Hyoid Fracture Research Articles

Hyoid fracture: consensual sex-play or non-consensual nonfatal strangulation: a case report.

Hyoid fractures are uncommon, but when they occur they are commonly the result of strangulation or hanging. Although there is a lack of available quantitative data, there is increasing evidence to suggest that strangulation is a relatively common feature of consensual sex play. This creates difficulty in clinical forensic medicine given the "rough sex" defence has previously been used successfully in cases of fatal intimate partner strangulation. We present a case where consensual and non-consensual strangulation has occurred in a woman who presents with a hyoid fracture. While manual strangulation was thought to be a more likely mechanism than consensual wearing of a sex-collar; ultimately the similar timeframes of the collar-wearing and the non-consensual manual strangulation meant that the accused was not convicted of this particular strangulation offense. This case highlights the importance of further research into consensual strangulation and the incidence of resultant injuries. It also demonstrates the importance of collecting a detailed forensic history and adequately documenting injuries in a contemporaneous matter.

Injury of the Hyoid Bone as a Rare Complication in Cervical Spine Rehabilitation: A Case Report.

Neck pain is a common reason for primary care visits, and its differential diagnosis should consider various conditions. The reported incidence of hyoid bone fractures is extremely low, accounting for only 0.002% of all fractures. The most common causes of hyoid bone fractures include strangulation attempts and motor vehicle accidents. We report a case of an uncommon complication of manual therapy of the cervical spine. A 76-year-old woman complained of neck pain that worsened during speaking and swallowing, originating from a neck physiotherapy session. The otolaryngological examination revealed tenderness on the right side of the neck. Flexible nasal endoscopy demonstrated a shallow right piriform recess and asymmetry of the arytenoid cartilages. Computer tomography scan of the neck showed an isolated fracture of the right greater horn (cornu major) of the hyoid bone. The treatment was nonsurgical, with the use of a Schantz collar and pain relief drugs. Reported symptoms of hyoid bone fractures include dysphagia, odynophagia, and neck pain. In most cases of hyoid fractures, conservative management suffices, involving rest, analgesic and anti-inflammatory treatment, and neck immobilization. Surgical treatment is often necessary in the cases of fractures accompanying other injuries.

Analysis of female strangulation homicides in King County, Washington, from 1978 to 2022.

Asphyxia due to strangulation is an uncommon but important modality of homicide that tends to disproportionately involve female victims. The present study was designed to investigate the circumstances, motivations, and injuries associated with strangulation homicides of females and to measure trends in incidence over time. Electronic records of the King County Medical Examiner's Office in Seattle, Washington, were used to compile a data set of all homicides in King County from 1995 through 2022. A second data set of female homicides due to strangulation was constructed with additional records prior to 1995, supplemented with data abstracted from autopsy reports, and linked to the Washington Attorney General's Office Homicide Investigation Tracking System database. This comprehensive data set was used to analyze demographics, circumstances, motives, and injuries of female strangulation homicides from 1978 through 2016. The results found that, from 1995 through 2022, females accounted for 22.8% of 2394 homicides but 80.3% of strangulation homicides. The average annual rate of all strangulation homicides decreased until 2020. Mean ages of female decedents were 27.7 years in homicides associated with sexual assault, 36.8 years with domestic violence, and 63.9 years with robbery. Lethal assaults most often occurred in private homes, and perpetrators were usually well known to the victim. Injuries included petechiae in 83%; ligature marks in 20%; fingernail marks in 1.4%; hyoid fractures in 23%; and thyroid cartilage fractures in 31%. Fractures were more common in manual strangulation and in decedents of ages over 40 years.

CT Findings in Laryngeal Trauma and the Clinical Implications.

