Laryngeal fractures occur mainly in the context of cervical trauma, hanging, or strangulation. Nontraumatic laryngeal fractures are rare and there are few reports in the literature. We present two cases of nontraumatic laryngeal fractures evaluated in our service.
Laryngeal fractures occur mainly from direct trauma, suicide by hanging, or strangulation [
A 36-year-old male patient presented to the emergency department with severe odynophagia and dysphonia. The patient had no significant prior medical or surgical history, except for a traffic accident 12 years ago resulting in complicated abdominal trauma with no cervical lesions. He reported that the symptoms started two hours ago and had an abrupt onset after a contained sneeze in a work meeting. He reports that after the sneeze he felt a crack in the neck and after that the symptomatology was installed.
It was evaluated in the otolaryngology department, on physical examination, that the oropharynx and neck examination revealed no tonsillar erythema or edema but diffuse tenderness over the thyroid cartilage without subcutaneous emphysema. A nasopharyngolaryngoscopy was performed, in which a left vocal fold hematoma was evidenced with normal vocal fold movement. The study was completed with a computed tomography, observing a left, complete, nondisplaced parasagittal fracture that compromises thyroid cartilage (Figure
Computed tomography, bone window. Left, complete, and nondisplaced parasagittal fracture that compromises thyroid cartilage (red arrows). (a) Axial view; (b) coronal view; (c) 3D bone reconstruction.
It was managed with oral corticosteroids for 7 days and vocal rest for 15 days, achieving complete resolution of symptoms in 21 days. At the 5-year follow-up, the patient has not had another episode.
A 32-year-old male patient with no significant prior medical or surgical history presented to the otolaryngology service with odynophagia, dysphagia, and dysphonia. The symptoms started six days ago and had an abrupt onset after swallowing and bending over during dinner. He reports that after that he felt a crack in the neck and then the symptomatology was gradually installed.
On physical examination the patient had pain over the thyroid cartilage without subcutaneous emphysema. A nasopharyngolaryngoscopy was performed, in which supraglottic edema with normal vocal fold movement was evidenced. The study was completed with a computed tomography that showed an anterior, left parasagittal, complete nondisplaced thyroid cartilage fracture (Figure
Computed tomography, bone window. Left, complete, and nondisplaced parasagittal fracture that compromises thyroid cartilage (red arrows). (a) Axial view; (b) coronal view; (c) 3D bone reconstruction.
It was managed with nonsteroidal anti-inflammatory drugs and vocal rest for 5 days, achieving complete resolution of symptoms in 10 days. The patient has not had another episode at the 3-month follow-up.
Nontraumatic laryngeal fractures are a rare pathology, with only 4 cases published in the literature, all of which are isolated case reports [
All the published cases correspond to men without a prior morbid or surgical history with a mean age of 40 years (range 29–47 years) [
Its etiology is still unknown. A congenital anomaly of the laryngeal cartilage is proposed, associated with an alteration in the mineralization and ossification, producing sites of focal weakness that predisposes them to develop fractures [
Clinically, the patients presented with the symptomatic triad of dysphonia, dysphagia, and odynophagia initiated after a precipitating event. The precipitating events described in the literature are sneezing attacks in two cases [
It is fundamental to perform a nasopharyngolaryngoscopy and a neck computed tomography to confirm the diagnosis [
Symptoms, signs, and endoscopic and imaging findings among patients with nontraumatic laryngeal fracture.
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Age/sex | 44/male | 29/male | 41/male | 47/male | 36/male | 32/male |
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Precipitating event | Sneeze | Sneeze | Cough | Cough | Sneeze | Swallowing and bending over |
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Symptoms/signs | Odynophagia, dysphagia, dysphonia. |
Odynophagia and dysphonia |
Odynophagia, dysphagia, dysphonia. |
Odynophagia, dysphagia, dysphonia. |
Odynophagia and dysphonia. |
Odynophagia, dysphagia, dysphonia. |
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Laryngoscopy | Supraglottic edema, normal vocal fold movement | Right true vocal fold edema, mucosal hematoma, normal vocal fold movement | Left true vocal fold hematoma, left ventricular edema, normal vocal fold movement | Edema of right aryepiglottic fold and both arytenoids, normal glottis, normal vocal fold movement | Left vocal fold hematoma, normal vocal fold movement | Supraglottic edema, normal vocal fold movement |
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Computed tomography (CT) | Not available | Nondisplaced anterior fracture, subcutaneous air | Mildly displaced anterior fracture, subcutaneous air | Mildly displaced anterior fracture, subcutaneous air. Phlegmon formation |
Left parasagittal, complete nondisplaced thyroid cartilage fracture | Left parasagittal, complete nondisplaced thyroid cartilage fracture |
The treatment basically consists of observation, anti-inflammatory, and vocal rest, achieving complete resolution of the symptoms between 14 and 21 days. A single case received antibiotics because it was associated with a cervical phlegmon. As all fractures were not displaced or mildly displaced, none required reduction with titanium plates [
Nontraumatic laryngeal fracture is a rare condition, affecting men between the third and fifth decade of life, which should be suspected in patients with the symptomatic triad of odynophagia, dysphagia, and dysphonia abruptly initiated after a precipitating event such as coughing or sneezing. Clinical suspicion, endoscopy, and imaging are fundamental for diagnosis.
The authors declare that there are no actual or potential conflicts of interest in relation to this article.