PMC5502499_01
Computed tomography - larynx (axial section) showing comminuted fracture of the left thyroid lamina with disruption of the anterior commissure (yellow long arrow) and narrowed lumen of larynx (red small arrow), due to falling back of vocal cords
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F1
It revealed a comminuted fracture of the left lamina of the thyroid cartilage with two fracture lines, one vertical in midline displacing the left lamina and other horizontal in the left thyroid lamina along with chip fracture of cricoid displacing the arytenoid anteromedially [Figures 1 and 2].
Computed tomography - larynx (axial section) showing triangular chip fracture of cricoid cartilage on the left side (yellow arrow)
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F2
It revealed a comminuted fracture of the left lamina of the thyroid cartilage with two fracture lines, one vertical in midline displacing the left lamina and other horizontal in the left thyroid lamina along with chip fracture of cricoid displacing the arytenoid anteromedially [Figures 1 and 2].
Preoperative videolaryngoscopic picture showing narrowed glottic chink on deep inspiration (red arrow) and the gap between anterior commissure and vocal cords fallen back (black solid arrow)
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F3
Preoperative videolaryngoscopy showed narrowed glottic chink even on deep inspiration and gap between the anterior commissure and vocal cords fallen back [Figures 3 and 4].
Preoperative videolaryngoscopic picture showing closed glottis on phonation (red arrow)
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F4
Preoperative videolaryngoscopy showed narrowed glottic chink even on deep inspiration and gap between the anterior commissure and vocal cords fallen back [Figures 3 and 4].
Preoperative photograph showing vertical fracture line in midline of thyroid cartilage passing through anterior commissure; after reduction and realignment of the fracture fragments
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F5
He was taken to the operating room and underwent an open reduction and internal fixation (ORIF) of the thyroid cartilage with 4-0 prolene sutures [Figures 5 and 6].
Preoperative photograph showing prolene sutures applied to the two fracture lines; plate application was attempted (blue arrow), but screws could not be tightened and had to be removed; cricoid chip fracture fragment can be seen (yellow arrow)
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F6
He was taken to the operating room and underwent an open reduction and internal fixation (ORIF) of the thyroid cartilage with 4-0 prolene sutures [Figures 5 and 6]. Plate fixation was not possible as the cartilage was soft and tight screw fixation was not possible [Figure 6].
Preoperative photograph showing endolaryngeal stent (endotracheal tube) held by prolene sutures (yellow arrow)
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F7
Endolaryngeal stenting was done with 3.5 mm long polyvinylchloride (PVC) endotracheal tube of 6 mm external diameter and closing the top end by sutures to prevent aspiration [Figure 7].
Postoperative videolaryngoscopic picture showing reasonably good glottic chink and realigned anterior commissure
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F8
Videostroboscopy performed 2 weeks after the event showed reduced left vocal cord mobility with normal anterior commissure and reasonably patent glottic chink [Figure 8].