Laryngeal trauma: Pearls, pitfalls and the illustrative gamut of mdct imaging findings.
Mallon S, Starcevic V, Rheinboldt M, and Proposto Z. Laryngeal trauma: Pearls, pitfalls and the illustrative gamut of mdct imaging findings. Emerg Radiol 2018; 25(5):574.
Learning Objectives To review the incidence, clinical presentation and potential prognostic implications of both blunt and penetrating laryngeal injury. To illustrate the imaging anatomy of the laryngeal skeleton as well as to review potential variant pitfalls in appearance. To present a case based review of the imaging gamut of potential acute and chronic post-traumatic sequelae of laryngeal injury Background Though relatively uncommon, external laryngeal trauma, has the potential for both high patient mortality and long-term morbidity, necessitating prompt and accurate diagnosis. Estimated to occur in 1 per 5000 polytrauma cases and up to 1% of all cervical trauma patients, laryngeal injury directly threatens airway patency with an estimated pre-hospitalization mortality rate of up to 80%. Long term morbidities include potential impairment to respiration, phonation and swallowing secondary to disruption of the laryngeal apparatus and subsequent scarring. Diagnosis is typically made withMDCT and endoscopic evaluation with MRI playing an adjunctive role. Both two and three dimensional multiplanar CTreconstructions (MPR) have shown additive value in noninvasive evaluation and treatment planning. Content Introduction Epidemiology MDCT imaging technique Laryngeal anatomy Normal anatomic variations Traumatic injury-Schaefer classification Hyoid, cricoid, thyroid fracture Arytenoid subluxation Thyrohyoid membrane laceration Glottic and subglottic hematoma Laryngeal ligamentous and muscular injury Secondary injuries Chronic sequelae Chondral pseudoarthrosis Cricoarytenoid ankylosis Subglottic stenosis Post-traumatic granuloma Summary Summary MDCT imaging is critical for the emergent non-invasive assessment of all suspected laryngeal injuries and should be performed expediently when warranted by clinical suspicion or injury mechanism. Axial images displayed in both soft tissue and osseous windows should be closely scrutinized given the oftentimes subtle appearance of nondisplaced chondral injuries. Review of multiplanar 2D and 3D reformatted images is critical for detection of horizontal fracture plane injuries, typically occurring at the hyoid and thyroid cartilage level aswell as for aiding in identification of cricoarytenoid subluxation.