Injury risk related to the helmet strap: Mandible and hyoid bone fractures with a hyoepiglottic ligament lesion

Abstract

The case we present isunusual.2. Case reportA 65-year-old male motorcycle accident victim wasbrought to the emergency department of our hospital.On arrival, he was awake and oriented. He had significantbleeding from the mouth and was in respiratory distress; healso had neck swelling and subcutaneous crepitus withoutsignificant pain (spontaneous or provoked by pressure). Physicalexamination of the neck was difficult because of the presenceof an orthopedic collar; he reported painful swallowing. Theskin on the chin was lacerated. No nosebleed or other skin injurywas present. He had dysphonia, with a guttural, helium-likevoice.The patient wore superior and inferior removable dentalprostheses: the inferior one had been broken and lost duringthe crash, while the superior one had been damaged, but notdislodged. After removing it, no mucosal wounds were seen in theoral cavity and no blood was seen draining from the pharynxposteriorly.Because bleeding from the nose and mouth were excluded, anENT surgeon and anesthesiologist were consulted with regard tothe respiratory distress, and the patient was intubated. Subse-quently, fibre optic endoscopy was used to evaluate the upperaero-digestive tract (UADT): a large laceration was found in theglossoepiglottic region, with a hyoepiglottic ligament lesion andsubsequent posterior epiglottis collapse on the glottic plane(Fig. 1). As the patient was stable and could be monitored,computed tomography (CT) was performed and showed fracturesof the mandibular symphysis and left condyle, thyroid cartilage,andhyoidbonebilaterally,withdisarticulationofthehyoidcorpusfrom the greater horns (Fig. 2). Significant subcutaneous emphy-sema of the neck was also seen. A maxillofacial surgeon was askedto evaluate the mandibular fractures. The physical examinationalso revealed left wrist trauma; standard X-rays showed disloca-tion of the lunate bone and a temporary brace was applied toimmobilise the wrist.The patient was transferred to the intensive care unit (ICU).Three days later, CT was repeated to re-evaluate the cervical softtissue emphysema, which appeared to have decreased slightly,with expected partial healing of the UADT fistula.Subsequently,thepatientwasbroughttotheoperatingroomtoundergo laryngoscopy, a tracheostomy to protect the lowerairways, a CO