Laryngeal Fracture due to Blunt Trauma Presenting with Pneumothorax and Pneumomediastinum

Aim: Injuries due to traffic accidents are frequent in childhood, and they have high mortality and morbidity. Laryngeal injury due to a traffic accident is a rare pathology and might be missed if not suspected. Here we present a laryngeal fracture in a child after a blunt chest trauma during a traffic accident that presented with pneumomediastinum and pneumothorax. Case: A 14-year-old girl was referred for pneumomediastinum. Her physical examination was normal except subcutaneous emphysema, edema and tenderness in the cervical area, hoarseness, facial and extremity abrasions and ecchymoses. Chest tomography revealed pneumothorax and pneumomediastinum, and cranial tomography revealed maxillofacial fractures. Upper airway damage was suspected, flexible endoscopy revealed right vocal cord paralysis and cervical tomography revealed thyroid cartilage fracture. The fracture was repaired and tracheotomy was performed. She was discharged on postoperative day 6. Facial fractures were repaired in another center. Tracheotomy was removed on postoperative day 20. Her hoarseness, alReceived: March 3, 2011 Accepted after revision: May 9, 2011 Published online: August 5, 2011 Adnan Narcı, Assoc. Prof. Afyon Kocatepe Universitesi Tip Fakültesi Cocuk Cerrahisi AD TR–03200 Afyon (Turkey) Tel. +90 272 246 3333, E-Mail adnannarci @ yahoo.com © 2011 S. Karger AG, Basel 0301–1569/11/0735–0246$38.00/0 Accessible online at: www.karger.com/orl Laryngeal Fracture due to Blunt Trauma ORL 2011;73:246–248 247 and ecchymoses. Chest tomography revealed lung contusion, pneumothorax and pneumomediastinum, and cranial tomography revealed maxillofacial fractures ( fig. 1, 2 ). Although pneumothorax was resolved, mediastinal air was increased during her hospital stay. Otorhinolaryngology consultation was requested. Right vocal cord paralysis was seen with flexible endoscopy. Cervical tomography revealed thyroid cartilage fracture. Neck exploration was performed. During surgery, thyroid cartilage was found fractured in the midline, and the superior thyroid lamina was displaced cranially. There was a horizontal cut on the left lamina ( fig. 3 ). The fracture was repaired with 4-0 prolene, and tracheostomy was performed by otorhinolaryngology surgeons ( fig. 4 ). She was discharged on postoperative day 6. Facial fractures were repaired in another center. Tracheostomy was removed on postoperative day 20. Her hoarseness, although decreased, still persists. Fig. 1. Pneumothorax, pneumomediastinum and lung contusion are seen in chest tomography. Fig. 2. Maxillofacial fractures are seen in reconstructive cranial tomography. Fig. 3. Fractured thyroid cartilage. Fig. 4. Repaired thyroid cartilage after surgery. Co lo r v er si on a va ila bl e on lin e Co lo r v er si on a va ila bl e on lin e Co lo r v er si on a va ila bl e on lin e 1