Any combination of these findings may be present initially so it is imperative to maintain a high index of suspicion concerning any patient presenting with a plausible mechanism for anterior neck trauma. Associated injuries are common, and special attention should be directed towards cervical spine, thoracic and central nervous system injuries. Although rare, esophageal injuries must be considered and ruled out with either radiographic contrast studies or direct esophagoscopy. If the airway is compromised, absolute priority must be given to establish an airway by the least traumatic means. The method of choice is tracheotomy.
Further treatment depends on the extent of laryngeal damage.
Group 2 injuries usually require tracheotomy for airway stabilization and control. Direct laryngoscopy and esophagoscopy should also be performed as soon as possible. Group 2 patients can often be decannulated in three to four days. Group 3 and 4 trauma require airway stabilization followed by open exploration via a midline thyrotomy. When open exploration is required it should be performed within the first 24 hours after the injury.