01Approach to the Critical Patient/attcp49

Immediate Airway Priorities

›Airway threats requiring immediate action

›Stridor (inspiratory or biphasic) indicating significant airway compromise

›Inspiratory stridor: supraglottic obstruction

›Biphasic stridor: glottic or subglottic obstruction

›Progressive dyspnea with desaturation below 94%

›SpO2 target: maintain above 94% with supplemental oxygen

›HFNC if desaturation with standard oxygen delivery

›Complete airway obstruction: laryngotracheal separation is the most catastrophic injury

›Emergency surgical airway required

›Awake tracheostomy preferred over orotracheal intubation for Schaefer grade III-V

›Subcutaneous emphysema at neck: suggests mucosal disruption or cartilage fracture

›Indicator of communicating airway injury

›CT neck immediately if not already obtained

Stabilization and Escalation Triggers

›Critical stabilization steps

›Awake tracheostomy preferred for severe laryngeal injuries (Schaefer grade III-V)

›Avoids risk of creating false passage through disrupted larynx

›Maintains surgical airway control

›Fiberoptic-guided orotracheal intubation if tracheostomy not immediately feasible

›Smallest appropriate ETT to minimize further injury

›Maintain spontaneous ventilation if possible

›Avoid paralytic agents (RSI) in unstable airways: loss of muscle tone may cause complete obstruction

›Cricothyrotomy only as last resort if intubation and tracheostomy fail

›Risk of worsening laryngeal injury

›Temporizing measure until definitive surgical airway

›If expanding neck hematoma: anticipate rapid airway loss

›Emergent ENT/otolaryngology at bedside

02History/hx62

Mechanism of Injury

›Blunt trauma mechanisms (91% of laryngeal trauma cases)

›Motor vehicle collision: steering wheel, dashboard, seatbelt impact

›Most common overall mechanism

›Steering wheel impact to anterior neck

›Sports injury: ball, stick, or elbow to anterior neck

›Predominantly young males

›Contact sports, martial arts

›Assault and strangulation

›Increasing proportion of intentional injuries

›Manual strangulation or ligature strangulation

›Clothesline-type injury: ATV, snowmobile, motorcycle

›High-energy impact to exposed anterior neck

›Older age with ossified cartilage: more prone to fracture

›Younger patients have more elastic cartilage and are more resilient

›Penetrating trauma mechanisms

›Gunshot wound: 81% of penetrating series

›Higher rates of Schaefer grade III-V injury

›Concurrent vascular injury common

›Stab wound or impalement

›Zone of neck injury determines vascular risk

›Platysma violation requires exploration

Symptom Characterization

›Presenting symptoms

›Dysphonia or hoarseness

›Immediate voice change suggests structural injury

›Delayed worsening suggests expanding hematoma or edema

›Dyspnea

03Physical Exam/exam40

Vital Signs and General Assessment

›Vital signs assessment

›Tachypnea: indicator of airway compromise

›Respiratory rate above 24 per minute is concerning

›Oxygen saturation: desaturation below 94% is critical threshold

›Pulse oximetry may be falsely normal early

›Tachycardia: hemorrhage or hypoxia

›Hypotension: hemorrhagic shock from vascular injury

Neck Inspection and Palpation

›Neck examination

›Inspection: swelling, ecchymosis, lacerations, deformity

›Loss of thyroid cartilage prominence (Adam's apple flattening)

›Subcutaneous emphysema visible as neck contour irregularity

›Palpation of laryngeal framework

›Tenderness over thyroid cartilage, cricoid, or hyoid

›Crepitus: fracture or subcutaneous air

›Step-off deformity: displaced fracture

›Loss of normal landmarks on palpation

›Penetrating wounds: do not probe

›Assess for bubbling, active hemorrhage, platysma violation

›Platysma violation requires surgical exploration

Airway and Voice Assessment

›Functional airway assessment

›Voice quality

›Hoarseness or breathy voice: vocal fold injury or recurrent laryngeal nerve damage

›Aphonia: complete loss of voice, indicates severe glottic injury

›Auscultation over trachea and larynx

›Stridor character: inspiratory (supraglottic), biphasic (glottic/subglottic)

04Differential Diagnosis/ddx28

Life-Threatening Mimics

›Conditions requiring immediate exclusion

›Cervical spine injury (ICD-10: S14.0-S14.9)

