Maxillofacial Fractures Associated with Laryngeal Injury: Red Flag Signs and Symptoms that Should not be Overlooked

Abstract

Background: Maxillofacial fractures with associated laryngeal injuries put both the quality and maintenance of life in jeopardy. Their symptoms vary widely from distinct airway obstruction to minor or subtle symptoms that often go unnoticed. Overlooking these clinical manifestations, however, may result in fatal outcomes. In this study, we review the incidence, management and outcome of these patients. We also tried to determine the risk factors of this life-threatening condition.

Methods: A retrospective review and analysis of medical records from 2008/8 to 2013/8 was conducted. We presented a case series (n=8) of these patients and applied propensity score matching for further statistical analysis.

Results: When comparing patients of maxillofacial fractures with laryngeal injuries to patients with only maxillofacial fractures and no laryngeal injuries (Groups C1 and C2), subcutaneous emphysema (87.5% vs. 8.3%, p<0.001), neck pain (87.5% vs. 12.5%, p<0.001), dyspnea (62.5% vs.8.3%, p=0.005), thoracic trauma (62.5% vs. 8.3%, p=0.005), hoarseness (50% vs. 4.2%, p=0.009) and neck swelling (50% vs. 4.2%, p=0.009) all showed significant differences.  The lengths of both hospital stay and ICU stay were also longer for patients with laryngeal traumas (p=0.029 and 0.012, respectively). Patients with high grade laryngeal injuries (III and IV) had relatively poor outcomes.

Conclusions: Laryngeal injuries should be highly suspected in maxillofacial fracture trauma victims presented with aforementioned symptoms or signs and possible uneven clinical course may be expected. Prompt diagnostic actions such as palpation of cervical region, neck CT and flexible bronchoscopes are recommended. All managements should be individualized.