Acute laryngeal injury is a rare, potentially lethal injury. It often poses difficulty in airway management. Commonly described are external laryngeal or blunt injuries. We report a case of penetrating neck injury resulting in complete transection of cricoid cartilage. A lady presented with a large, deep slash wound in her neck from a knife injury. There was complete laryngotracheal separation. The airway was secured before she was taken to the operating theatre. A tracheostomy was performed. Exploration revealed the cricoid ring was cut horizontally into two. Anastomosis of the cartilaginous framework was undertaken. Fibreoptic laryngoscopy showed bilateral vocal cords paralysis. After two months the patient recovered without airway compromise, she regains her voice. Repeat laryngoscopy showed good mobility of the vocal cords. In conclusion surgical reconstruction should be meticulously done to ensure good respiratory and phonatory abilities.
Laryngotracheal separation is a rare variant of laryngeal trauma. However it is life threatening and potentially fatal. Patients with this injury usually succumb at the site of the accident itself. Here we present two cases of laryngotracheal separation of different etiology and of different outcomes. The treatment advocated for laryngotracheal separation is initially airway stabilization followed by formal repair of the transected trachea. However both our cases illustrates that the outcomes can be different and that a long term treatment plan should be individualized to each patient.
Penetrating neck trauma present difficult management issues by virtue of their rarity. Undiagnosed laryngotracheal injuries have serious implications, especially in the context of multiple trauma, where other injuries overshadow that of the laryngotracheal complex. This is a case of a schizophrenic patient with multiple self-inflicted cuts on his throat and abdomen. Injuries include open, comminuted laryngeal complex lacerations with vocal cord avulsion, as well as evisceration of small bowel. Adequate assessment using both direct laryngoscopy and rigid endoscopy, coupled with open exploration, allowed optimal exposure and fixation of the larynx in the anatomical configuration. The post-operative outcome of the airway and voice remained satisfactory at follow-up. A high index of suspicion coupled with adequate surgical approach allowed establishment of a functional larynx.