Surgical Repair of Laryngeal Fractures: A Case Series and Management Algorithm

Sunday, October 12, 2025

1:42 PM - 1:48 PM EDT

Location: 242

Disclosure(s):

Aaron L. Zebolsky, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

C. Burton Wood, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Marion B. Gillespie, MD, MSc:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Anas A. Eid, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Open reduction and internal fixation (ORIF) is required for certain laryngeal fractures; however, there is limited data to inform a management protocol and a paucity of literature on surgical techniques.

Methods: A single-institution case series was performed on patients undergoing laryngeal ORIF between 2021 to 2024. Demographics, trauma data, concomitant injuries, surgical techniques, and outcomes were analyzed. This was used to develop an algorithm for laryngeal ORIF with surgical pearls for various clinical scenarios.

Results: Five patients (80% male, age 16 – 68 years) had thyroid (n=4, 80%) and/or cricoid (n=2, 40%) fractures. ORIF was performed within 24 hours for three (60%) and delayed for two (40%), including one diagnosed outpatient. Thyroid fractures were fixated using titanium cranial mesh with 4mm self-drilling screws or polydioxanone suture (PDS), a double-y plate with 4mm screws, or multiple 2-hole 0.6mm miniplates with 4mm screws. Cricoid fractures were repaired with a 4-hole miniplate, 4mm screws, and PDS or with simple 3-0 Vicryl suture. Four patients (80%) underwent simultaneous tracheostomy. One had complete laryngotracheal separation in which the distal trachea was emergently sutured to the neck as with a laryngectomy. One had panfacial fractures requiring a delayed Le Fort ORIF with maxillomandibular fixation. Another had bilateral carotid dissections requiring bypass grafting. Postoperatively, one patient (20%) had a neck hematoma requiring evacuation. Two patients had postoperative vocal cord paralysis (unilateral, n=1 [20%]; bilateral, n=1 [20%]). Of the 4 patients with a tracheostomy, 3 were decannulated at 27, 35, and 85 days postoperatively. One remained tracheostomy dependent at last follow-up 77 days later but was progressing towards decannulation. There were no deaths over the study period.

Conclusions: Laryngeal fractures often require ORIF for optimizing airway results. This study proposes a management algorithm describing multiple fixation techniques for varying clinical situations.

Presenting Author(s)

AZ

Aaron L. Zebolsky, MD

Resident Physician
University of Tennessee
Memphis, TN, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

JK

Jillian Krebs, N/A

Student
The Ohio State University, Dept. of Otolaryngology--Head and Neck Surgery
Columbus, Ohio, United States

Disclosure information not submitted.
Emily R. Baker, MD

Resident Physician
Vanderbilt University Medical Center
Memphis, Tennessee, United States

Disclosure information not submitted.
Travis Jonathan Clarke, MD

Resident Physician
University of Tennessee
Memphis, TN, United States

Disclosure information not submitted.
C. Burton Wood, MD

Assistant Professor
University of Tennessee Health Science Center
Memphis, TN, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
MG

Marion B. Gillespie, MD, MSc

Professor and Chair
UTHSC
Memphis, Tennessee, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Samuel H. Smith, MD

Assistant Professor
University of Tennessee Health Science Center
Memphis, Tennessee, United States

Disclosure information not submitted.

Senior Author(s)

Anas A. Eid, MD

Assistant Professor
University of Tennessee, Department of Otolaryngology--Head and Neck Surgery
Memphis, TN, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.