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Laryngeal trauma
In laryngeal trauma the first question is the airway: a stable patient has flexible laryngoscopy and CT, and an unstable patient receives a surgical airway (tracheostomy under local anaesthesia) — not a blind intubation attempt that can turn a partial tear into complete separation; the injury is classified by Schaefer and repaired, when needed, within 24 to 48 hours.
Why it matters in the exam
Mechanisms: blunt impact (road traffic accident, seat belt, "clothesline", strangulation or hanging) or penetrating injury. Signs: hoarseness, stridor, pain on swallowing, haemoptysis, subcutaneous emphysema and loss of the thyroid cartilage prominence. In a stable patient the first test is flexible laryngoscopy, and the preferred imaging is thin-slice CT of the larynx — it shows cartilage fractures and displacement. Even a patient who looks stable with hoarseness or pain after neck trauma needs assessment, because oedema can worsen over the following hours.
Schaefer classification: group I — small haematoma or minor lacerations without fracture; II — oedema, non-displaced fracture and mucosal tear without exposed cartilage; III — massive oedema, tears with exposed cartilage, displaced fractures or an immobile vocal fold; IV — as III, with anterior commissure injury or unstable fractures; V — laryngotracheal separation. Group I is treated conservatively: humidified air, voice rest, head elevation, anti-reflux treatment and sometimes steroids, with follow-up. Groups III to IV require tracheostomy and surgical exploration with mucosal repair and fracture fixation; in IV a stent is sometimes placed.
Cricothyroidotomy is unsuitable when laryngotracheal separation is suspected, because the injury lies exactly there. Early repair — within 24 to 48 hours — improves voice outcomes and reduces stenosis. After hanging, the cervical spine, the neck vessels and the neurological state are also assessed. A penetrating neck injury also requires oesophageal and vascular injury to be excluded.
Key points
- The airway comes first.
- Stable: laryngoscopy and CT.
- Unstable: tracheostomy under local anaesthesia.
- Schaefer I conservative; III to IV surgery.
- Repair within 24 to 48 hours.
Summary table
| Schaefer group | Finding | Treatment |
|---|---|---|
| I | Small haematoma, no fracture | Conservative: humidity, voice rest, follow-up |
| II | Oedema, non-displaced fracture, no exposed cartilage | Close observation or tracheostomy and endoscopy |
| III | Massive oedema, exposed cartilage, displaced fracture, immobile fold | Tracheostomy and surgical exploration |
| IV | As III with anterior commissure injury | Tracheostomy, repair and sometimes a stent |
| V | Laryngotracheal separation | Urgent tracheostomy and repair |
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Sources
- Schaefer SD. Management of acute blunt and penetrating external laryngeal trauma, 2014 — Classification and treatment
- ATLS: Advanced Trauma Life Support Student Course Manual, 10th edition (2018) — Airway and neck trauma
- Cummings Otolaryngology: Head and Neck Surgery, 7th edition (2021) — Laryngeal and tracheal trauma
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.