Download Laryngology seminar Hyoid bone fracture

Laryngology seminar
Hyoid bone fracture
R3 康焜泰
2007/7/11
Embryology of hyoid bone
Second pharyngeal arch (hyoid arch) : Æ
Reichert’s cartilage Æ lesser horn of the hyoid
bone + upper portion of body
„ Third pharyngeal arch:
Æ greater horn +
lower portion of body
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Anatomy of hyoid bone
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Derived from Greek word hyoeides
meaning “shaped like the letter upsilon”
(Os hyoideum; ligual bone)
U-shaped or horseshoe shaped bone in
the anterior neck
C3 : angle between thyroid cartilage and
mandible
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The only bone not articulated to any other bone
Suspend from tip of the styloid process of
temporal bone by stylohoid ligament
Consist of 5 segments
1. body
2. greater cornua
3. lesser cornua
• Body : (corpus oss. hyoidei)
• Anterior surface :
geniohyoideus(most)
hyoglossus notch(lateral)
mylohyoideus
sternohyoideus
omohyoideus
• superior surface : genioglossus
• Lateral border : connect greater cornu by synchondroses or bony union
• The Greater
Cornua(cornua majora)
• Protect backward from
lateral border of body
• Upper surface :
hyoglossus and constrictor
pharyngis medius
• Near junction :
digastricus and stylohyoideus
• Medial border :
• hyothyroid membrane
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The Lesser Cornua(cornua minora)
Two small, conical eminences, attach their
base to junction
body: fibrous tissue
Greater cornua: diarthodial joint
Apex : attach to stylohyoid ligament
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Ossified : 6 centers
Body (2) : end of fetal life
Greater cornua (1) : end of fetal life
Lesser cornua (1) : 1st or 2nd year after
birth
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Function :
production of human speech
Wider range of tongue and laryngeal
movement
Hyoid biodynamic system Æ regulate
mastication, deglutition and phonation
Suprahyoid muscle
stylohyoid
Styloid processÆ
Body of hyoid
Geniohyoid Inf. mental spine of
mandible
Æbody
Mylohyoid
Mylohyoid lineÆ
body of hyoid
Digastric
Ant
belly
Digastric fossa of
mandible Æ body
and greater horn
Post
belly
Mastoid notch of
temporal bone Æ
body and greater
horn
Elevate and retract
hyoid boneÆ
elongation mouth floor
VII
Pull the hyoid b.
C1
via
XII
Anteriorly and
superiorly Æ shorten
mouth floor
Elevate floor of mouth,
tongue and hyoid
during speech and
swallowing
V
Raise and stable the
hyoid
V
VII
Infrahyoid muscle (Strap muscle)
Manubrium and med
Sternohyoid
aspect of clavicleÆ
Body of hyoid
Omohyoid
sternothyroid
Scapula near the
suprascapular
notchÆinferior
aspect of hyoid
Post aspect of
manubriumÆ
thyroid cartilage
thyrohyoid
Oblique line of
thyroid cartilage Æ
inferior aspect of
body and greater
horn
Depress hyoid
bone following
elevation during
swallowing
C1-C3
Depress and
retract hyoid
bone
C1-C3
Depress the
larynx and
thyroid
C1-C3
Ansa
cervicalis
Ansa
cervicalis
Ansa
cervicalis
Depress the hyoid C1(XIIl)
and elevate the
larynx
Classification of
hyoid bone fracture-1
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1. inward compression fracture with
outside periosteal tears
2. anterior-posterior compression fracture
with inside periosteal tears
3. avulsion fracture
Weintraub CM. Fracture of hyoid bone. Med Leg J 1961
1. inward compression fracture
with outside periosteal tears
manual strangulation, squeezing force
pushing two cornua
together
2. anterior-posterior compression
fracture with inside periosteal tears
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Hanging or
other antpost force
Hyoid bone
against C2
The causes of hyoid bone
changed
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In the past : strangulations and hanging
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Æ Æ Æ road traffic accident recently
Hyoid bone fracture in
strangulation
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1. Fractured in 1/3 all homicides by
strangulation
(14% thyroid and cricoid cartilage fracture)
2. Detect hyoid bone fracture Æ
strangulation ?
