Current state of causes, pathophysiology, and treatment methods of laryngeal and tracheal trauma in Japan

Abstract

Objective

Appropriately managing laryngeal and tracheal trauma is important. However, coherent reports on this appropriate management are limited and include inconsistent treatment methods. We sought to survey the causes, pathophysiology, and treatment methods of laryngeal and tracheal trauma in Japan. Furthermore, we aimed to propose a classification and treatment guidelines that enable consistent evaluation and treatment regardless of the evaluator or facility.

Methods

Based on a survey conducted at facilities certified by the Japan Broncho-Esophagological Society, we retrospectively evaluated 86 patients.

Results

There were 84 cases of laryngeal trauma, of which 2 cases were complicated by tracheal trauma. Tracheal trauma was reported in 2 cases. The median age was 35.5 years; 68 (81 %) were male patients. The most common mechanism was sports-related laryngeal trauma (39 %). Airway management was performed in 11 patients (13 %), including tracheostomy in 9 patients. Laryngeal fractures were observed in 29 (35 %) patients, with reduction being performed in 12 patients. Based on clinical symptoms, the severity was classified according to the classification proposed by Umeno et al. [1]: group 1, 24 cases (28 %); group 2, 8 cases (9 %); group 3, 19 cases (22 %); group 4, 2 cases (2 %); unclassified, 13 cases (14 %); and no abnormalities, 21 cases (24 %).

Conclusions

We proposed Severity Classification and Treatment Guidelines for laryngeal trauma that could only evaluate the presence or absence of four clinical findings. Using this classification, the severity of almost all cases could be classified; treatment plans could be determined accordingly. Furthermore, the addition of comprehensive judgment using phonatory ability tests and acoustic analysis would enable consistent evaluation and treatment that are unlikely to differ among evaluators and institutions, which is expected to help establishing treatment of blunt laryngeal trauma in the future.