A contemporary review of voice and airway after laryngeal trauma in children.

OBJECTIVES/HYPOTHESIS: To discuss three cases of pediatric laryngeal trauma that highlight current techniques in diagnosis and treatment of the voice following laryngeal trauma. To examine the diagnostic utility of "chip tip" video laryngoscopy and to explore the current uses for open, endoscopic, or combined approaches within the context of these cases.

STUDY DESIGN: Case series with review of contemporary techniques.

METHODS: A case series of three children who sustained laryngeal trauma is presented. Ages range from 6 weeks to 17 years. The diagnostic evaluation and treatment strategies are reviewed with a focus on contemporary techniques.

RESULTS: A 15-year-old boy who sustained blunt neck trauma was diagnosed with a vocal fold avulsion on video laryngoscopy with digital image processing and a significant mucosal tear with exposure of the paraglottic space on direct laryngoscopy. Anatomical reapproximation required a combined open and endoscopic repair. A 17-year-old football player developed a glottic hematoma after blunt cervical trauma. This was managed conservatively with serial chip tip video laryngoscopy that provided high fidelity images and facilitated proper and timely diagnosis and treatment. A 6-week-old male suffered vocal fold avulsion from a traumatic intubation. Laryngofissure with reattachment of the vocal fold resolved his aspiration and reconstructed the laryngeal anatomy.

CONCLUSIONS: Enhanced imaging via chip tip video laryngoscopy, compared to conventional fiberoptic endoscopy, might provide additional diagnostic information in pediatric patients with laryngeal trauma. Additionally, there could be a role for video strobolaryngoscopy in selected laryngeal trauma patients. Open, endoscopic, and combined approaches could be used to optimize voice and swallowing outcomes in pediatric laryngeal trauma.