3. Lack hyoid bone fracture Æ not exclude
strangulation
Fractured and unfractured hyoids
from victims of strangulation
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1.age , magnitude of force, nature,
instrument (hand or ligature)
2. Fractured hyoid : older victims (39+/14 years) vs unfractured hyoid (30+/-10
years) Æ degree of ossification and
fusion of synchondroses
3. Fractured hyoid: longer in ant-post
plane, more steeply sloping
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Incidence : 0.002 % of all fractures
Age : 15-55, most under 35 y/o
Male (28 cases) > female (3 cases)
Rare, because
1. hyoid bone well protect by mandible
2. mobility in all directions
Rarer in pediatric
Æ Hyoid bone not completely ossified
Æ flexibility and decreased rigidity
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Causes and mechanisms:
1. Road traffic accidents (14 cases)
2. Gun shot and knife (3 cases)
3. basketball, ice hockey (3 cases)
4. falling assault (3 cases)
5. iatragenic, after C spine surgery or
resuscitation (2 cases)
Associated fractures
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Isolated hyoid bone fracture : 16 cases
With mandibular fractures : 5 cases
With facial bone fractures : 4 cases
C spine injury : 3 cases
Thyroid fracture, facial laceration, external
carotid artery pseudoaneurysm, cricoid
cartilage fractures
Clinical manifestations
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Ecchymosis of the neck, edema, crepitus or
stridor
Ant. Neck pain
Pain with nose blowing, swallowing
Dysphonia
Cough (persistent, painful)
Gagging
Decrease range of motion
Dysphagia
Dyspnea
Respiratory distress
hemoptysis
Diagnosis
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Difficult
Made with strong suspicious
(history+physical examination)
Radiographic diagnosis:
Radiograph (Cervical lateral view)
Computed tomography
Laryngoscopy
Surgical inspection (penetrating trauma)
Neck lateral view, soft tissue density
demonstrating hyoid bone fracture
• Radiolucent line, interruption of cortical
continuity, displacement of the fragment
Neck lateral view, soft tissue density
demonstrating hyoid bone fracture
CT demonstrating hyoid bone fracture
Complications
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Early complications
Subcutaneous emphysema, dyspnea,
pharyngeal tears, thyroid cartilage injury
Late complications
Dysphagia, stridor, pseudoaneurysm, of
external carotid artery
Treatment
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Close observation for minimally 48-72
hours : dysphagia, dysphonia and dyspnea
may develop quickly
Depend on severity, case by case
Laryngoscopic examination unless
contraindicated
Associated injuries Æ taken into
consideration
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Asymptomatic : close observation
Symptomatic
- mild to severe pain:
analgesics
limitation of head movement
keep soft diet
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- pharyngeal laceration
suture deep wound
remove fragment of hyoid bone fracture
fixation of fractured fragments by wiring
dysphagiaÆ NG feeding
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- external laceration of the neck
primary wound care
excision of fragment of hyoid bone
- respiratory distress
endotracheal intubation
tracheostomy
surgical exposure and drainage
of retropharyngeal space
Prognosis
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Good except rare complications
(dysphagia, crepitus by neck flexion,
pseudoaneurysm of the external carotid
artery)
Conclusion
1. fracture of hyoid bone resulting from
trauma other than strangulation is rare
„ 2.most : traffic accident
„ 3.Diagnosis:
history, clinical manifestation, laryngoscopy
Radiography
4. 48-72 hours observation
5. prognosis: good
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Reference
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1. Levine E, Taub PJ. Hyoid bone fractures. Mt Sinai J Med. 2006
Nov;73(7):1015-8.
2. Boots RJ, Joyce C, Mullany DV, Anstey C, Blackwell N, Garrett PM,
Gillis S, Alexander N.Near-hanging as presenting to hospitals in
Queensland: recommendations for practiceAnaesth Intensive Care.
2006 Dec;34(6):736-45.
3. Sethi A, Sareen D, Chopra S, Mrig S, Agarwal AK.Pharyngeal
perforation with deep neck abscess secondary to isolated hyoid
bone fracture.J Laryngol Otol. 2005 Dec;119(12):1007-9.
4. Dalati T.Isolated hyoid bone fracture. Review of an unusual
entity.Int J Oral Maxillofac Surg. 2005 Jun;34(4):449-52. Review
5. Bux R, Padosch SA, Ramsthaler F, Schmidt PH.Laryngohyoid
fractures after agonal falls: not always a certain sign of
strangulation.Forensic Sci Int. 2006 Jan 27;156(2-3):219-22. Epub
2005 Jul 15. Am J Forensic Med Pathol. 2003 Jun;24(2):179-82.
Reference
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6.Chowdhury R, Crocco AG, El-Hakim H.An isolated hyoid fracture
secondary to sport injury. A case report and review of literature.Int
J Pediatr Otorhinolaryngol. 2005 Mar;69(3):411-4. Epub 2004 Dec 8.
Review
7. Ladenheim JC.Hyoid bone fracture from a gunshot wound.J
Trauma. 2004 Jul;57(1):199
8. Gross M, Eliashar R.Hyoid bone fracture Ann Otol Rhinol Laryngol.
2004 Apr;113(4):338-9.
9. Campbell AS, Butler AP, Grandas OH. A case of external carotid
artery pseudoaneurysm from hyoid bone fracture.Am Surg. 2003
Jun;69(6):534-5.
10.Nikolic S, Micic J, Atanasijevic T, Djokic V, Djonic D.Analysis of
neck injuries in hanging.
Reference
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11.Doring A, Kahle M.[Isolated hyoid bone fracture]Unfallchirurg.
2000 Nov;103(11):996-8. German
12.Anthony R, Martin-Hirsch D, England J.Dysphagia secondary to
iatrogenic hyoid bone fracture.Br J Neurosurg. 2000 Aug;14(4):3378.
13.Miller KW, Walker PL, O'Halloran RL.Age and sex-related
variation in hyoid bone morphology.
J Forensic Sci. 1998 Nov;43(6):1138-43.
14.Pollanen MS, Chiasson DA. Fracture of the hyoid bone in
strangulation: comparison of fractured and unfractured hyoids from
victims of strangulation.J Forensic Sci. 1996 Jan;41(1):110-3.
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