Laryngeal trauma refers to laryngeal cartilage fractures, hematoma, arytenoid dislocation, and soft tissue injury resulting from blunt (motor vehicle accident, sports injury, strangulation, clothesline injury) or penetrating (knife, gunshot) neck trauma. Although it constitutes less than 1% of neck traumas, it carries high mortality due to airway compromise. CT is the gold standard imaging modality — thin-section axial images + multiplanar and 3D reformats demonstrate cartilage fracture lines, emphysema, hematoma, and airway narrowing. Schaefer-Fuhrman classification (Grade I-V) determines the treatment approach.
Age Range
15-60
Peak Age
35
Gender
Male predominant
Prevalence
Uncommon
Laryngeal cartilages are in a relatively protected position in the neck but are vulnerable to direct trauma. In blunt trauma (especially anterior neck), cartilage is compressed against the vertebral column — in children, elastic cartilage is more resistant, while in adults, ossification increases fragility. The thyroid cartilage is the most commonly fractured laryngeal cartilage — median vertical fracture ('butterfly fracture') is the classic pattern. Since the cricoid cartilage is ring-shaped, it usually fractures at 2 or more points. Arytenoid dislocation results from cricothyroid or cricoarytenoid joint damage. Air entering through the fracture line creates subcutaneous and paralaryngeal emphysema — the pathognomonic imaging finding. Hematoma develops from bleeding at fractured cartilage edges or vascular injury — appearing hyperdense on CT, hyperintense on T1 MRI (acute blood). Mucosal tear carries risk of airway bleeding and aspiration. Edema and hematoma can narrow the airway both internally (intraluminal) and externally (compression).
Coexistence of air in neck soft tissues and fracture line in laryngeal cartilage on CT is pathognomonic for laryngeal trauma. Emphysema indicates disruption of mucosal integrity.
On thin-section CT (0.5-1mm), fracture line is seen in thyroid and/or cricoid cartilage. 3D volume rendering and multiplanar reformats best demonstrate fracture pattern, displacement, and fragment count. Median vertical fracture ('butterfly') is most common in thyroid cartilage. Cricoid cartilage usually fractures at 2+ points of the ring. Arytenoid cartilage fracture or dislocation is detected as arytenoid position asymmetry on axial sections.
Report Sentence
A [median vertical/paramedian/bilateral] fracture line is seen in the [thyroid/cricoid] cartilage. The fracture is [displaced/non-displaced], with __ mm displacement. Arytenoid cartilages are [in normal position/dislocated/subluxed]. Consistent with Schaefer-Fuhrman Grade __.
Gas collections at air density (-1000 HU) are seen within neck soft tissues on CT. Subcutaneous emphysema is seen in subcutaneous fat, paralaryngeal emphysema in soft tissues around the larynx. Mediastinal extension should be assessed (pneumomediastinum). The extent of emphysema is proportional to the severity of mucosal tear.
Report Sentence
[Subcutaneous/paralaryngeal/bilateral] emphysema is seen. Gas extent is [limited/extensive]. [Pneumomediastinum is present/not identified]. Findings are consistent with mucosal tear.
On CT, a hyperdense collection is seen around the larynx (paralaryngeal, pre-epiglottic, or paraglottic space) — representing acute hematoma. Acute blood shows 40-70 HU density on CT. Hematoma may narrow the airway lumen, causing airway compromise. If active bleeding is present, extravasation (contrast blush) may be seen on contrast-enhanced CT.
Report Sentence
A __ x __ mm hyperdense collection (average __ HU) is seen in the [paralaryngeal/pre-epiglottic/paraglottic] space, consistent with acute hematoma. Airway lumen is [preserved/narrowed, diameter __ mm]. [No active bleeding sign is seen/contrast extravasation is present].
On MRI T1-weighted sequences, paralaryngeal hematoma shows hyperintense signal in the acute phase (due to methemoglobin content). Signal on T2 may be heterogeneous. Hematoma is better characterized on MRI than CT — signal varies according to the oxidation stage of hemoglobin (hyperacute: T1 iso/hypo; acute: T1 hypo; early subacute: T1 hyper; late subacute: T1+T2 hyper).
Report Sentence
A hyperintense collection is seen in the paralaryngeal space on MRI T1 (consistent with subacute hematoma). Signal on T2 is [heterogeneous/hyperintense]. Soft tissue injury [is described].
On axial CT, the arytenoid cartilage is seen dislocated or subluxed from its normal position. Arytenoid position asymmetry is evident compared to the healthy side. Dislocated arytenoid causes ipsilateral vocal cord immobility — vocal cords are seen in asymmetric position (affected side in paramedian or lateral position). Cricoarytenoid joint subluxation may appear as widening of the joint space on CT.
Report Sentence
[Right/Left] arytenoid cartilage shows [anterior/posterior/lateral] dislocation. Ipsilateral vocal cord is in [paramedian/lateral] position. Cricoarytenoid joint is [subluxed/normal].
Criteria
Minor endolaryngeal hematoma/lacerations, no fracture
Distinct Features
Conservative treatment sufficient. Observation + medical management.
Criteria
Displaced fracture, vocal cord immobility
Distinct Features
Requires surgical exploration + repair. Tracheotomy + cartilage reduction.
Criteria
Laryngotracheal separation
Distinct Features
Most severe form, high mortality. Emergency surgical repair. Complete laryngotracheal separation means airway is completely disrupted.
Distinguishing Feature
No trauma history, fracture, or emphysema in epiglottitis. Inflammatory edema predominates.
Distinguishing Feature
No cartilage fracture in retropharyngeal abscess, rim-enhancing collection present. Trauma collection = hematoma (hyperdense), abscess collection = pus (hypodense).
Distinguishing Feature
Subglottic stenosis is chronic, concentric narrowing; trauma is acute with fracture + emphysema + hematoma.
Urgency
emergentManagement
surgicalBiopsy
Not NeededFollow-up
specialist-referralAirway securing is the most urgent priority — intubation in stable patients, emergent tracheotomy in unstable patients. Schaefer-Fuhrman Grade I-II conservative, Grade III-V requires surgical treatment. Surgery should be performed within 24-48 hours — delay increases risk of laryngeal stenosis and permanent voice impairment.
Airway securing is the most urgent priority. Schaefer-Fuhrman Grade I-II requires conservative, Grade III-IV surgical treatment. Surgical repair includes cartilage stabilization and airway reconstruction. Delayed diagnosis may lead to laryngeal stenosis and permanent voice impairment.