Controversies in occult laryngeal fractures: underreported and overtreated?

Laryngeal fractures are typically diagnosed by symptomology, with current guidelines recommending open reduction internal fixation (ORIF) for displaced fractures. However, little is known about asymptomatic, incidentally discovered fractures in polytrauma patients. This single institution, retrospective case series included four patients with maxillofacial trauma from August 2022 to January 2024. Displaced laryngeal fractures were identified incidentally by maxillofacial surgeons and confirmed by a neuroradiologist. 4/4 patients with displaced laryngeal fractures - qualifying for ORIF under current guidelines - were managed conservatively. No patients underwent ORIF. All patients recovered without long-term complications. One patient experienced transient hoarseness that resolved without intervention. These findings suggest that asymptomatic laryngeal fractures may be underrecognized in polytrauma cases. Conservative management could be appropriate in select cases, even when displacement is present. Broader imaging and further research are needed to refine surgical criteria and optimize management of asymptomatic laryngeal injuries.