›Assume concomitant until cleared in blunt trauma

›Cervical immobilization until imaging complete

›Vascular injury: carotid or jugular (ICD-10: S15.0-S15.9)

›Expanding hematoma, pulsatile mass, neurologic deficits

›CTA neck required for penetrating injuries

›Laryngotracheal separation (ICD-10: S11.0)

›Most catastrophic injury, may present with paradoxical respiratory improvement then deterioration

›Emergency surgical airway required

›Tracheal injury (ICD-10: S27.5)

›May coexist with laryngeal injury

›Subcutaneous emphysema extending to mediastinum, pneumomediastinum

Other Diagnoses to Consider

›Additional differential diagnoses

›Pharyngeal or esophageal perforation (ICD-10: S11.2)

›Subcutaneous emphysema, dysphagia, odynophagia

›Evaluate with esophagoscopy

›Hyoid bone fracture (ICD-10: S12.8)

›Pain with swallowing, tenderness at hyoid level

›May occur without laryngeal fracture

›Retropharyngeal hematoma

›Can cause airway compromise

›Visible on lateral neck X-ray or CT as prevertebral soft tissue swelling

›Angioedema: if no clear trauma history

›Allergic or ACE-inhibitor etiology

›Responds to epinephrine, antihistamines, steroids

05Laboratory Tests/lt25

Essential Laboratory Studies

›Core laboratory evaluation

›Arterial blood gas or venous blood gas

›Respiratory distress assessment

›PaO2 below 60 mmHg or SaO2 below 94% indicates significant compromise

›Rising PaCO2 indicates ventilatory failure

›Complete blood count

›Baseline hemoglobin if hemorrhage suspected

›Leukocytosis may indicate concomitant infection

›Type and screen or crossmatch

›Significant hemorrhage or anticipated surgical intervention

›Penetrating trauma with vascular injury risk

Coagulation and Metabolic Studies

›Secondary laboratory evaluation

›Coagulation studies: PT/INR, PTT

›Essential in anticoagulated patients

›Guides reversal strategy for expanding hematoma

›INR above 3.0 significantly increases hematoma progression risk

›Lactate

›Shock or significant hemorrhage concern

›Lactate above 2 mmol/l indicates tissue hypoperfusion

›Comprehensive metabolic panel

›Baseline renal function before contrast CT

›Electrolytes if prolonged hypoxia

›Blood culture

›If open penetrating wound with signs of infection

›Prior to antibiotic administration

06Diagnostic Tests/dt65

Scoring Systems

›Schaefer-Fuhrman Classification System

›Grade I: minor endolaryngeal hematoma or laceration, no fracture

›Management: observation and medical management

›Expected outcome: full recovery without surgical intervention

›Grade II: edema, hematoma, mucosal disruption without exposed cartilage, nondisplaced fracture

›Management: observation versus surgical exploration

›Serial FFL to monitor progression

›Grade III: massive edema, mucosal disruption, exposed cartilage, vocal fold immobility, displaced fracture

›Management: surgical exploration and repair

›Operative within 24-48 hours for optimal outcomes

›Grade IV: same as Grade III with more than 2 fracture lines or massive mucosal injury with disruption of anterior commissure

›Management: open reduction and internal fixation, possible stenting

›Titanium miniplate fixation of displaced fractures

›Grade V: complete laryngotracheal separation

›Management: emergency tracheostomy and surgical repair

›Highest mortality category

MRI

›MRI in laryngeal trauma

›Not indicated acutely due to time constraints and patient instability

›CT is first-line for acute evaluation

›MRI delayed in acute trauma setting

›Utility in subacute and chronic phase

›Superior soft tissue resolution for cartilage edema versus fracture

›Evaluation of vocal fold paresis versus mechanical fixation

›Assessment of soft tissue injury in delayed presentations

›Potential indications

›Persistent dysphonia weeks after injury when CT is inconclusive

›Subglottic stenosis evaluation

›Recurrent laryngeal nerve mapping

CT

›CT neck with IV contrast

›First-line imaging modality for laryngeal trauma

›Sensitivity 100% for laryngotracheal injury in key series (Mace, 1986)

›Evaluates cartilage fractures, soft tissue edema, hematoma, airway narrowing, subcutaneous emphysema

