Laryngeal injuries: evaluation with CT of nine patients and comparison with endoscopic studies

The aim of the present study was to evaluate the utility of computed tomography (CT) in moderate and severe laryngeal injuries (LI). For this purpose, a retrospective study of nine patients with LI was carried out in which CT was performed prior to any treatment, with the exception of airway clearance, for comparison with endoscopic studies. Endoscopic studies were available for six of the nine patients. The injury was classified as very severe in three patients, severe in two, moderate in another three and mild in one. The different etiologies were direct impact in 3 cases, penetrating wound in 4 cases and iatrogenic causes in the remaining two. The predominant endolaryngeal lesions were edema/hematoma (all cases) and cartilage fracture (66%) with the thyroid cartilage being that most frequently involved (66%), followed by the cricoid cartilage (22%). The extralaryngeal lesions consisted of hematomas, contusions and tissue laceration. Three patients received conservative treatment, while the rest underwent surgical repair of the larynx. The prognosis of the patients was most closely correlated with cartilage damage, especially the involvement of the cricoid cartilage,and the timing of treatment. CT provides sufficient fundamental information alone, and is sometimes the only diagnostic method capable of: 1) revealing the existence of significant intra-or extralaryngeal injuries, 2) determining their extension and 3) predicting which LI will benefit from surgical treatment to differentiate those that should be treated conservatively, although an endoscopic study in necessary to define the nature of certain endolaryngeal lesions. In this study, however, the lesions that CT failed to disclose would not have modified the treatment. (Author) 23 refs