Traumatic fracture of the hyoid bone: Three case presentations of cardiorespiratory compromise secondary to missed diagnosis

Hyoid bone fractures secondary to blunt trauma other than strangulation are rare (ML Bagnoli et al., J Oral Maxillofac Surg 1988; 46: 326-8), accounti ng for only 0.002 per cent of all fractures. The world literature reports o nly 21 cases. Surgical intervention involves airway management, treatment o f associated pharyngeal perforations, and management of painful symptomatol ogy. The importance of hyoid fracture, however, rests not with the rarity o f it, but with the lethal potential of missed diagnosis. We submit three ea ses with varying presentations and management strategies. All three of our cases incurred injury by blunt trauma to the anterior neck. Two patients re quired emergent surgical airway after unsuccessful attempts at endotracheal intubation. One patient presented without respiratory distress and was man aged conservatively. After fracture, the occult compressive forces of hemat oma formation and soft tissue swelling may compromise airway patency. It is our clinical observation that hypoxia develops rapidly and without warning , leading to cardiorespiratory collapse. With endotracheal intubation prohi bited by obstruction, a surgical airway must be established and maintained. Recognition of subtle clinical and physical findings are critical to the d iagnosis of laryngotracheal complex injuries and may be life-saving in many instances. To ensure a positive outcome, a strong degree of suspicion base d on mechanism of injury is mandated.