded. The primary outcome was tracheostomy dependence at the last follow-up. Secondary outcomes included time to laryngeal stent removal, time to tracheostomy decannulation, time to feeding tube removal, voice functionality, and hospital length of stay.

Thirty-two patients were included. Thirty-one (97%) were men. Mean age was 35 years. The mean injury severity score (ISS) was 19 (range: 5-59). Twenty-six (81%) patients suffered gunshot wound(s), and six (19%) stab wound(s). Twenty-two (69%) patients had Schaefer-Fuhrman group 3 or higher injury. Of 22 (69%) patients requiring tracheostomy, 20 (91%) underwent tracheostomy decannulation and resumed an oral diet. Only five (17%) patients underwent ORIF. All surviving patients had functional voices at the time of the last follow-up, except for two patients unable to voice for neurological reasons.

Patients with penetrating laryngeal trauma with a Schaefer-Fuhrman Group 3 or higher injury who were managed without ORIF had good recovery from an airway, voice, and swallowing perspective.