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Maxillofacial Fractures Associated With Laryngeal Injury

A Craniofacial Surgeon Should be Alert

Wu, John Chung-Han, MD*; Chen, Hsin-Yu, MD*; Liao, Chien-Hung, MD; Wang, Shang-Yu, MD; Fu, Chih-Yuan, MD; Chen, Chih-Hao, MD, PhD*; Chen, Chien-Tzung, MD*

doi: 10.1097/SAP.0000000000001720
Head and Neck Surgery

Objective Maxillofacial fractures with concomitant laryngeal injuries put both the quality and maintenance of life in jeopardy. Because of its low incidence, it is often overlooked in the clinical setting. The purpose of this study is to review the incidence, clinical presentations, managements, and outcomes of these patients.

Methods A retrospective analysis of medical records from 2008 to 2015 was conducted at a single institute. A case series (n = 12, which contributed 22.2% of laryngeal injuries in our institute) of these patients was presented, and propensity score matching was applied for further statistical analysis.

Results When comparing patients who sustained maxillofacial fractures with concomitant laryngeal injuries with patients with only maxillofacial fractures and no laryngeal injuries, subcutaneous emphysema (83.3% vs 4.2%, P < 0.001), neck pain (75.0% vs 6.3%, P < 0.001), dyspnea (75.0% vs 0%, P < 0.001), hoarseness (41.7% vs 0%, P < 0.001), neck swelling (66.7% vs 4.2%, P = 0.012), stridor (16.7% vs 0%, P = 0.037), hemoptysis (16.7% vs 0%, P = 0.037), and thoracic trauma (58.3% vs 10.4%, P = 0.001) all showed significant differences. The length of intensive care unit stay (7.42 days vs 3.21 days, P = 0.008), ventilator use (66.7% vs 18.8%, P = 0.002), and tracheostomy (58.3% vs 0%, P < 0.001) were also significantly different.

Conclusions A significant portion of laryngeal injuries is concurrent with maxillofacial fractures. As a craniofacial surgeon, we should be alert to the signs of laryngeal injury. Diagnosis of laryngeal injuries should be established before definitive surgery for maxillofacial fractures.

From the *Departments of Plastic and Reconstructive Surgery and

Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan, ROC.

Received September 25, 2018, and accepted for publication, after revision October 3, 2018.

J. Wu and H.Y. Chen contributed equally to this study as co-first authors.

Conflicts of interest and sources of funding: None of the authors have any commercial associations or financial disclosures that might pose or create conflicts of interest with anything discussed in this article. Each author has contributed original work to the article and adhered to the ethical requirements as outlined by the journal.

Reprints: Shang-Yu Wang, MD, Departments of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, 5, Fu-Hsin St, Kwei-Shan, Taoyuan 333, Taiwan, ROC. E-mail:,

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