Introduction: Laryngeal mucosal perforation is a frequent event whose diagnosis is based on clinical, laryngoscopic and CT findings.
Material and methods: We reviewed retrospectively the data relative to 77 patients with blunt neck trauma examined October, 1991, to June, 1996. All patients were submitted to clinical examination first and then, to fiberoptic laryngoscopy and CT on the clinician's request.
Results: Nineteen patients with small skin tears and no signs and symptoms of laryngeal injury were immediately discharged while 37 patients were submitted to surgery: 17 to remove cerebral hematomas, 13 to stabilize cervical fractures and 7 because of hemodynamic instability. Twenty-one patients underwent laryngoscopy which showed laryngeal lesions in 12: wide mucosal disruption with fractures of the laryngeal skeleton and hematomas were observed, which needed immediate surgery with airway reconstruction in 7 cases; small mucosal tears and hematomas were seen and laryngeal CT examination was requested to establish the possibility of conservative management in 5 cases which are the subject of the present study. Laryngoscopic findings were: 1) laryngeal mucosal tear near the thyroid cartilage with quadrangular membrane edema, 2) thyroid mucosal tear with thyrohyoid muscle edema, 3) edema of the left false vocal cord, 4) edema of the oblique arytenoid muscle, 5) posterior cricothyroid muscle edema with bleeding near the cricoid ring. In cases 1, 2 and 3 CT showed gas bubbles in the paralaryngeal space, where laryngeal tear or edema were indicated at laryngoscopy.
Discussion: CT does show the "gas bubbles" in the paralaryngeal space when laryngoscopy cannot distinguish laryngeal mucosal perforation from tear.
Conclusions: The routine use of CT in minor, laryngeal injuries in the emergency department is useful for the early diagnosis of laryngeal mucosal perforation.