Keywords
laryngeal injury
gunshot wound
airway management
cricoid fracture
thyroid cartilage
emergency surgery
multidisciplinary care
How to Cite
Abstract
Introduction: Penetrating neck injuries (PNIs) from firearms are life-threatening emergencies due to the risk of airway compromise and major hemorrhage. Laryngeal trauma, though uncommon, adds further complexity and can be fatal without prompt intervention.
Case Presentations:
Case 1: A 44-year-old male sustained a gunshot wound to the anterior neck. Imaging revealed fractures and displacement of the right thyroid cartilage, soft tissue hematomas, and subcutaneous emphysema, with an exit wound in the left submandibular area. The patient exhibited stridor, dysphonia, and active bleeding. Emergency airway stabilization and surgical repair led to a full recovery of respiratory and vocal function.
Case 2: A 40-year-old male presented with a trans-neck gunshot wound exiting through the left scapulohumeral region. He had associated clavicular and humeral fractures and signs of hemorrhagic shock. Immediate airway management via intubation and tracheostomy, along with hemodynamic stabilization, resulted in a favorable outcome after 14 days in intensive care.
Successful management of PNIs involving the larynx necessitates a rapid, multidisciplinary approach. Imaging, airway protection, and timely surgical intervention are crucial for preserving laryngeal function.
Conclusion: Firearm-related PNIs with laryngeal involvement demand immediate, coordinated care. These cases highlight the importance of early airway control, accurate diagnosis, and surgical expertise in optimizing outcomes and preserving vital functions.
References
Nowicki, J. L., Stew, B., & Ooi, E. (2018). Penetrating neck injuries: a guide to evaluation and management. Annals of the Royal College of Surgeons of England, 100(1), 6–11. https://doi.org/10.1308/rcsbull.2018.6
Hamilton, J. M., Chan, T. G., & Moore, C. E. (2023). Penetrating Head and Neck Trauma: A Narrative Review of Evidence-Based Evaluation and Treatment Protocols. Otolaryngologic clinics of North America, 56(6), 1013–1025. https://doi.org/10.1016/j.otc.2023.05.006
Shiroff, A. M., Gale, S. C., Martin, N. D., Marchalik, D., Petrov, D., Ahmed, H. M., Rotondo, M. F., & Gracias, V. H. (2013). Penetrating neck trauma: a review of management strategies and discussion of the 'No Zone' approach. The American Surgeon, 79(1), 23–29. https://doi.org/10.1177/000313481307900113
Schaefer, S. D. (2014). Management of acute blunt and penetrating external laryngeal trauma. The Laryngoscope, 124(1), 233–244. https://doi.org/10.1002/lary.24068
Inaba, K., Branco, B. C., Menaker, J., Scalea, T. M., Crane, S., DuBose, J. J., Tung, L., Reddy, S., & Demetriades, D. (2012). Evaluation of multidetector computed tomography for penetrating neck injury: a prospective multicenter study. The journal of trauma and acute care surgery, 72(3), 576–804. https://doi.org/10.1097/TA.0b013e31824badf7
Dogjani, A., Vassiliu, P., Georgiou, C., et al. (2025). The 9th Albanian Congress of Trauma and Emergency Surgery. Albanian Journal of Trauma and Emergency Surgery, 9(2.9), 1-159. https://doi.org/10.32391/ajtes.v9i2.9.508
Kim, J. P., Cho, S. J., Son, H. Y., Park, J. J., & Woo, S. H. (2012). Analysis of clinical feature and management of laryngeal fracture: recent 22 case review. Yonsei medical journal, 53(5), 992–998. https://doi.org/10.3349/ymj.2012.53.5.992
Laher, N., Monzon, B., & Mauser, M. (2023). Results of Selective Non-Operative Management for Penetrating Neck Trauma in 594 Patients. Albanian Journal of Trauma and Emergency Surgery, 7(1), 1114–1119. https://doi.org/10.32391/ajtes.v7i1.302
Schaefer, S. D. (1992). The acute management of external laryngeal trauma. A 27-year experience. Archives of otolaryngology--head & neck surgery, 118(6), 598–604. https://doi.org/10.1001/archotol.1992.01880060046013
Dogjani, A., Bendo, H., Blloshmi, A. (2018). Management of Trauma Patients in Hospital Settings. Albanian Journal of Trauma and Emergency Surgery, 2(2.2), 12- 13. https://doi.org/10.32391/ajtes.v2i2.2.155
Moonsamy, P., Sachdeva, U. M., & Morse, C. R. (2018). Management of laryngotracheal trauma. Annals of cardiothoracic surgery, 7(2), 210–216. https://doi.org/10.21037/acs.2018.03.03
Francis, S., Gaspard, D. J., Rogers, N., & Stain, S. C. (2002). Diagnosis and management of laryngotracheal trauma. Journal of the National Medical Association, 94(1), 21–24.
Dogjani, S. A., Hasanaj, E. B., Matevossian, E., & Doll, D. (2014). Management of the blunt pediatric cervical trauma challenge for the trauma surgeon and the options of solving their emergency conditions (a case report). Новости хирургии, 22(4), 488-4 DOI: http://dx.doi.org/10.18484/2305-0047.2014.4.488
Dogjani, A. et al. (2012). Subcutaneous emphysema in the anterior coli area in a child with blunt chest trauma. 13th European Congress of Trauma and Emergency Surgery (ECTES 2012) - 12 - 15 May 2012. Basel, Switzerland. DOI: https://doi.org/10.18484/2305-0047.2014.4.48
Jalisi, S., & Zoccoli, M. (2011). Management of laryngeal fractures--a 10-year experience. Journal of voice: official journal of the Voice Foundation, 25(4), 473–479. https://doi.org/10.1016/j.jvoice.2009.12.008
Dogjani, A., et al. (2020). Politrauma, Challenges in Management. Albanian Journal of Trauma and Emergency Surgery, 4(2.4). https://doi.org/10.32391/ajtes.v4i2.4.175