Acute traumatic osseous and cartilaginous injuries to the larynx are rare injuries presenting to the emergency department. Despite the low reported incidence, laryngeal trauma carries ahigh morbidity and mortality. The purpose of this study is to identify fracture and soft tissue injury patterns in laryngeal trauma and explore associations with patient demographics, mechanisms of injury, urgent airway and surgical intervention. Aretrospective review of patients with laryngeal injury who underwent multidetector computed tomography (MDCT) imaging was performed. The CT findings of laryngeal and hyoid fracture location, fracture displacement, and soft tissue injuries were recorded. Clinical data including patient demographics, mechanisms of injury, frequency of airway and surgical intervention were also recorded. Correlation of imaging characteristics with patient demographics, mechanism of injury and interventions were assessed for statistical significance using χ2 and Fisher's exact tests. The median patient age was 40years old with astrong male predominance. The most common mechanisms of injury included motor vehicle collisions and penetrating gunshot wounds. Thyroid cartilage fractures were the most common fracture type. Findings of fracture displacement and airway hematoma had ahigher correlation with requiring urgent airway management. Radiologists' early recognition and prompt communication of laryngeal trauma to the clinical service is important to reduce associated morbidity and mortality. Displaced fractures and laryngeal hematomas should be promptly conveyed to the clinical service as they are associated with more complex injuries and higher rates of urgent airway management and surgical intervention.

Isolated Hyoid Fracture Associated with Blunt Trauma

Trauma-related hyoid fractures are rare entities. These fractures represent only 0.002% of head and neck region fractures. Victims of hanging and strangling constitute the great majority of cases. Fractures associated with trauma are extremely rare. These fractures are difficult to diagnose and can easily be overlooked during physical examination. However, they are also important traumas since airway safety is endangered in these rare cases. We describe a case of a young male presenting with isolated neck injury associated with hitting an electric cable while riding a motorbike. Tenderness was present in the anterior neck region at physical examination, but movement was not restricted and no respiratory difficulty was determined. Isolated hyoid fracture was detected at tomography of the neck performed in the emergency department. Hyoid bone fractures should not be forgotten in patients with pain and tenderness in the anterior neck region following blunt trauma to the neck.

Hyoid Kemik Büyük Boynuz Kırığı

The primary symptom of a hyoid bone fracture is a sharp pain that increases with swallowing, coughing, and speaking in front of the neck. Closed hyoid fractures may be asymptomatic or may be missed in the presence of multiple injuries. It may cause clinical findings such as difficulty in swallowing and speaking, pain, limitation in mouth opening. Soft and hard tissue manifestations of neck trauma should be carefully evaluated. If there is a strong clinical suspicion of organ damage, ancillary diagnostic methods such as computed tomography, direct nasolaryngoscopy, pharyngoscopy, and laryngobronchoscopy may be useful to exclude or confirm the possibility of injury.

The Multidisciplinary Approach for the Diagnosis of Laryngohyoid Lesions: a Systematic Literature Review and Meta-Analysis.

The diagnosis of neck lesions remains a medico-legal diagnostic challenge because of the complexity of the anatomical relationship of the neck's organs and their anthropometric morphological variability. We compared the multidisciplinary approach using autopsy and postmortem computed tomography (PMCT), postmortem fine preparation (PMFP), postmortem micro-computed tomography (micro-CT), and postmortem magnetic resonance (PMMR) with the performance of a single diagnostic method among them evaluating the significance of different results. The multidisciplinary approach significantly reduced the number of unidentified neck lesions. The analysis demonstrates the need to better define the scan protocols and compose forensic guidelines for radiological application. The results of this study point out the need to compare the different diagnostic approaches in deceased subjects to better define the radiological scan protocol based on a multidisciplinary approach, including autopsy and radiological methods and the radiological scan protocols. We performed a systematic electronic search of retrospective scientific articles in PubMed, the Scopus database, and the Cochrane Library. The following combinations of words were used: "hyoid fracture"; "comparison between PMCT AND autopsy"; "hyoid fracture PMCT AND autopsy"; "hyoid bone fracture AND forensic imaging"; "hyoid fracture AND PMCT"; "neck fracture PMCT AND autopsy"; "laryngohyoid lesions"; "postmortem CT AND autopsy in strangulation"; "postmortem AND strangulation Signs "; "strangulation virtopsy"; and "strangulation AND MRI". We selected 16 articles that were published between March 2003 and June 2020. We conducted a meta-analysis with R software to evaluate the rates. We obtained related confidence intervals and a forest plot. Thyroid cartilage damages were significantly more common than hyoid bone fractures (61.7% vs 42.2%) in a sample of 128 subjects. The synergic uses of autopsy/PMCT, autopsy/PMFP, autopsy/microCT, and autopsy/PMMR revealed significantly higher rates than a single investigation. We analyzed the PMCT scan data. The scan parameters evaluated were as follows: row, scan sample, reconstruction, kernel, slice thickness, kVp, and mAs. A lack of uniformity in the application of the protocol was observed. Further studies are needed to better define the radiological scan protocols and to draw guidelines to identify the appropriate radiological methods in relation to the specific case.

