A complex fracture of the hyoid bone and the larynx after a bicycle accident – Case report and review of literature

Abstract

Introduction and importance Reports about laryngeal trauma and fractures of the hyoid bone are rare in the literature. Most cases are forensic cases and the results of postmortem analysis. Traumatic larynx and hyoid bone fractures represent a rare but important differential diagnosis of the common symptom hoarseness. Case presentation A 60-year-old female patient presented with unclear dysphonia and globus sensation following intubation for a surgical treatment for a lower leg fracture after a bicycle accident two months ago. Endoscopy and the computed tomography (CT) of the neck revealed a fixed and immobile fractured piece of the larynx, a hyoid bone fracture and a pseudarthrosis between the greater horn of the hyoid bone and the upper edge of the thyroid cartilage. The hyoid bone fracture led to a distortion of the supraglottis. After surgical removal of the fractured part of the hyoid bone and the pseudarthrosis separation, the supraglottis appeared symmetrical again. Four weeks after surgery the patient was symptom-free. Clinical discussion Though combined hyoid bone and larynx fractures after traumatic injuries are rare, they represent an important differential diagnosis in trauma patients with dysphagia or dysphonia. The clinical symptoms can vary and occur immediately or within a latent period taking weeks or months until the proper diagnosis. Depending on the symptoms, surgical management can be effective. Conclusion An isolated partial resection of the hyoid bone with separation of the pseudarthrosis is a reasonable therapeutic option and can lead to completely resolving symptom. Preoperatively, a CT provides further valuable information.

Hyoid Bone and Thyroid Cartilage Fractures at Forensic Autopsies

“…1,3 In the literature, HB and TC fractures are accompanied by findings to the multiple facial fractures, including Le Fort and mandible fractures. 2,3,8 The etiology of laryngeal fractures is often associated with direct trauma to the neck such as hanging or strangulation 1,4 as mentioned previously; however, there are rare reports of cases without direct trauma. Iatrogenic fractures also play a small but important role in etiology.…”

“…Both HB and TC are vulnerable to indirect trauma due to excessive neck movements. 2 Fractures are important in the clinical approach as they are in autopsy. Hyoid bone and TC fractures are important clinical conditions that should be detected at the first examination because they may cause airway obstruction both directly and because of edema of the surrounding tissue.…”

“…Thyroid cartilage is attached to several laryngeal and neck muscles and ligaments. Both HB and TC are vulnerable to indirect trauma due to excessive neck movements 2 . Fractures are important in the clinical approach as they are in autopsy.…”

“…Strangulation is the most commonly reported cause of HB and TC fractures, 1–3 but direct blunt trauma, transportation injuries, sports injuries, falls from height, and penetrating injuries directly to the neck are also reported as causes of HB and TC fractures 1,3 . In the literature, HB and TC fractures are accompanied by findings to the multiple facial fractures, including Le Fort and mandible fractures 2,3,8 .…”

“…Fractures of the hyoid bone (HB) and thyroid cartilage (TC) are important findings that ensure correct triage in emergency medicine as well as an important milestone in manner determination in forensic pathology. Hyoid bone and TC fractures, typically associated with hanging and with homicidal neck traumas such as ligature strangulation, manual strangulation, neck pressure (holds, restraint), and smothering in forensic pathology, can also result from direct or indirect trauma to the neck 1–4 . Because their fragility and the localization of these structures in the neck, where they can be directly exposed to trauma, these fractures can occur with many mechanisms besides homicidal trauma, and even interventions to the neck during cardiopulmonary resuscitation may play a role in the emergence of these fractures.…”