[Diagnostic approach to acute laryngeal trauma: role of computerized tomography]

Aim of this study was to assess the role of Computed Tomography (CT) in the management of acute laryngeal injuries by reviewing our 5 years' experience. From January, 1991, to November, 1996, sixteen patients with blunt trauma and 2 patients with penetrating injuries of the larynx underwent physical examination, laryngoscopy and CT; 2 of them underwent angiography too. The patients were divided into 3 groups according to Schaefer classification [13], first on the basis of physical examination, CT and laryngoscopy findings. The definitive group and therapy were decided on the basis of final spatial assessment. Physical examination diagnosed the presence and the anatomical level of laryngeal injuries in group I (4 patients); laryngoscopy and CT depicted the type of injury and suggested conservative management in 100% of cases. In group II (10 patients), conservative management was suggested by CT findings in the laryngeal, submucosal soft tissues and fascial plane injuries in 100% of cases. Physical examination findings were correct in 30% of cases, questionable in 30% and incorrect in 30%; the exam was not performed in 10% of cases. Finally, laryngoscopy findings were correct in 60% of cases, incorrect in 20% and not diagnostic in 20%. In group III (2 patients), exposed laryngeal injuries required immediate surgery. In group II, the selective application of CT was useful for assessing the degree of damage in 100% of cases and was helpful in planning conservative management. CT avoided surgery in one patient, showed laryngeal cartilaginous features in 2 patients and 2 pseudoaneurysmal injuries not suspected on the basis of physical examination findings.