Optimal Timing of Surgical Intervention Following Laryngeal Trauma

What is the optimal timing of surgical intervention following adult laryngeal trauma?

Background: Airway management is paramount in cases of adult laryngeal trauma. Even with a secured airway, however, laryngeal lacerations and fractures require further therapeutic interventions. While some propose immediate surgical intervention, others suggest a three- to five-day waiting period prior to operative intervention.

Study design: Multi-institution database analysis.

Setting: Division of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles.

Synopsis: Researchers used the National Trauma Data Bank to obtain 564 laryngeal trauma diagnoses in adults from 2001 through 2005, along with the degree of injury severity and the surgical interventions provided. Descriptive and analytic statistics were applied, comparing surgical groups. The authors noted that laryngeal trauma is frequently encountered with multi-organ injury, so that optimal management of the larynx is typically complicated by concurrent treatments. Trauma severity, placement of tracheostomy and delayed tracheostomy placement were associated with increased ventilator dependence, intensive care unit stay and overall hospital admission duration. Significant associations were noted between tracheostomy performed within 24 hours and shortened ICU stay and overall hospital stay.

Bottom line: Surgical airway should be placed within 24 hours of presentation to improve the overall hospital course.

Citation: Mendelsohn AH, Sidell DR, Berke GS, et al. Optimal timing of surgical intervention following adult laryngeal trauma. Laryngoscope. 2011;121(10):2122-2127.

—Reviewed by Sue Pondrom