Fracture of the Hyoid Bone

Abstract

Fracture of the hyoid bone is likely to prove fatal because of asphyxia. Sufficient stress to cause a hyoid fracture will frequently produce soft-tissue injuries which mask its presence unless the attending physician deliberately examines the bone radiographically, or familiarity with the clinical symptoms alerts him to its possibility. Conversely, the external visible evidence of a fracture or severe soft-tissue injury may be so slight that the possibility is overlooked. Patients may die because of asphyxia associated with pharyngeal and laryngeal spasm, unless relieved by tracheotomy. The radiologic diagnosis of fractures of the hyoid bone has been neglected, only 8 cases having been reported in the last twenty to twenty-five years. Two cases to be presented here illustrate the clinical problems and the radiologic findings. Case I: Gunshot Fracture of the hyoid Bone. A 23-year-old white male prisoner was struck in the left side of the neck by a single buckshot fired during a prison riot. The shot entered the neck about 1 cm. below the body of the mandible, near the angle, and passed through the body of the right mandible about 2 cm. anterior to the ramus, producing a fracture of the hyoid in its course across the neck. The patient was transported a distance of about 16 miles from the penal institution to the hospital. Hemorrhage and swelling in the neck were plainly visible. Dyspnea was marked and was relieved by tracheotomy. The fractured mandible was treated by wiring the teeth. Several small loose fragments were removed from the point of exit of the shot. No particular treatment was directed to the comminuted fracture of the cornu of the hyoid (Fig. 1). Convalescence was uneventful. Case II: Fracture of the Hyoid Bone from a Blow by a Fist. A 22-year-old white man became involved in a fist fight and sustained a fracture of the nose and hyoid bone. He was brought directly to the hospital from a short distance but was quite dyspneic on arrival. While he showed evidence of a beating about the face and nose, the neck was not unusual in appearance. The patient could be relieved of his dyspnea by grasping his lower jaw, elevating his chin, pushing the jaw forward and putting his head in the Trendelenburg position. Complete relief was afforded by tracheotomy. In the roentgenograms of the facial skull and cervical spine, a fracture of the greater cornu of the hyoid bone close to its junction with the body was easily visible (Fig. 2). The tracheotomy tube was removed after about three days, and convalescence was uneventful. Symptoms and Signs Fractures of the hyoid bone are the result either of direct trauma, as strangulation, car accidents, or gunshot wounds, or of muscular action, as in sudden hyper-extension of the neck or forcible deglutition. According to Olmstead (6), early bony union between the body and the greater cornua or anomalous ossification is a predisposing factor.