E1947. Crikey! Crash Course on Blunt Laryngeal Trauma
  1. Phoebe Chang; LAC + USC Medical Center
  2. Redmond Anderson; LAC + USC Medical Center
  3. Jay Acharya; Keck Hospital of USC
  4. Anandh Rajamohan; Keck Hospital of USC
Blunt laryngeal trauma is rare, but can result in injuries that quickly become life threatening. They occur from high energy impact and can result in disruption of the laryngeal architecture and anatomy. Given the relatively small diameter of the airway at this level, any resulting fractures, edema and hemorrhage can quickly lead to life threatening airway obstruction. They can be clinically difficult to detect due to mild and variable presentations, and easily missed in radiology evaluation due to subtle CT findings. Timely radiology evaluation and diagnosis is critical for optimal patient care as misdiagnosis or delay in care can lead to significant morbidity and mortality.

Educational Goals / Teaching Points
The purpose of this educational exhibit is to review complex laryngeal anatomy, demonstrate CT findings of blunt laryngeal trauma in a variety of cases, and discuss critical steps in radiology evaluation to provide timely diagnosis and optimal patient care.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Thyroid cartilage fractures require a tremendous amount of force and are often associated with thyroarytenoid muscle and ligament tears which can result in hemorrhage, rapid edema development and airway obstruction. Similarly, the lateral aspects of the cricoid cartilage consist of thicker cartilage and if injury occurs at this location, it is highly likely that there is an associated mucosa tear where edema/hemorrhage may or may not yet be evident. The recurrent laryngeal nerves also course over the lateral cricoid cartilage and impingement/injury can be seen. If not recognized and repaired in a timely manner, chronic hoarseness and voice deficits can occur. The traumatic mechanism of high impact and hyperextension in hanging can result in shearing of the fascial planes, subcutaneous emphysema, and cricothyroid disruption, for which emergent tracheostomy may need to be performed for airway protection. High impact frontal force seen with laryngeal trauma can also translate to the cervical spine. It is important to report the presence of any cervical spine injuries in laryngeal trauma because it can affect surgical operative repair planning.

This educational exhibit will review CT findings of blunt laryngeal trauma and discuss important time-sensitive considerations during radiology evaluation.