Paediatric Blunt Laryngeal Trauma: A Review

Abstract

Paediatric blunt laryngeal trauma is infrequently encountered; however, it can have fatal consequences if managed inappropriately. This paper provides an overview of the relatively limited literature available on the subject and highlights current controversies and recent advances in the management of these injuries.

Airway management in laryngotracheal injuries from blunt neck trauma in children

“…Compared to adults, children are less likely to be involved in motor vehicle accidents and violent altercations. Anatomically the pediatric larynx is located higher in the neck, allowing the mandibular arch to protect the larynx . Additionally, the laryngeal cartilages in children are more pliable, decreasing the likelihood of laryngeal fractures.…”

“…Additionally, the laryngeal cartilages in children are more pliable, decreasing the likelihood of laryngeal fractures. However, the narrower lumen of the pediatric airway and loose attachment of mucosa to underlying laryngeal cartilages in children increases the risk of soft tissue damage, edema, and hematoma formation resulting in airway obstruction .…”

“…The mechanisms of laryngotracheal injuries from blunt neck trauma include : Rapid deceleration of a motor vehicle, causing an unrestrained passenger to be thrown forward, usually with the head extended and the neck collides with the steering wheel or dashboard, crushing the laryngeal and/or tracheal cartilages against the cervical vertebrae. Clothesline injuries to the neck while riding motorcycles, all‐terrain vehicles, or snowmobiles when the rider strikes a stationary object such as a wire fence or tree limb. Clothesline injuries can also occur in high contact sports and martial arts. Direct trauma to the neck from interpersonal violence (direct blows using fists, feet, or blunt weapons). Strangulation from hanging, ligature suffocation, or manual choking. Blunt chest trauma causing antero‐posterior compression, resulting in sudden increase in transverse diameter of the chest, lateral traction on the trachea, and linear rupture. …”

“…The etiology of blunt neck trauma in children is age dependent. In younger children, common etiologies include falls onto furniture or bicycle handlebars with the neck extended, causing compression of the larynx and trachea against the vertebral column . Among adolescents, the etiology is similar to adults and includes motor vehicle accidents, sports injuries, and clothesline injuries .…”

“…A detailed history of the mechanism of injury along with a description and duration of symptoms must be obtained. Presenting symptoms are varied and range from mild dysphonia and hoarseness of voice to stridor and acute respiratory distress . Other symptoms include dyspnea, dysphagia, anterior neck pain, hemoptysis, and cough.…”