Pattern of Death Due Hanging Special Emphasized on Neck cartilages

introduction: Commonest form of asphyxial death come across during autopsy in the country is Hanging. The present study was carried out to studying the pattern of fracture in hyoid bone and neck cartilage (thyroid cartilage and cricoids) in deaths due to hanging in the Department of Forensic Medicine, M. P. Shah Govt. Medical College, Jamnagar. We found that death due to compression of ligature seen maximum in the age group of 21-30 years (36.9%), males are accounted for 43% as compared to 57% in females. Ligature material used was dupatta in 43.68% of cases. In hanging ligature mark was oblique, above thyroid cartilage, going backward and laterally. In the majority cases, the ligature mark was above the thyroid cartilage (88% cases), followed by at and above the thyroid cartilage (10% cases) and only in 1 case the ligature mark was below the thyroid cartilage. In maximum cases, the position of the knot was present at the occipital region of the neck (49% cases), followed by the left mastoid region (30% cases). In the majority of cases, the ligature mark was prominent and discontinuous. Hyoid fracture was found in only 8.05% cases. There was only 1 case with thyroidcartilage fracture and no case of cricoidcartilage fracture.

Ligature strangulation in 2001–2020 in the materials of the Jagiellonian University Department of Forensic Medicine, Kraków

Aim: The aim of the study was to analyze and compare the most common post-mortem changes which can be found in the body after ligature strangulation and compare it with the most recent literature. Materials and methods: autopsy protocols from years 2001–2020 gathered in the Department of Forensic Medicine in Kraków were investigated. 37 cases of certain and possible strangulation were found and analysed. Prevalence of ligature strangulation, age, sex, information concerning perpetrator and post-mortem changes were considered. Results: we found and analysed 37 cases, however only in 16 cases the certain cause of death was ligature strangulation. in the remaining 18 cases the mechanism of death was not precisely defined. in 3 cases advanced late post-mortem changes disturbed establishment of certain identification. Women constituted 87.5% of all victims, while men 12.5%. among 16 certain ligature strangulations we analysed the most important post-mortem changes. Both subconjunctival hemorrhagic petechiae and facial skin petechiae were observed in 93.8% of the cases, laryngeal or hyoid fracture in 56.3%, and hemorrhages in neck muscles were detected in 87.5% of the cases. Conclusions: The most frequent post-mortem changes after ligature strangulation include subconjunctival petechiae, facial skin petechiae and hemorrhages in the neck muscles which are convergent with the data found in literature. The autopsy may not indicate the circumstance of strangulation.

Hyoid Bone also Known as Suicide Bone – A Case Report

Objective: The goal of this paper is to provide a case of traumatic hyoid bone fracture as well as a literature review. Rationale: Traumatic hyoid bone fractures are uncommon; but, as martial arts become more popular, the incidence of traumatic hyoid bone fractures may rise. Clinical Characteristics: After getting a kick to the anterior neck, a thirteen-year-old taekwondo athlete fell. Following immediate first-aid treatment, the athlete complained of difficulty speaking and swallowing, as well as breathlessness. Over the hyoid bone, there was ecchymosis and soreness. Intervention and Result: Lateral radiographs indicated a hyoid fracture. The patient was given analgesics and told to rest at home. At four weeks after the injury, the athlete was cleared to return to sports. Conclusion: In the management of suspected bone fractures, ensuring airway integrity and screening for symptoms of laryngeal laceration are critical. It is strongly advised that you observe for 48-72 hours. (JCCA 2012; 56(4):269-274)

