High-Impact Laryngotracheal Trauma: A Combined Narrative and Systematic Review Evaluating Gaps in the Current Laryngeal Injury Reporting System.

INTRODUCTION: External neck trauma represents a potentially life-threatening clinical scenario. Blunt and penetrating injuries are the primary etiologies and may result in laryngeal injuries with concurrent tracheal involvement. High-impact or high-energy laryngotracheal trauma arises from diverse mechanisms; therefore, injury reporting must account for varied patterns and incorporate any synchronous tracheal injury, thereby establishing a more effective framework for managing complex external airway trauma. METHODS: Data from 7 patients experiencing high-intensity extreme laryngotracheal trauma were retrospectively analyzed, focusing on injury mechanisms, clinical presentations, site and grade of injury, imaging findings, management approaches and outcomes. In parallel, a PRISMA-guided search of PubMed, Embase, Scopus, and Web of Science (January 1980-April 2025) identified English language case series reporting ≥5 patients. Data on injury mechanisms, Schaefer-Fuhrman grade, management, and outcomes were extracted. RESULTS: Seven cases of severe laryngotracheal trauma with varying mechanisms are presented, including closed glottis barotrauma, penetrating and blunt neck injury, accidental strangulation, prolonged labor and rough manipulation of a vertex presentation, clothesline injury, and post-intubation injury. The obstetric patient did not survive, while other patients underwent prompt airway stabilization with favorable functional outcomes. The systematic review incorporated 11 studies: blunt trauma predominated (65-75%), severe injuries (Schaefer grades III-V) accounted for one-half of cases, and overall mortality was 2%. Tracheal extension, including cricotracheal separation, was predominantly reported after high-impact blunt trauma in several studies. CONCLUSION: The current classification system for external laryngeal trauma does not adequately capture the severity or anatomical complexities of high-impact laryngotracheal injuries. Our experience, supported by pooled literature data, underscores the limitations of laryngeal-only grading. Incorporating both the mechanism and extent of injury is essential to improve clinical decision-making, guide treatment strategies, and ultimately, enhance patient outcomes and prognosis.