{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:48:09Z","timestamp":1790948889306,"version":"4.1.0"},"reference-count":19,"publisher":"S. Karger AG","issue":"5-6","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ORL"],"abstract":"<jats:p>&lt;p&gt;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\u2013April 2025) identified English language case series reporting \u22655 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\u201375%), severe injuries (Schaefer grades III\u2013V) 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. &lt;\/p&gt;<\/jats:p>","DOI":"10.1159\/000549780","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T17:01:45Z","timestamp":1764867705000},"page":"218-229","source":"Crossref","is-referenced-by-count":3,"title":["High-Impact Laryngotracheal Trauma: A Combined Narrative and Systematic Review Evaluating Gaps in the Current Laryngeal Injury Reporting System"],"prefix":"10.1159","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3373-0216","authenticated-orcid":false,"given":"Asimakis D.","family":"Asimakopoulos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kishore","family":"Sandu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thorsurg.2018.04.008"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-024-08456-9"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2018.07.018"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/s1052-3359(03)00004-8"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24068"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2009.07.034"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.125.8.877"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24432"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-005-0989-z"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2012.53.5.992"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1002\/hed.2880110603"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2009.12.008"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2014.04.079"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-023-08298-x"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000003843"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000003160"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2009.01.053"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016\/s0003-4975(00)02453-x"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1177\/000348940411301003"}],"container-title":["ORL"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000549780","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T16:01:00Z","timestamp":1784736060000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000549780"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,4]]},"references-count":19,"journal-issue":{"issue":"5-6","published-online":{"date-parts":[[2026,7,22]]},"published-print":{"date-parts":[[2026,8,5]]}},"URL":"https:\/\/doi.org\/10.1159\/000549780","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.30782498","asserted-by":"subject"}]},"ISSN":["0301-1569","1423-0275"],"issn-type":[{"value":"0301-1569","type":"print"},{"value":"1423-0275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,4]]}}}