Hyoid Bone also Known as Suicide Bone – A Case Report

Objective: The goal of this paper is to provide a case of traumatic hyoid bone fracture as well as a literature review. Rationale: Traumatic hyoid bone fractures are uncommon; but, as martial arts become more popular, the incidence of traumatic hyoid bone fractures may rise. Clinical Characteristics: After getting a kick to the anterior neck, a thirteen-year-old taekwondo athlete fell. Following immediate first-aid treatment, the athlete complained of difficulty speaking and swallowing, as well as breathlessness. Over the hyoid bone, there was ecchymosis and soreness. Intervention and Result: Lateral radiographs indicated a hyoid fracture. The patient was given analgesics and told to rest at home. At four weeks after the injury, the athlete was cleared to return to sports. Conclusion: In the management of suspected bone fractures, ensuring airway integrity and screening for symptoms of laryngeal laceration are critical. It is strongly advised that you observe for 48-72 hours. (JCCA 2012; 56(4):269-274)

Rare inward compression fracture of hyoid bone in hanging: A case report and review of literature

Fracture of hyoid and laryngohyoid complex may result from violence like strangulation, hanging, accidents, therapeutic interventions or postmortem processing. Inward compression fracture of hyoid bone usually indicates strangulation, and unexpected finding of hyoid fracture may cast suspicion of throttling or manual strangulation and may misguide the investigation. Here, we report a case of a rare, occurring inward compression fracture of hyoid bone identified in the autopsy examination of a 41-year-old decedent male who committed suicide by complete hanging.

Hangings: Lessons Learned from the Coroner's Office

BackgroundHangings are an infrequent wounding mechanism among patients arriving alive to hospital but are frequently encountered by the Coroner's Office. It is unclear if classically described hanging injuries, such as the Hangman's fracture, are common among contemporary hangings patients who typically do not suspend from height. This study was undertaken to define patient and injury characteristics after hangings causing death. MethodsAll patients presenting to the Los Angeles County Medical Examiner/Coroner's Office (January 2016 – May 2020) who died by hanging were included. Demographics, psychiatric history, hanging details, autopsy type, and sustained injuries were collected. Data variables were summarized with descriptive statistics and the diagnostic yield of a ligature mark in the diagnosis/exclusion of cervical injuries was calculated. ResultsOver the study, 1,401 patients died by hanging. Patients underwent external exam alone (n = 1,282, 92%), traditional neck autopsy (n = 114, 8%), or traditional neck autopsy plus postmortem computed tomography scan (n = 5, <1%). Home was the most frequent hanging setting (n = 1,028, 73%) followed by public spaces (n = 80, 6%) and jail (n = 28, 2%). The manner of death was almost exclusively suicide (n = 1,395, >99%) and psychiatric disease was common (n = 968, 69%). Of the patients undergoing traditional autopsy, most had a ligature mark (n = 109, 92%) and only 9 (8%) had a cervical injury (hyoid fractures, n = 6, 5%; thyroid cartilage fractures, n = 4, 3%). None had a vertebral fracture/dislocation. Sensitivity, specificity, positive predictive value, and negative predictive value of a ligature mark were 100%, 5%, 8%, and 100%. ConclusionsHangings are a frequent cause of death in Los Angeles County. Patients typically have a psychiatric history and die almost exclusively from suicide. Hangings commonly occur at home, in public places, and in jail. Injuries were exceedingly rare and no patient sustained a Hangman's fracture, which may be related to the lack of significant suspension with modern hangings.

CT-based assessment of laryngeal fracture patterns and associated soft tissue abnormality.

