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CT-based assessment of laryngeal fracture patterns and associated soft tissue abnormality

  • Head and Neck
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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.

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Abbreviations

CT:

Computed tomography

CTA:

Computed tomography angiogram

MDCT:

Multidetector-row CT

PACS:

Picture archiving and communication systems

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Karen Buch

  2. Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA

    Koji Takumi & Osamu Sakai

  3. Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

    Koji Takumi

  4. Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA

    Hugh D. Curtin

  5. Department of Otolaryngology – Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA

    Osamu Sakai

  6. Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA

    Osamu Sakai

Authors
  1. Karen Buch
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  2. Koji Takumi
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  3. Hugh D. Curtin
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  4. Osamu Sakai
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Corresponding author

Correspondence to Osamu Sakai.

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Guarantor

The scientific guarantor of this publication is Osamu Sakai.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• multicenter study

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Buch, K., Takumi, K., Curtin, H.D. et al. CT-based assessment of laryngeal fracture patterns and associated soft tissue abnormality. Eur Radiol 31, 5212–5221 (2021). https://doi.org/10.1007/s00330-020-07548-4

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  • DOI: https://doi.org/10.1007/s00330-020-07548-4

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