Laryngotracheal trauma (LTT) is a rare but clinically important injury that may be missed without a high index of suspicion. Forty patients with LTT admitted to the University of Tennessee, Memphis from 1984 through 1989 were retrospectively reviewed. Twenty-six patients sustained penetrating (P)-LTT and 14 had blunt (B)-LTT. Three patients with P-LTT and one with B-LTT arrived in full arrest. Sixty-five per cent of blunt injuries, and 100 per cent of penetrating injuries had neck tenderness or overlying evidence of trauma. A combination of angiography, barium swallow, esophagoscopy, CT scan, bronchoscopy and/or laryngoscopy was used for evaluation, depending on the mechanism. Twenty-two of the 23 surviving P-LTT patients underwent surgery; 11 (50%) had concomitant esophageal injury. All patients with complications from P-LTT were in the group with esophageal injury. B-LTT was classified as either mild5, moderate3, or severe6; all 6 severely injured patients had preoperative airway compromise. All complications of B-LTT occurred in the severely injured group. The following conclusions were reached: LTT usually presents with symptoms and/or signs, but they may be minimal and nonspecific. Emergency tracheostomy should not be delayed if ventilation is compromised. Concomitant esophageal injuries are frequent in P-LTT and predispose the patient to postoperative complications. Airway compromise frequently correlates with severity of injury in B-LTT and these patients are also at high risk for complications.