Computed tomographic diagnosis of traumatic laryngeal injuries

Fifty-seven consecutive patients with acute laryngeal trauma were referred to our emergency department for evaluation. On the basis of the physical examination findings, 40 (70%) of the patients were excluded from further diagnostic evaluation, 2 (4%) patients with penetrating laryngeal trauma underwent immediate surgery, and 15 (26%) patients with blunt trauma were submitted to laryngoscopy and computed tomography (CT). Findings at CT and laryngoscopy were independently evaluated before classifying patients as having grade 1 or grade 2 lesions: grade I included the presence of minor injuries (mild edema, laryngeal hematomas, or minor laryngeal lacerations); grade 2 included evidence of major injuries (subcutaneous emphysema, mucosal disruption, and/or laryngeal fractures without exposed cartilages). According to the CT findings, 11 of 15 (73%) patients were classified as having grade 1 and 4 of 15 (27%) patients as having grade 2 injuries. At laryngoscopy, owing to local bleeding, findings were nondiagnostic in 2 of 15 (13%) patients (classified as grade 1 at CT); furthermore, 11 of 15 (73%) patients were classified as grade 1 injuries: of these 11 patients, 9 had clinical follow- up confirmation of appropriate grading of lesions, whereas 2 cases were proved to be underestimated by laryngoscopy owing to the absence of indirect signs of laryngeal skeleton fractures. Finally, in 2 of 15 (13%) patients, findings at laryngoscopy were consistent with grade 2 injuries. CT is the imaging modality of choice in cases of laryngeal injuries, giving valuable support to the physical findings and providing useful information for planning appropriate treatment.