Near-Complete Supraglottic Transection of the Larynx after a Motorbike Accident

Severe laryngeal trauma is rare in the civilian environment and requires appropriate and timely surgical intervention. We report a case from Sydney, Australia, which was managed with open reduction and internal fixation of the larynx with resorbable plates. The use of resorbable plates for operative fixation of the larynx has rarely been reported in literature but may be a viable alternative. 1. Introduction Laryngeal trauma is a rare injury in the civilian environment but can cause significant mortality and morbidity without timely, appropriate management. We report a case of a near-complete supraglottic transection of the larynx after a motorbike accident and discuss its surgical management. 2. Case History A 26-year-old male presented to a tertiary referral hospital in Sydney, Australia, following a motorbike accident, during which the patient suffered an impact to the anterior neck from the upper horizontal pillar of an opened car door. On arrival, the patient was able to ventilate through the exposed lumen with minimal respiratory distress, and soft oral phonation was achieved by covering the wound. Initial assessment revealed a significant transverse penetrating injury with near-complete transection of the larynx between the hyoid bone and thyroid cartilage (Figure 1), with the cranial border of the thyroid cartilage evident protruding into the base of the wound. The great vessels of the neck were uninjured. Figure 1: The laryngeal injury which was obvious at the time of initial presentation is demonstrated. Decision was made to immediately proceed to theatre to secure the airway. Rapid sequence induction was initiated, and the patient was intubated using a reinforced size 8 endotracheal tube inserted via the open wound (Figure 2). The patient was then reintubated orally. Figure 2: The patient was initially intubated via the open wound. Intraoperative examination revealed an oblique, comminuted fracture of the anterior thyroid cartilage extending from the laryngeal incisure to the lower left margin, with muscular and mucosal transection through infrahyoid muscles. The median thyrohyoid ligament and thyrohyoid membrane were divided with extension to the posterior laryngeal wall, corresponding to a Schaefer-Fuhrman type IV laryngeal injury. The anterior commissure of the glottis was separated in the midline. There was complete avulsion of the thyroepiglottic ligament at the petiole. Tracheostomy was first performed through a separate caudal incision. The comminuted nature of the laryngeal fracture required fixation with a resorbable tripolymer plate