Blunt Laryngeal Injury in a Teenage Hockey Player

A 13-year-old boy presented to the Emergency Department (ED) after sustaining blunt neck trauma while playing hockey. He reported falling forward with his neck landing directly on the edge of the boards. Immediately after the injury, he began coughing, with a single episode of hemoptysis, but no difficulties breathing. On arrival to the ED, he endorsed mild pain in his anterior neck. He was cooperative, smiling, and in no distress. His voice was hoarse. Vital signs were: temperature 37.2°C, heart rate 95 beats/min, blood pressure 133/72 mm Hg, respiratory rate 18 breaths/min, and oxygen saturation 100% on room air. A small abrasion was noted on his neck (Figure 1). Crepitus was palpable from the submandibular region to the clavicles bilaterally. He had no stridor. There was no cervical spine tenderness. Computed tomography (CT) of the neck showed extensive subcutaneous emphysema from the nasopharynx to the mediastinum (Figure 2), and significant narrowing of the larynx at the level of the left pyriform sinus. No laryngeal fracture was identified. A flexible nasolaryngoscopic examination performed at the bedside showed limited movement of the left arytenoid and vocal fold. The patient was taken to the operating room for diagnostic laryngoscopy and bronchoscopy, which confirmed hypomobility of the left arytenoid without dislocation, and identified a left infraglottic hematoma with surrounding echymosis (Video 1, available online). A small abrasion was noted in the proximal esophagus.