Laryngeal Mucosal Sensation Impairment Following Cervical Spine Injury

Pathophysiological Mechanisms

Cervical spine injuries, particularly those affecting the upper cervical levels, can compromise neural pathways that innervate the larynx, leading to sensory deficits in the laryngeal mucosa 1
Injuries at C5 level specifically impact respiratory function and can lead to ineffective clearance of secretions, which may further compromise laryngeal sensation through chronic irritation 1

Diminished laryngeal mucosal sensation increases the risk of silent aspiration, as the protective cough reflex may be impaired or absent 1
Patients with cervical spine injuries often demonstrate reduced ability to generate adequate expiratory pressures needed for effective cough, compounding the problem of impaired laryngeal sensation 1
The combination of sensory deficits and motor impairment can significantly increase morbidity and mortality due to respiratory complications 1

Higher cervical spine injuries pose greater risk to laryngeal sensory function than lower cervical injuries 1
The presence of pre-existing airway pathology or cricoid cartilage involvement increases the risk of sensory complications 2

Early assessment of laryngeal sensory function should be performed in patients with cervical spine injuries, particularly those affecting upper cervical levels 1
Videolaryngoscopy is recommended for airway management in patients with suspected or confirmed cervical spine injury to minimize further trauma 3
A bundle approach including active physiotherapy and mechanically-assisted insufflation/exsufflation devices is recommended to facilitate respiratory management 1

Early implementation of respiratory protocols including bronchial drainage physiotherapy can improve outcomes and potentially reduce the impact of sensory deficits 1

In emergency situations involving patients with cervical spine injuries and potential laryngeal sensory deficits, standard emergency front-of-neck airway access techniques may be complicated 2
Ultrasound guidance should be considered to identify and mark the cricothyroid membrane before attempting any emergency airway intervention in these patients 2
A multidisciplinary approach involving spine surgeons, otolaryngologists, and speech pathologists is essential for comprehensive management of patients with laryngeal sensory deficits following cervical spine injury 2