Sharks’ defenseman Doug Murray added his name to my list of Guys Who Are Tougher Than You last week when a puck to the throat left him with a fractured Adam’s apple. Yes, that’s a real thing, and it can be really, really bad. It can also be no big deal*. Let’s learn about the Adam’s apple (what exactly is that thing?) and what happens when you break yours.
*If you define “No big deal” as “Doesn’t immediately kill you, but may kill you later if not appropriately managed”.
The Adam’s Apple: It has a real name, and that’s not it.
It’s actually called the laryngeal prominence, and it’s a part of the thyroid cartilage. That’s whole bunch of long words that boil down to this: The Adam’s apple is a lump on the front of some cartilage in your throat. It’s bigger in men than in women, and like any cartilage if you hit it hard enough you can crack it.
From the outside:
From the inside:
There’s a lot of cartilage in your throat/neck area – nine different structures make up your larynx (one of which is the thyroid cartilage that we’re discussing). The larynx is the area of your neck that separates your trachea (the tube you breathe through) from the outside world (by way of your mouth and nose). It also houses your vocal cords, and thus your voice. Its importance is obvious – if you crush your larynx then air can’t get through, and you can’t breathe. Breathing, as you may know, is kind of a Big Deal.
So what happens if you break it?
Fracturing the cartilage in your larynx can have a lot of different outcomes. Consider the case of Montreal’s Trent McCleary, who fractured his larynx in 2000 off a Chris Therien shot. McCleary’s airway immediately began to swell shut, with the added complication of bleeding in the area, and air leaking out into surrounding tissues. His injury was so severe that team physicians were unable to pass an ET tube (endotracheal tube, aka breathing tube) through the area, and ended up doing an emergency cricothyroidotomy on him at the rink – basically cutting a hole in his throat under the injured area so he could breathe. McCleary endured several surgical repairs on the area and made a full recovery, with the glaring exception being that his airway was so narrowed by scarring that he couldn’t breathe well enough to ever play NHL hockey again.
On the less horrible (but still pretty awful) end of the spectrum is Patrick Wiercioch of the AHL’s Binghamton Senators, who took a puck to the throat in early December. He spent a few days in the hospital on a ventilator, but didn’t need surgery and recovered completely. Intubation can be a preventative measure in the case of less serious laryngeal injuries like his – keeping the airway open artificially just in case swelling worsens can prevent the need for a surgical airway (like in McCleary’s case).
The management of an injury like these depends on exactly how bad it is. If there’s any kind of airway compromise, that has to be handled before anything else. Once the airway is stable, a look inside the larynx can determine severity. If your airway is bad, then you’re probably in an induced coma (ie they’ve sedated you) and on a ventilator, and they’ll look directly at the inside of your larynx to determine if immediate surgery is required. Cartilage poking out? Surgery. Obvious deformity in the larynx? Surgery. Airway occluded? Surgery. If your airway is good and you’re awake, visualization usually done by way of a small flexible fiberoptic scope that a doctor stuffs up your nose after the traditional “This really doesn’t hurt at all!” (blatant lie). Any abnormalities will probably buy you a CT scan, which will clarify if you’re okay to just take it easy and let things heal, or if you need surgical repairs.
How do you fix a broken Adam’s apple?
If the injury isn’t that bad (which is a relative term, seeing as how this can kill the crap out of you), then you’ll probably end up sleeping with your head elevated, not using your voice, and possibly not eating solid foods for a while. You’ll have to relax and get familiar with your couch and tv remote, because you’ll probably be ordered not to exert yourself. You’d want to avoid doing anything that could cause any further damage to the area, or anything that could irritate your airway. You really don’t want to incite any swelling in the one place air can get into your lungs (remember: BIG DEAL).
If the injury is bad enough to require surgery, there are a few options. First off, you may have just bought yourself a tracheostomy – that’s the attractive little breathing tube that’s cut into the base of your throat. A trach (rhymes with snake) is necessary if the repair is so complex or the damage is so bad that an extended recovery is expected – you can’t stay intubated, sedated, and on a vent for weeks (well, you can, but it sucks). With a trach you can more or less be up and around (and breathing through a hole in your neck) while things heal. You’ll also get a feeding tube (or IV nutrition), and you may not be able to speak if your vocal cords have been damaged. The goals of surgery will be to repair the vocal cords (yes, you can just stitch those back together), make sure there’s a passage for air, and repair any damage to the cartilage (with wire sutures or plates) and the mucosa (the “skin” of the inside of your throat).
You’ll get a prescription for antibiotics (because your mouth is filthy, and if you’ve ripped the inside of your throat open you really don’t want any mouth-stuff getting in there), and you may or may not get steroids to help with swelling (doctors seem unable to agree on whether they actually help). You’ll keep the trach for about a week, or longer if they’ve had to put a stent in your airway. A stent is a spacer that sits in there for two to three weeks and keeps your trachea from scarring down to something too narrow for air. Those super fun tube feedings (or IV nutrition) will keep going for about two weeks. Then you’ll hope you don’t have any chronic complications like voice loss, tracheal stenosis (narrowing), problems breathing or swallowing, or a fistula (where a connection develops between the trachea and the esophagus or the outside of the neck – no explanation is really necessary to explain why those aren’t good).
So what the heck happened to Doug Murray?
Murray deflected a pass right up his stick and into his throat in a game against Tampa Bay on Thursday. He left the game (duh) and spent the night in a Tampa hospital, then flew to Detroit ahead of the rest of his team, who made a quick stop in Raleigh to lose to the Hurricanes. The trip was supposedly so Murray could have “more tests”, which may have meant serial laryngoscopies (remember that lie about it not hurting?) to assess for any swelling. He was up and around talking to reporters in Detroit over the weekend, but didn’t skate or play. Sounds like he came down on the not-so-deadly end of the laryngeal fracture spectrum. But seeing as how he still BROKE HIS DAMN THROAT, he definitely gets a solid place on the badass list. Also the very, very lucky list.