Acute traumatic injuries to the larynx, including fractures of the hyoid bone, cricoid, and thyroid cartilage, are uncommon injuries. The purpose of this study was to assess fracture and soft tissue patterns associated with laryngeal trauma. This was a retrospective review of patients with laryngeal fractures who presented to two level I trauma centers and underwent CT imaging. Imaging findings, including fractures of the cartilaginous structures of the larynx and hyoid bone, and soft tissue abnormalities including focal hematoma, edema with non-focal hemorrhage, and additional penetrating injuries were recorded. Frequencies of fracture patterns were recorded. Thyroid cartilage fractures were most frequently observed occurring in 45/55 patients, followed by cricoid fractures in 13/55 patients. Hyoid fractures were encountered in 8/55 patients. Multi-site fractures were observed in 12/55 patients with thyroid-cricoid fractures occurring in 8/12 patients, followed by thyroid-hyoid fractures in 2/12 patients. Most multi-site fractures occurred in association with focal supraglottic hematomas (10/12), supraglottic edema and non-focal hemorrhage (11/12), and focal subglottic hematoma (5/12). All 13 cricoid fractures occurred with either focal supraglottic hematoma (7), focal subglottic hematoma (4), or edema with non-focal hemorrhage (13). Thyroid cartilage fractures were the most frequently encountered fracture, followed by cricoid cartilage fractures. Cricoid fractures always occurred with soft tissue abnormalities. Recognition of fracture patterns in the setting of laryngeal trauma and associated patterns of soft tissue injury is important for practicing radiologists for early diagnosis of these conditions and reduction of associated morbidity. • Acute fractures to the larynx may be isolated fractures or occur as multi-focal fractures. • Thyroid cartilage fractures are the most frequent fractures followed by cricoid cartilage fractures. • Cricoid cartilage fractures always occurred in association with soft tissue abnormalities.

Isolated hyoid fracture as the result of judo practice: a rare cause of globus sensation in ENT outpatients

Isolated hyoid fractures are rare injuries, usually associated with road traffic accidents, trauma or strangulation.[1][1] The majority present immediately to the emergency department with neck pain, dysphagia and dysphonia. Severe...

Retrospective Analysis of 73 Hanging and Ligature Strangulation Cases.

Objective To retrospectively analyze 40 cases of hanging and 33 cases of ligature strangulation in Kunming, to explore the neck injury characteristics and similarities and differences of related asphyxia signs of corpses in hanging and ligature strangulation cases, in order to provide reference for forensic identification. Methods Statistics of hanging and ligature strangulation cases accepted by Kunming Municipal Public Security Bureau from 2000 to 2017 were collected. Data including the gender, age, injury tool, neck injury and related asphyxia signs of the deceased in hanging and ligature strangulation cases were statistically tested by SPSS 23.0. Results There were more males in hanging cases than females. However, there were more females than males in ligature strangulation cases. In hanging cases, suicide was common, while homicide was rare. In ligature strangulation cases, homicide was common, while suicide or accidental death was rare. The average age of the deceased in hanging cases were older than those in ligature strangulation cases. The ligature mark in hanging was usually above the thyroid cartilage. The ligature mark in ligature strangulation was usually at the same level of the thyroid cartilage. The most common vital reactions were exfoliation and subcutaneous hemorrhage at the ligature mark, common among the deceased in hanging cases. Hyoid fracture rate of the deceased in ligature strangulation cases was more common than those in hanging cases. Conclusion The gender, age distribution, position of ligature mark, detection rate of vital reactions at the ligature mark and hyoid fracture rate of the deceased can help distinguish hanging from ligature strangulation.

