Concurrent hyoid bone fracture associated with multiple facial fractures secondary to assault: Case report and review of literature

Abstract

Introduction

Hyoid bone fractures are rarely reported as an isolated entity due to the infrequent occurrence accounting for only 0.002% of all head and neck fractures and 1.15 as the highest incidence. Strangulation remains the most common cause of isolated hyoid bone fractures with an incidence of 27–50%. However, blunt trauma, motor vehicle crash, sport related injuries, falls, assaults, and gunshot wounds are additional documented causes of hyoid bone fractures.

Case report

A 23-year-old male who was assaulted to the face. He complained of pain to the face and neck, sore throat, dysphagia and changes in speech. The face and neck CT scans revealed multiple facial fractures along with a hyoid bone fracture. Patient was admitted to for observation and close monitoring for airway protection until the mandible and hyoid bone fractures were treated. ORIF of the mandibular fractures took place; we elected to treat the hyoid bone fracture conservatively as it was asymptomatic. The patient’s hospital course was unremarkable.

Result

56 articles were reviewed from 1949 to 2017, which revealed that isolated hyoid bone fractures and hyoid bone fractures associated with other facial fractures are very rare. Hyoid bone fractures due to direct trauma, road traffic accidents, falls, assault and gunshot wounds are more common in males than females. However, in strangulation and suicidal hanging, the incidence is higher in females than males. Multiple methods can be used to evaluate the hyoid bone fractures. The majority of hyoid bone fractures are treated conservatively

Highlights

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Hyoid bone fracture incidence is extremely rare 0.002–1.15%.
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Hyoid bone fractures can occur with other facial fractures and laryngeal injuries.
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Strangulation is the most common cause of isolated hyoid bone fractures with an incidence of 27–50%.
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The incidence of hyoid bone fracture is higher in females when related to attempts at suicide by hanging.
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The primary management modality of hyoid bone fractures depends on the severity of the injury.

1 Introduction

Fractures of the hyoid bone are rarely reported as an isolated entity due to the infrequent occurrence accounting for only 0.002% of all head and neck fractures [ , , , ] and 1.15 as the highest incidence [ ]. Strangulation remains the most common cause of isolated hyoid bone fractures with an incidence of 27–50% [ , , , ]. However, blunt trauma, motor vehicle crash, motorcycle crash, sport related injuries (skiing and hockey), vomiting, falls, assaults, and gunshot wounds are additional documented causes of hyoid bone fractures [ , , , , , ]. Hyoid bone fractures have been associated with other injuries including thyroid, cricoid cartilage fractures, and cervico-spinal fractures. Hyoid bone fractures occur more frequently in men than women due to the incidence of blunt trauma, gunshot wounds, sport related injuries, falls, and assault as in this case [ , ]. However, the incidence of hyoid bone fracture is higher in females when related to attempts at suicide by hanging [ , , ].

2 Case report

We present a 23-year-old male who was assaulted and presented emergently to the trauma center via ambulance. Per EMS report, the patient was struck in the face and neck multiple times. Upon arrival, he was neurologically and hemodynamically stable, and was alert and awake with a GCS of 15. He complained of pain to the face and neck (primarily the lower jaw), sore throat, dysphagia and changes in speech. His physical examination revealed mild to moderate swelling and ecchymosis to the right cheek and anterior neck areas. The patient stated that there was a change in his occlusion along with trismus of approximately 1cm. He had significant deviation of the mandible to the right side upon opening. Brain, facial, and neck computed tomography (CT) scans were obtained. The neck CT scan revealed right mandibular ramus, right mandibular angle, left mandibular symphysis, right pterygoid plate fractures along with a hyoid bone fracture without any effects on the airway ( Figs. 1–3 ); the brain and spinal CT were negative. Laryngoscopy did not reveal any pharyngeal lacerations or injuries. Patient was admitted to the OMFS service for observation and close monitoring for airway protection until the mandible and hyoid bone fractures were treated. He received 10 mg of dexamethasone IV x three doses. On the third post injury day, he was taken to the operating room by OMFS for open reduction and internal fixation of the mandibular fractures; OMFS team elected to treat the hyoid bone fracture conservatively as it was asymptomatic by the end the third day and the neck swelling had significantly decreased ( Figs. 4–10 ). The patient’s hospital course was unremarkable, the pain and swelling to left cheek and the anterior neck area improved within 2 days and he never presented with any airway distress. The patient was discharged on the fifth post injury day and was limited to a liquid diet. The patient returned for a postoperative visit one week later and his examination revealed a stable/repeatable occlusion, decreased swelling, diminished anterior neck ecchymosis, and no complaints of dysphagia. The patient was followed up an additional 3 weeks later, which revealed no neck ecchymosis and the neck edema had completely resolved. In the 3 months follow up, patient presented with a complete recovery of the mandibular and hyoid bone fractures. The patient was provided another 6 months follow up appointment, however, he did not show.