Karen Buch1, Koji Takumi2,3, Hugh D Curtin4, Osamu Sakai5,6,7. 1. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 2. Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA. 3. Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. 4. Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA. 5. Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA. osamu.sakai@bmc.org. 6. Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. osamu.sakai@bmc.org. 7. Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA. osamu.sakai@bmc.org.
Abstract
OBJECTIVE: Acute traumatic injuries to the larynx, including fractures of the hyoid bone, cricoid, and thyroid cartilage, are uncommon injuries. The purpose of this study was to assess fracture and soft tissue patterns associated with laryngeal trauma. METHODS: This was a retrospective review of patients with laryngeal fractures who presented to two level I trauma centers and underwent CT imaging. Imaging findings, including fractures of the cartilaginous structures of the larynx and hyoid bone, and soft tissue abnormalities including focal hematoma, edema with non-focal hemorrhage, and additional penetrating injuries were recorded. Frequencies of fracture patterns were recorded. RESULTS: Thyroid cartilage fractures were most frequently observed occurring in 45/55 patients, followed by cricoid fractures in 13/55 patients. Hyoid fractures were encountered in 8/55 patients. Multi-site fractures were observed in 12/55 patients with thyroid-cricoid fractures occurring in 8/12 patients, followed by thyroid-hyoid fractures in 2/12 patients. Most multi-site fractures occurred in association with focal supraglottic hematomas (10/12), supraglottic edema and non-focal hemorrhage (11/12), and focal subglottic hematoma (5/12). All 13 cricoid fractures occurred with either focal supraglottic hematoma (7), focal subglottic hematoma (4), or edema with non-focal hemorrhage (13). CONCLUSIONS: Thyroid cartilage fractures were the most frequently encountered fracture, followed by cricoid cartilage fractures. Cricoid fractures always occurred with soft tissue abnormalities. Recognition of fracture patterns in the setting of laryngeal trauma and associated patterns of soft tissue injury is important for practicing radiologists for early diagnosis of these conditions and reduction of associated morbidity. KEY POINTS: • Acute fractures to the larynx may be isolated fractures or occur as multi-focal fractures. • Thyroid cartilage fractures are the most frequent fractures followed by cricoid cartilage fractures. • Cricoid cartilage fractures always occurred in association with soft tissue abnormalities.
OBJECTIVE: Acute traumatic injuries to the larynx, including fractures of the hyoid bone, cricoid, and thyroid cartilage, are uncommon injuries. The purpose of this study was to assess fracture and soft tissue patterns associated with laryngeal trauma. METHODS: This was a retrospective review of patients with laryngeal fractures who presented to two level I trauma centers and underwent CT imaging. Imaging findings, including fractures of the cartilaginous structures of the larynx and hyoid bone, and soft tissue abnormalities including focal hematoma, edema with non-focal hemorrhage, and additional penetrating injuries were recorded. Frequencies of fracture patterns were recorded. RESULTS: Thyroid cartilage fractures were most frequently observed occurring in 45/55 patients, followed by cricoid fractures in 13/55 patients. Hyoid fractures were encountered in 8/55 patients. Multi-site fractures were observed in 12/55 patients with thyroid-cricoid fractures occurring in 8/12 patients, followed by thyroid-hyoid fractures in 2/12 patients. Most multi-site fractures occurred in association with focal supraglottic hematomas (10/12), supraglottic edema and non-focal hemorrhage (11/12), and focal subglottic hematoma (5/12). All 13 cricoid fractures occurred with either focal supraglottic hematoma (7), focal subglottic hematoma (4), or edema with non-focal hemorrhage (13). CONCLUSIONS: Thyroid cartilage fractures were the most frequently encountered fracture, followed by cricoid cartilage fractures. Cricoid fractures always occurred with soft tissue abnormalities. Recognition of fracture patterns in the setting of laryngeal trauma and associated patterns of soft tissue injury is important for practicing radiologists for early diagnosis of these conditions and reduction of associated morbidity. KEY POINTS: • Acute fractures to the larynx may be isolated fractures or occur as multi-focal fractures. • Thyroid cartilage fractures are the most frequent fractures followed by cricoid cartilage fractures. • Cricoid cartilage fractures always occurred in association with soft tissue abnormalities.
Authors: Danice K Eaton; Laura Kann; Steve Kinchen; Shari Shanklin; Katherine H Flint; Joseph Hawkins; William A Harris; Richard Lowry; Tim McManus; David Chyen; Lisa Whittle; Connie Lim; Howell Wechsler Journal: MMWR Surveill Summ Date: 2012-06-08