ISPUB.COM The Internet Journal of Otorhinolaryngology Volume 9 Number 1 1 of 5 Extensive Laryngotracheal Trauma N Baisakhiya, A Agrawal, P Banode, K Patil Citation N Baisakhiya, A Agrawal, P Banode, K Patil. Extensive Laryngotracheal Trauma. The Internet Journal of Otorhinolaryngology. 2008 Volume 9 Number 1. Abstract Isolated laryngotracheal trauma is rare in modern days. Evaluation and treatment (time and mode of treatment) of these types of injury varies from patient to patient and surgeon to surgeon. Air way maintenance is the first priority irrespective of type and cause of trauma. We are reporting this case to give importance to do early tracheostomy in air way breach cases in spite of no stridor at presentation. Inexperience Surgeon should wait till the proper radiological and clinical evaluations are not done. Delaying the surgical intervention for some time may give more favorable result as in our case. INTRODUCTION Injury to the larynx is rare (less than 1% of all traumas). Mode and type of blunt trauma has play major role to the type of injury. It is usually associated with intracranial (13%), cervical spine (8%) and esophagus injury (3%) 1 . Upper airway injury should be considered in every patient of neck trauma. Dyspnoea and dysphonia are the main features which indicate laryngeal injury. CT is helpful for those who have mild to moderate injury. The primary aim is to protect the airway and secondarily successful management of the phonatory role of the larynx. Early recognition, accurate evaluation and appropriate treatment are the main principal to a successful outcome. CASE REPORT A 35 year old male presented in casualty with an increasing neck swelling on the right side and face region after having a blunt trauma over the neck region by autorickshaw about 5 hrs back. There was history of change in voice and difficulty in swallowing. There was no history of respiratory distress, vomiting, loss of consciousness and disorientation. On examination there was surgical emphysema mainly present on the right side of neck and parotid region. There was blunting of the thyroid prominence and tenderness all along the larynx (Figure1). The voice was breathy and cough was effective. On coughing emphysema was increasing. There was no neurological deficit. Chest and abdominal examination was normal. Provisional diagnosis of isolated laryngeal trauma with air-way breach was made. Figure 1 Figure 1: Clinical photograph showing surgical emphysema CT scan showed surgical emphysema in the neck and parotid region mainly on the right side with minimal on the left side, right sided paramedian thyroid ala fracture with sub mucosal hematoma along the interior of larynx and subglottis narrowing (Figure2a and 2b). Vocal cords seem to be normal and no other associated vascular, esophagus and cervical spine injury. Scan also able to demonstrate site of air leak (crico-thyroid membrane region). Tracheostomy was done in view of severity of trauma, giving rest to the vocal cords and spontaneous closure of leak site. There was sign of resolution of emphysema in 3-4 days.