A case of tracheal injury with cricoid fracture due to blunt laryngeal trauma.

Background: Laryngeal injuries, especially cricoid cartilage fractures, are rare but may present with airway emergencies, and appropriate airway management is vital. Case presentation: A 24-year-old man admitted to the emergency room with isolated blunt cervical trauma after a motorcycle accident. The patient presented dysphonia, stridor, hemoptysis, cervical subcutaneous emphysema, and increasing respiratory distress. Oral intubation was initially successful, however, worsening subcutaneous emphysema and loss of effective ventilation suggested airway disruption. Emergency cricothyrotomy was performed, but persistent air leakage from the incision site prompted bronchoscopy, which revealed a 7-mm tracheal laceration on the right side of the larynx. The patient was reintubated under bronchoscopy. Computed tomography showed a cricoid cartilage fracture. Tracheostomy and complete repair were performed 2 days after the injury. The cricoid cartilage was fractured fully circumferentially, with the anterior part deviated toward the caudal side, and its deepest part had perforated the right side of the trachea. The cricoid cartilage was repaired, and the tracheal perforation was dilated to create a laryngo-cutaneous fistula. Persistent hoarseness after fistula closure was associated with scar formation of the left vocal fold and arytenoid cartilage dislocation. Although symptoms gradually improved with voice rehabilitation, increased vocal demand after a job change led to thyroplasty 2 years after injury. Conclusion: Cricoid cartilage fractures associated with blunt laryngeal injuries may cause tracheal injury. This case highlights the challenges of managing concurrent cricoid fracture and tracheal injury, where the surgical airway site coincided with the traumatic defect. Rapid decision-making balancing exploration and stabilization was critical.