Sign Up Submit Enquiry

Case Report: Comminuted Laryngeal Fracture Following Penetrating Neck Trauma From a Bull Horn—A Surgical Challenge

Home Case Report: Comminuted Laryngeal Fracture Following Penetrating Neck Trauma From a Bull Horn—A Surgical Challenge

Related Articles

Contact us

Article Content

Abstract

Introduction

Laryngeal fractures are rare but critical injuries that require prompt evaluation and intervention to prevent long-term complications involving airway compromise, voice disturbance, and dysphagia. These injuries become particularly complex in cases of penetrating neck trauma.

Case Presentation

A 26-year-old Indian male sustained a comminuted and displaced fracture of the thyroid cartilage and hyoid bone following a bull horn–inflicted penetrating neck injury. The trauma resulted in an anterior commissure defect, extensive soft tissue disruption including torn strap muscles and thyrohyoid membrane, and vascular injury. The patient presented with hemorrhage, respiratory distress in the supine position, hoarseness, and subcutaneous emphysema. Airway stabilization was achieved with an early tracheostomy after confirming cervical spine integrity. Surgical management included open reduction and internal fixation using absorbable sutures, vascular control, and primary repair of torn membranes and musculature. A corrugated drain was placed and removed after 48 h. Oral feeding was cautiously initiated at 24 h following clinical and endoscopic evaluation. Three months post-surgery, the patient showed near-normal breathing and swallowing, and his voice had improved with speech therapy. CT imaging and video laryngoscopy were instrumental in grading the injury and guiding the surgical approach.

Conclusion

Early airway stabilization, imaging-based grading of injury, timely surgical repair, and structured rehabilitation are essential for favorable outcomes in penetrating laryngeal trauma.

Explore related subjects

Discover the latest articles and news from researchers in related subjects, suggested using machine learning.

  • Dental trauma
  • Head and Neck Surgery
  • Surgery
  • Trauma Surgery
  • Wounding
  • Fracture Repair

Data Availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Code Availability

The code used in this study can be requested. Access to the code is limited due to journal policies and patient privacy regulations. Interested individuals should contact the corresponding author for more details.

References

  1. Schaefer SD. The acute management of external laryngeal trauma. A 27-year experience. Arch Otolaryngol Head Neck Surg. 1992;118:598–604.

    CAS PubMed Google Scholar

  2. Mendelsohn AH, Sidell DR, Berke GS, John MS. Optimal timing of surgical intervention following adult laryngeal trauma. Laryngoscope. 2011;121:2122–7.

    PubMed Google Scholar

  3. Jain S, Singh P, Gupta M, Kamble B, Phatak SS. Comminuted laryngeal fracture following blunt trauma: a need for strict legislation on roads! Ann Maxillofac Surg. 2017;7(1):124–8. https://doi.org/10.4103/ams.ams_60_15.

    Article PubMed PubMed Central Google Scholar

  4. Munjal M, Kaur J, Rishi P, Singh H, Tuli N, Munjal S. Managing laryngotracheal trauma: 3 year experience at a tertiary hospital in North India. Int J Otorhinolaryngol Head Neck Surg. 2020;6:459–65.

    Google Scholar

  5. Gussack GS, Jurkovich GJ, Luterman A. Laryngotracheal trauma: a protocol approach to a rare injury. Laryngoscope. 1986;96:660–5.

    CAS PubMed Google Scholar

  6. Schaefer N, Griffin A, Gerhardy B, Gochee P. Early recognition and management of laryngeal fracture: a case report. Ochsner J. 2014;14(2):264–5.

    PubMed PubMed Central Google Scholar

  7. Becker M, Leuchter I, Platon A, Becker CD, Dulguerov P, Varoquaux A. Imaging of laryngeal trauma. Eur J Radiol. 2014;83(1):142–54. https://doi.org/10.1016/j.ejrad.2013.10.021.

    Article PubMed Google Scholar

  8. Roon AJ, Christensen N. Evaluation and treatment of penetrating cervical injuries. J Trauma. 1979;19:391–7.

    CAS PubMed Google Scholar

  9. Spahn DR, Bouillon B, Cerny V, et al. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care. 2013;17:R76. https://doi.org/10.1186/cc12685.

    Article PubMed PubMed Central Google Scholar

  10. Hicham A, Ayman EF, Karim K, Mounir H, Nabil T, Ali E, Brahim Z. Diagnosis and management of laryngeal fracture: a case report. Int J Otorhinolaryngol Head Neck Surg 2017. https://doi.org/10.18203/issn.2454-5929.ijohns20174098.