›Thyroid cartilage fractures most common at 82% of all laryngeal fractures

›Cricoid fractures in 24% of cases

›Cricoid fractures always associated with soft tissue abnormalities

›Axial imaging limitations

›Axial images alone may miss up to 12% of fractures

›2D multiplanar and 3D reconstructions required for complete evaluation

›Coronal and sagittal reformats improve detection of thyroid fractures and arytenoid luxation

›CTA neck for vascular injury

›Penetrating trauma, expanding hematoma, zone II or III neck injuries

›Evaluate carotid and vertebral artery integrity

›Chest CT or chest X-ray adjunct

›Evaluate for pneumomediastinum, pneumothorax, subcutaneous emphysema

›Pneumomediastinum indicates tracheal or esophageal injury

›Lateral soft tissue neck X-ray

›May show prevertebral soft tissue swelling, subcutaneous air

›Largely supplanted by CT but useful when CT delayed

›Imaging unnecessary for trivial mechanism with completely normal exam, normal voice, no tenderness

›Low threshold for CT given risk of occult injury

Ultrasound

›Ultrasound in laryngeal trauma

›Non-invasive complementary tool especially in pediatric patients

›No radiation exposure

›Bedside availability

›FAST exam adjunct in blunt trauma

›Excludes hemothorax and hemoperitoneum in polytrauma

›Not diagnostic for laryngeal injury specifically

›Laryngeal ultrasound applications

›Identifies subcutaneous hematoma and soft tissue swelling

›Guides assessment of airway anatomy before intubation

›Tracheal midline confirmation

›Limitations

›Operator dependent

›Limited visualization of cartilage fractures compared to CT

›Subcutaneous emphysema impairs sonographic windows

07Disposition/dispo34

ICU Admission Criteria

›ICU-level care indications

›Stridor or respiratory distress at any point

›Active airway monitoring required

›Immediate access to surgical airway

›Patients with tracheostomy post-injury or post-operative

›Tracheostomy tube management and suctioning

›Tracheostomy site care

›Expanding hematoma or confirmed vascular injury

›Invasive hemodynamic monitoring

›Anticoagulation reversal management

›Anticoagulated patients with any laryngeal hematoma

›Even isolated arytenoid hematoma can progress to obstruction

›Reversal of anticoagulation consideration

Surgical Disposition

›Operating room indications

›Schaefer grade III-V injuries

›Operative within 24-48 hours for optimal outcomes

›Voice outcomes are good in 83% of surgically managed patients

›Penetrating injuries requiring surgical exploration

›Platysma violation

›Vascular injury or expanding hematoma

›Direct laryngoscopy and rigid esophagoscopy in OR prior to repair

›Complete mucosal survey before definitive repair

Inpatient Ward Admission

›Ward admission criteria

›All patients with confirmed or suspected laryngeal injury

›Minimum 24-hour observation recommended to detect delayed complications

08Treatment/t67

Immediate Airway Management

›Definitive airway strategy

›Awake tracheostomy under local anesthesia for Schaefer grade III-V

›Surgeon at bedside with patient awake and breathing

›Avoids risk of false passage through disrupted larynx

›Class I recommendation for severe laryngeal injuries

›Fiberoptic-guided orotracheal intubation for cooperative stable patients

›Smallest appropriate ETT: typically 6.0-6.5 mm internal diameter

›Maintain spontaneous ventilation throughout

›Video laryngoscopy as adjunct

›Avoid succinylcholine or rocuronium in unstable airways

›Paralysis removes protective muscle tone

›May cause complete obstruction in partially patent airway

›Cricothyrotomy only if intubation and tracheostomy fail

›High risk of worsening cartilage injury

›Temporizing measure only

Medical Management for Schaefer Grade I-II

›Conservative medical therapy

›Head of bed elevation at 30-45 degrees

›Reduces laryngeal edema

›Improves work of breathing

›Humidified oxygen delivery

›Reduces mucosal dryness and secretion retention

›Voice rest: strict for minimum 5-7 days

›Reduces vocal fold trauma and promotes mucosal healing

›Corticosteroids for edema reduction

›Dexamethasone 8-10 mg IV loading dose then 4 mg IV every 6-8 hours

›Extrapolated from airway edema management; no high-level evidence specific to laryngeal trauma

