Overview
An open fracture of the larynx and trachea involves a disruption of the integrity of these upper airway structures with external communication. This is a severe injury requiring prompt assessment and management to ensure airway patency and prevent complications.Diagnosis
Diagnosis is typically made clinically based on the mechanism of injury and physical examination findings, including visible trauma, palpable crepitus, and signs of airway compromise 1.
Imaging, such as CT scans, may be used to further delineate the extent of injury and associated structures 1.Management
Immediate management focuses on securing the airway, which may involve endotracheal intubation or, in severe cases, emergent cricothyroidotomy or tracheostomy 1.
Surgical exploration and repair are often necessary to address the fracture and any associated soft tissue or cartilaginous damage 1.
Prophylactic antibiotics are generally recommended to prevent infection 1.Key Recommendations
Secure the airway promptly in patients with open laryngeal or tracheal fractures, considering intubation, cricothyroidotomy, or tracheostomy as indicated by the severity of airway compromise 1. (Evidence: Moderate)
Administer prophylactic antibiotics to reduce the risk of infection following open laryngeal or tracheal fractures 1. (Evidence: Moderate)
Surgical intervention is typically required for open laryngeal and tracheal fractures to facilitate repair and optimize healing 1. (Evidence: Moderate)References
1 Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R et al.. Guidelines for the management of tracheal intubation in critically ill adults. British journal of anaesthesia 2018. link