When endolaryngeal approaches are inadequate and when there is significant injury to the larynx, transcervical approaches are necessary. This is most often necessary for Schaefer-Fuhrman Class II-IV. Assessment and treatment always begin with evaluation and management of the airway followed by operative endoscopy to determine the extent of injury and guide surgical repair. Treatment includes open reduction and fixation of cartilaginous fractures but when there is significant endolaryngeal injury, a laryngofissure with or without stenting is often necessary. Postoperative care continues until decannulation. Secondary procedures may be required.
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