An Extremely Rare Isolated Hyoid Bone Fracture in a Patient Involved in a Traffic Accident

Hyoid fractures in victims of strangulation and hanging are well defined. Nevertheless, an isolated hyoid bone fracture caused by blunt neck trauma is extremely rare and accounts for only 0.002% of all fractures. The diagnosis of a patient with a hyoid bone fracture can be difficult. This type of fracture may go unseen during a physical examination, causing a life-threatening airway obstruction. We present a case of a young male with an isolated fracture of the hyoid bone induced by direct blunt neck trauma. The patient complained of anterior neck pain. A physical examination revealed tenderness in the neck, but no respiratory distress or limited range of motion of the neck was detected. A cervical computed tomography scan revealed a bony fracture involving the right greater horn of the hyoid bone with adjacent soft tissue swelling. A hyoid bone fracture should be considered when neck tenderness and pain are detected following blunt trauma to the neck region. J Curr Surg. 2018;8(1-2):18-21 doi: https://doi.org/10.14740/jcs346e

Prevalence of hyoid injuries in dogs and cats undergoing computed tomography

Fractures of the hyoid bones have been reported occasionally in dogs, but the prevalence and significance of hyoid injury in dogs and cats are unknown. In human beings, hyoid injury is rare and usually is caused by direct trauma to the greater cornu, which are analogous to the paired canine and feline thyrohyoid bones. The aim of this study was to describe the prevalence and morphology of hyoid bone injury detected in dogs and cats undergoing computed tomography (CT) for unrelated disease. CT studies of 293 dogs and 100 cats from 2012 to 2016 were identified and reviewed retrospectively. Hyoid fracture (total of eight bones) or luxation (total of four sites) was present in 9/293 (3.1%) dogs, but none of the cats. One dog had bilateral fractures and one dog had bilateral luxations. The most frequently fractured bone was the epihyoid bone (4/8 fractures). Fracture margins were tapered and sclerotic, consistent with chronic non-union. There was no history of trauma, dysphagia or dyspnea in 7/9 dogs with hyoid fractures. Hyoid bone injury, particularly epihyoid bone fracture, may be an incidental finding in dogs.

Crucial Factors Frequently Overlooked in Deaths due to Hanging: A Prospective Study

For long time forensic investigators have considered Hyoid and laryngeal injuries as important findings in cases of deaths due to strangulation. Further the incidence of injuries to the neck structures in such cases being related to various factors like the age, gender, the type of the hanging based on suspension and the position of the knot are well documented. Our study highlights the impact of other crucial factors which are usually overlooked, but having strong association in the deaths due to strangulations in general and hanging in particular. The study was undertaken in Central Delhi in 100 cases of hanging, where we studied the association between the hyoid and laryngeal fractures with other variables like type of the ligature material used, the number of turns around the neck, the width of the ligature mark, the type of the knot (fixed/running noose), the duration of suspension and the Body Mass Index of the individuals. In our study 42% of cases had hyoid/laryngeal injuries. These injuries were more common in those who had used hard ligature material with more than one turn around their neck and with a broader ligature mark on their neck. Hyoid and laryngeal injuries were also more common in victims who had a running noose and a prolonged duration of suspension.

Management of traumatic hyoid bone fractures: A case series

Purpose: Hyoid bone fractures are uncommon, reported mainly in cases of hanging. There is a paucity of reports involving other mechanisms, and only a handful of case reports are available to guide the management of these fractures, especially within the emergency department setting. This study focused on identifying optimal initial airway management and subsequent treatment of patients with hyoid fractures. Methods: Patients presenting to an adult major trauma referral centre between January 2007 and July 2014 with a diagnosis of hyoid bone fracture were identified. Patient records were reviewed retrospectively. Results: Of the 19 patients identified, 16 cases were secondary to blunt force trauma. Motor vehicle crashes accounted for eight of the 19 cases. All patients with major trauma were intubated as part of their initial airway management, while 50% of the minor trauma patients were intubated. Only one patient underwent surgical repair of the hyoid bone. Most patients experienced excellent outcomes with no hyoid fracture-related complications. Conclusion: Early intubation for suspected hyoid fractures is advised for those with a penetrating mechanism of injury, clinical features of airway compromise, and severe associated injuries. Conservative, nonsurgical management of hyoid fractures remains the mainstay of management. A minimum 24-hour period of observation for patients who are not managed with endotracheal intubation is advised.