›Duration typically 24-48 hours

›Methylprednisolone 1 mg/kg IV as alternative

›Proton pump inhibitor therapy

›Pantoprazole 40 mg IV once daily

›Reduces acid reflux irritation to injured mucosa

›Continue until oral intake established

›Antibiotics for mucosal disruption

›Amoxicillin-clavulanate 875/125 mg orally twice daily for outpatient

›Covers oral flora contaminating mucosal wounds

›Clindamycin 600 mg IV every 8 hours for inpatient with disrupted mucosa

›Alternative if penicillin allergy

›Piperacillin-tazobactam 3.375 g IV every 6 hours for penetrating injuries

›Broader gram-negative coverage for contaminated wounds

›Anticoagulation management

›Hold anticoagulants if laryngeal hematoma present

›Warfarin reversal: 4-factor PCC (Kcentra) 25-50 units/kg if life-threatening hematoma

›Plus vitamin K 10 mg IV

›Dabigatran reversal: idarucizumab 5 g IV

›Rivaroxaban or apixaban reversal: 4-factor PCC 25-50 units/kg

Surgical Management for Schaefer Grade III-V

›Operative repair principles

›Operative within 24-48 hours for optimal outcomes

›Delayed surgery beyond 48 hours associated with worse voice outcomes

›Emergency surgery for Grade V laryngotracheal separation

›Operative sequence

›Direct laryngoscopy and rigid esophagoscopy performed first in OR

›Complete mucosal survey of larynx, pharynx, and esophagus

›Identifies all mucosal lacerations requiring repair

›Thyrotomy approach for endolaryngeal access

›Primary mucosal closure with absorbable sutures

›Open reduction and internal fixation (ORIF) for displaced fractures

›Titanium miniplates and screws for thyroid cartilage fractures

›Anatomic reduction restores laryngeal framework

›Absorbable plates for cricoid fractures when possible

›Endolaryngeal stenting

›Reserved for massive mucosal trauma, comminuted fractures, or anterior commissure disruption

›Silicone keel or Montgomery T-tube stent

›Stent duration typically 4-6 weeks

›Prevents anterior commissure synechiae

›Recurrent laryngeal nerve identification and preservation

›Map nerve during open repair

›Nerve repair or reanastomosis if lacerated

09Special Populations/sp67

Pregnancy

›Laryngeal trauma in pregnancy

›Anatomic considerations

›Laryngeal edema normal in pregnancy due to increased circulating estrogens

›May mask or exacerbate traumatic edema

›Baseline airway assessment more critical

›Gravid uterus limits patient positioning

›Left lateral decubitus preferred to avoid aortocaval compression

›Airway management modifications

›Anticipated difficult intubation due to mucosal edema and friability

›Smaller ETT size: 6.0 mm recommended

›Avoid multiple intubation attempts

›Rapid desaturation due to decreased FRC

›Preoxygenation critical before any airway manipulation

›Succinylcholine safe to use with pseudocholinesterase monitoring

›Medication safety

›Dexamethasone safe in pregnancy and may benefit fetal lung maturity if preterm

›Avoid NSAIDs in third trimester (premature ductus closure)

›Clindamycin preferred over metronidazole in first trimester

›Fetal monitoring

›Continuous fetal heart rate monitoring during resuscitation

›Obstetric consultation for any significant trauma in pregnancy

Geriatric

›Laryngeal trauma in older adults

›Anatomic and physiologic changes

›Calcified and ossified laryngeal cartilages more prone to fracture from minor trauma

›Lower-energy mechanisms may cause significant injury

›Higher rates of comminuted fractures

›Reduced respiratory reserve: decreased FEV1 and FVC

›Less tolerance of partial airway obstruction

›Earlier respiratory decompensation

›Atherosclerosis increases vascular injury risk in blunt neck trauma

›Medication considerations

›Higher prevalence of anticoagulant use: warfarin, NOACs

›Significantly increased risk of progressive hematoma

›Early reversal consideration

›Steroid side effects more pronounced

›Glucose monitoring essential if corticosteroids used

›Renal dose adjustment for contrast agents and antibiotics

›eGFR assessment before IV contrast

›Clinical decision-making

›Lower threshold for admission given reduced physiologic reserve

›Earlier surgical intervention may be warranted

›Frailty assessment impacts postoperative recovery planning

Pediatrics

›Laryngeal trauma in children

›Anatomic differences

›Pediatric larynx is smaller, higher in the neck (C3-C4 in infants versus C4-C5 in adults)

›More susceptible to compression from seat belts

›More protected by mandible than adult larynx

›Cartilages are more elastic and less calcified in young children

›Energy absorption reduces fracture risk

›Significant endolaryngeal injury can occur without fracture

›Subglottis is the narrowest point in pediatric airway (vs. glottis in adults)