  11. Lee WT, Eliashar R, Eliachar I. Acute external laryngotracheal trauma: diagnosis and management. Ear Nose Throat J. 2006;85(3):179–84.

    PubMed Google Scholar

  12. Advanced Trauma Life Support for Doctors (ATLS®). Student course manual. 8th ed. American College of Surgeons Committee on Trauma; 2008.

  13. Bent JP 3rd, Silver JR, Porubsky ES. Acute laryngeal trauma: a review of 77 patients. Otolaryngol Head Neck Surg. 1993;109(3 Pt 1):441–9. https://doi.org/10.1177/019459989310900309.

    Article PubMed Google Scholar

  14. Armstrong WB, Netterville JL. Anatomy of the larynx, trachea, and bronchi. Otolaryngol Clin North Am. 1995;28:685–99.

    CAS PubMed Google Scholar

  15. Jalisi S, Zoccoli M. Management of laryngeal fractures – a 10-year experience. J Voice. 2011;25:473–9.

    PubMed Google Scholar

  16. Bailey H. Surgery of modern warfare. 3rd ed. Baltimore: Williams & Wilkins; 1944. p. 674.

    Google Scholar

  17. Fogelman MJ, Stewart RD. Penetrating wounds of the neck. Am J Surg. 1956;91:391–3.

    Google Scholar

  18. Stone HH, Callahan GS. Soft tissue injuries of the neck. Surg Gynecol Obstet. 1963;117:745.

    CAS PubMed Google Scholar

  19. Demetriades D, Charalambides D, Lakhoo M. Physical examination and selective conservative management in patients with penetrating injuries of the neck. Br J Surg. 1993;80:1534–6.

    CAS PubMed Google Scholar

  20. Thoma M, Navsaria PH, Edu S, Nicol AJ. Analysis of 203 patients with penetrating neck injuries. World J Surg. 2008;32:2716–23.

    PubMed Google Scholar

  21. Van Waes OJ, Cheriex K, Navsaria PH, et al. Management of penetrating neck injuries. Br J Surg. 2012;99(1):149–54.

    PubMed Google Scholar

  22. Butler AP, Wood BP, O’Rourke AK, Porubsky ES. Acute external laryngeal trauma: experience with 112 patients. Ann Otol Rhinol Laryngol. 2005;114:361–8.

    PubMed Google Scholar

  23. Hall JR, Reyes HM, Meller JL. Penetrating zone-II neck injuries in children. J Trauma. 1991;31:1614–7.

    CAS PubMed Google Scholar

Acknowledgements

We extend our gratitude to the almighty, family and our colleagues for their support and guidance.

Author information

Authors and Affiliations

  1. Department of ENT, St. Stephen’s Hospital, Delhi, India

    Gautam Kumar Arora, Pankaj Kumar Doloi & Gunjan Verma

Contributions

GKA, the conception of work, acquisition, analysis and drafting.  PKD, critical analysis, approved the version to be published and agreed to be accountable for all aspects of work. GV, data acquisition and drafting, proof reading and agreed to be accountable for all aspects of wok.

Corresponding author

Correspondence to Gautam Kumar Arora.

Ethics declarations

Ethics Approval

Institutional ethics committee clearance was obtained from St. Stephen’s Hospital, Delhi, and the study was carried out in compliance with Ethical Standards.

Consent to Participate and Consent for Publication

Patient informed consent to participate and consent to publish were obtain as this research involves human participants.

Competing interests

The authors declare no competing interests.

Additional information

Supplementary Information

Below is the link to the electronic supplementary material.

About this article

Cite this article

Arora, G.K., Doloi, P.K. & Verma, G. Case Report: Comminuted Laryngeal Fracture Following Penetrating Neck Trauma From a Bull Horn—A Surgical Challenge. SN Compr. Clin. Med. 7, 208 (2025). https://doi.org/10.1007/s42399-025-01999-w

  • Received
  • Revised
  • Accepted
  • Published
  • DOI https://doi.org/10.1007/s42399-025-01999-w

Keywords

  • Laryngeal injury
  • Neck trauma
  • Thyroid cartilage fracture
  • Subcutaneous emphysema
  • Open reduction internal fixation

Copyright © All rights reserved Designed and Developed by Digital Flavers

WhatsApp