Acute laryngeal trauma in the pediatric patient

We reviewed the evaluation and management of pediatric laryngeal trauma, focusing on the unique characteristics of the immature airway as they affect functional results. The study was based on 91 cases of acute laryngeal trauma managed by the senior author (E.S.P.) from 1973 to 1996. Patients over 15 years old were considered physically mature and excluded. The remaining 10 cases (mean age 9.7) were reviewed in detail and compared to the adult series. Intervention ranged from level I (observation) to level III (open repair with stent placement). Outcome measure was by functional evaluation of swallowing, voice, and airway. Injuries were rated from group 1 (minor trauma) to group 4 (massive laryngeal injury with multiple fractures). Sixty percent fell into group 1 or 2. Conservative management in these patients produced excellent results as measured by decannulation (100%), functional speech (100%), and normal deglutition (100%). Conversely, 2 of the 4 patients with group 3 or 4 injuries had persistent airway and/or voice complications despite more aggressive intervention. As the pediatric larynx is protected by pliable cartilage and a more craniad location in the neck, traumatic laryngeal injuries in children tend to be less severe than those in the adult population. Group 1 or 2 injuries respond well to conservative treatment. However, children with extensive laryngeal injuries may have more long-term sequelae.