›Small amount of edema causes significant reduction in cross-sectional area

›Airway management in children

›Uncuffed or cuffed ETT based on age and clinical situation

›Cuffed ETT acceptable in children above 1 year with appropriate sizing

›Use Broselow tape or weight-based ETT size calculation

›ETT internal diameter = (age/4) + 4 for uncuffed tubes

›Surgical airway more difficult in children: needle cricothyrotomy preferred as temporizing

›Imaging considerations

›Ultrasound preferred to reduce radiation in pediatric evaluation

›Non-invasive and does not require sedation

›Low-dose CT protocols when imaging required

›MRI useful for follow-up when CT concerns are present

›Epidemiology in children

›Laryngeal fractures rare in children below 12 years

›Elastic cartilage provides protection

›Non-accidental trauma must be considered

10Background/b69

Epidemiology

›Epidemiological data

›Laryngeal trauma accounts for approximately 1% of all trauma presentations

›Rare but potentially fatal injury

›High index of suspicion essential

›Mechanism distribution

›Blunt trauma accounts for 91% of laryngeal trauma cases

›Penetrating trauma accounts for approximately 9% of cases

›81% of penetrating laryngeal trauma from gunshot wounds in one series

›Fracture pattern data

›Thyroid cartilage fractures most common at 82% of all cartilage fractures

›Cricoid fractures in 24% of cases

›Cricoid fractures always associated with soft tissue abnormalities and higher rates of airway narrowing

›Mortality and outcomes

›Overall mortality approximately 3.8% in published series

›Mortality 1.4-3.8% with appropriate management

›Voice outcomes good in 83% of surgically managed patients

›All patients requiring tracheostomy in most series are eventually decannulated

›Associated injuries

›96% of laryngeal fractures have concomitant maxillofacial injuries in some series

›Cervical spine injury commonly associated with blunt mechanism

Pathophysiology

›Mechanisms of injury

›Blunt anterior neck compression

›Larynx compressed against cervical spine

›Thyroid cartilage buckles and fractures

›Cricoid ring fractures under compression load

›Mucosal disruption from cartilage displacement

›Energy transfer and tissue damage

›Direct mucosal contusion and hematoma formation

›Cartilage fracture with endolaryngeal displacement

›Recurrent laryngeal nerve stretch or laceration causing vocal fold immobility

›Arytenoid dislocation or subluxation from blunt impact

›Progressive edema and hematoma

›Edema peaks at 24-72 hours after injury

›Progressive hematoma in anticoagulated patients

›Laryngeal framework instability from displaced fractures

›Laryngotracheal separation (Grade V)

›Hyperextension mechanism tears cricotracheal membrane

›Trachea descends into mediastinum

›May present with paradoxical respiratory improvement then rapid deterioration

›Chronic complications without treatment

›Subglottic stenosis from granulation tissue formation

›Vocal fold scarring and anterior commissure synechiae

›Glottic or subglottic stenosis from improperly healed fractures

Therapeutic Considerations

›Evidence base for treatment decisions

›Schaefer-Fuhrman classification guides surgical decision-making

›Grade I-II: medical management with close observation

›Grade III-V: surgical exploration and repair within 24-48 hours

›Timing of surgical repair

›Early repair within 24-48 hours associated with best voice and functional outcomes

›Delayed repair beyond 48 hours associated with worse long-term outcomes (Comer, 2012)

›Awake tracheostomy versus intubation

›Awake tracheostomy is gold standard for severe laryngeal injuries

›Prevents worsening injury from blind intubation attempts

›Fiberoptic intubation acceptable for stable Grade I-II patients

›ORIF with titanium miniplates

›Standard of care for displaced thyroid cartilage fractures

›Restores laryngeal framework and voice function

›Recent evidence: some penetrating injuries (Schaefer grade III or higher)

›May have good outcomes without ORIF in select cases (Nguyen, 2025)

›Patient selection criteria still being defined

›Endolaryngeal stenting controversy

›Reserved for comminuted fractures and anterior commissure disruption

›Carries risks of granulation tissue and stent-related complications

›Corticosteroids: extrapolated benefit, no high-level RCT evidence specific to laryngeal trauma

›ICD-10 coding

›S11.0: open wound of larynx

›S12.8: fracture of other parts of neck (includes hyoid)

