ABSTRACT
Laryngotracheal injuries are rare, and typically associated with multisystem trauma.
They may be blunt or penetrating in nature, and are in the great majority of cases
related to motor vehicle accidents or “clothesline” injuries with a small percentage
due to direct blows sustained during assaults or athletic contests, hanging or manual
strangulation, or other less common etiologies including iatrogenic causes. Missed
diagnoses or mismanagement may result in the patient's death or significant long-term
morbidity. The radiologist must be familiar with the normal computed tomographic (CT)
appearance of laryngotracheal anatomy to correctly interpret CT studies following
injury, and must also be aware of the central role that CT plays in diagnosis, management,
and selection of therapy. This should include an understanding of the Shaefer classification
of laryngeal injuries that is based on a combination of the CT and endoscopic findings.
Although an acceptable evaluation of the traumatized larynx is obtainable with most
commercially available CT scanners, optimal studies are produced by CT devices capable
of spiral technique and subsecond scan times, particularly in regard to their ability
to generate thin retrospectively reconstructed two-dimensional (2D) axial sections,
2D coronal and sagittal images, and three-dimensional (3D) images. Our discussion
of laryngotracheal injuries is divided into four parts. Part 1 deals with injuries
to the endolaryngeal soft tissues structures, including the mucosa, vocal cords, and
deep compartments. The ability of CT to demonstrate endolaryngeal edema and hematoma,
vocal cord injuries, subcutaneous emphysema, and aspirated radiopaque foreign bodies
is discussed along with its inability to demonstrate the site of mucosal perforations
or degloving injuries. Part II deals with fractures of the hyoid bone, epiglottis,
and thyroid and cricoid cartilages, while Part III discusses dislocations of the cricoarytenoid
and cricothyroid joints. Finally, Part IV discusses laryngotracheal separation, the
most immediately life-threatening laryngotracheal injury, and the difficulties inherent
in making this diagnosis prospectively by CT.
KEYWORDS
Larynx trauma - neck trauma - neck CT - trauma CT
