Closed Traumatic Laryngeal Injury With Partial Tracheal Rupture: A Case Report and Literature Review.

Blunt neck trauma may cause major laryngotracheal injury, a rare but potentially life-threatening condition in which early airway decision-making is critical. This report aims to describe the clinical course of a patient with closed traumatic laryngeal injury with partial tracheal rupture and to propose a practical airway management algorithm for similar high-risk scenarios. A 61-year-old man sustained blunt head, neck, and chest trauma after a ground-level fall. He presented with hoarseness, intermittent hemoptysis, mild mixed dyspnea, and extensive subcutaneous emphysema of the neck and chest. Computed tomography (CT) demonstrated subglottic tracheal deformity/narrowing, suspected cricoid cartilage fracture, and pneumomediastinum, raising concern for major laryngotracheal injury with partial tracheal rupture. Because of the anticipated difficulty and hazards of conventional endotracheal intubation in distorted airway anatomy, emergency tracheostomy was performed under local anesthesia. This was followed by staged tracheoplasty with placement of a silicone laryngotracheal mold. The patient was successfully decannulated at two weeks. On postoperative day 18, dynamic flexible laryngoscopy demonstrated reduced bilateral vocal fold mobility with incomplete glottic closure, while the airway remained patent and the patient had no respiratory compromise. This case highlights the importance of early recognition of major airway injury after blunt neck trauma, prompt multidisciplinary assessment, and timely establishment of a surgical airway when oral intubation is predicted to be unsafe. Based on this experience, we propose a practical airway management algorithm that emphasizes early transition to a surgical airway and definitive reconstruction in selected patients with suspected major laryngotracheal disruption.