›S19.8: other specified injuries of neck

›S27.5: injury of thoracic trachea (if laryngotracheal separation)

11Patient Discharge Instructions/pdi37

copy discharge instructions

›Laryngeal Trauma Discharge Instructions

›Activity restrictions

›Strict voice rest for minimum 5-7 days

›Avoid whispering as it strains the vocal folds

›Use written communication or text messaging instead

›Avoid straining, heavy lifting above 5 kg, or Valsalva maneuvers for 2-4 weeks

›Sleep with head elevated on 2 pillows

›No contact sports or activities with neck impact risk for minimum 6 weeks

›Diet and swallowing

›Soft diet or liquids as tolerated

›Avoid hot liquids, alcohol, and acidic foods that worsen mucosal edema

›Small frequent meals to reduce swallowing effort

›Do not eat if difficulty swallowing develops: return to emergency department

›Medications

›Take all prescribed antibiotics for the full course

›Continue proton pump inhibitor as prescribed

›Take pain medications as directed: avoid NSAIDs if on anticoagulants

›Do not restart blood thinners until cleared by your doctor

›Follow-up

›ENT (ear, nose, and throat) appointment within 1 week mandatory

›Repeat flexible laryngoscopy to assess healing

›Voice assessment and speech therapy referral if dysphonia persists

›Return earlier if any symptoms worsen

›Return to emergency department immediately for

›Worsening difficulty breathing or shortness of breath

›New or worsening stridor (high-pitched noisy breathing)

›Inability to swallow or drooling

12References/r32

Guidelines and Key Sources

›Primary references for laryngeal trauma management

›Eskander A, de Almeida JR, Irish JC. Acute Upper Airway Obstruction. New England Journal of Medicine. 2019

›Comprehensive review of upper airway obstruction including laryngeal trauma

›Management algorithms for acute presentations

›Comer BT, Gal TJ. Recognition and Management of the Spectrum of Acute Laryngeal Trauma. Journal of Emergency Medicine. 2012

›Spectrum of injury classification and management principles

›Timing of surgical repair evidence

›Nganzeu C, Esce A, Abu-Ghanem S, Meiklejohn DA, Sims HS. Laryngeal Trauma. Otolaryngologic Clinics of North America. 2023

›Current review of diagnosis and management strategies

›Schaefer SD. Management of Acute Blunt and Penetrating External Laryngeal Trauma. The Laryngoscope. 2014

›Original Schaefer-Fuhrman classification system

›Blunt and penetrating injury management principles

›Pincet L, Lecca G, Chrysogelou I, Sandu K. External Laryngotracheal Trauma: A Case Series and an Algorithmic Management Strategy. European Archives of Oto-Rhino-Laryngology. 2024

›Algorithmic approach to airway management in laryngeal trauma

›Nguyen HH, Tong J, Varone A, et al. Penetrating Laryngeal Trauma: Management of Severe Injuries Without Open Reduction Internal Fixation. The Laryngoscope. 2025

›Emerging evidence for conservative surgical approach in penetrating injuries

›Shi J, Uyeda JW, Duran-Mendicuti A, Potter CA, Nunez DB. Multidetector CT of Laryngeal Injuries: Principles of Injury Recognition. Radiographics. 2019

›CT interpretation principles and multiplanar reconstruction utility

›Becker M, Duboé PO, Platon A, et al. MDCT in the Assessment of Laryngeal Trauma: Value of 2D Multiplanar and 3D Reconstructions. AJR. 2013

›12% fracture miss rate on axial-only CT; 2D/3D reconstructions required

›Buch K, Takumi K, Curtin HD, Sakai O. CT-based Assessment of Laryngeal Fracture Patterns and Associated Soft Tissue Abnormality. European Radiology. 2021

›Cricoid fracture associations and fracture pattern data

›Mace SE. Blunt Laryngotracheal Trauma. Annals of Emergency Medicine. 1986

›Landmark study: CT sensitivity 100% for laryngotracheal injury

›Jalisi S, Zoccoli M. Management of Laryngeal Fractures: A 10-Year Experience. Journal of Voice. 2011

›Voice outcome data: 83% good outcomes with surgical repair

›Li H, Li Z, Zhao J, et al. Management of Paediatric Laryngotracheal Trauma. Journal of Laryngology and Otology. 2022

Evidence & Review

Evidence & Review