A case series of penetrating laryngeal trauma managed without tracheotomy

Background: This study is a case series that involves two patients with penetrating laryngeal trauma managed without tracheotomy. Laryngeal trauma is a rare but potentially life-threatening injury. Injuries involving Zone II of the neck are classically managed with a tracheotomy. Our aim is to illustrate that in select cases Zone II laryngeal trauma can be surgically managed conservatively without tracheotomy or stenting. Case Presentation: The two patients presented in this study both had penetrating trauma to the anterior neck in zone 2. While they were not in distress, both had subcutaneous air, loss of laryngeal prominence on exam, and fracture of the thyroid cartilage. In both cases the airway was secured via awake fiberoptic intubation, neck exploration and fracture fixation performed using sutures and microplates via a single incision through an extension of the original traumatic wound. Esophagoscopy was performed at the time of exploration and a brief period of endotracheal intubation was used to manage the airway, avoiding the use of laryngeal stenting. Conclusion: In select cases zone II/Schaefer-Fuhrman group 3 laryngeal trauma can be surgically managed without tracheotomy or stenting, without compromising the basic tenets of airway management and patient safety. The above management led to a shorter hospital stay than advocated for in the literature and improved cosmetic outcome without any adverse voice or swallowing outcomes.