Thyroid Cartilage Fracture Research Articles

Asphyxialdeath due to fracture of thyroid cartilage, cricoid cartilage and arytenoid cartilage as result of blunt trauma of neck in a motorcycle accident:An Autopsy report

Laryngeal fracture is rare but fatal traumatic injury which is mainly caused by severe blunt trauma from interpersonal violence, motor vehicle accident or sports injuries. Laryngeal fracture can lead to severe airway collapse and death.Mortality decreases to less than 5% once the airways made patent and laryngeal injuries are corrected.People must take motorcycle riding safety course to learn how to ride safely. Always follow traffic rules. The motor vehicle accident can be prevented largely through public awareness and education

Outcome of isolated and combined direct feminization laryngochondroplasty: Our first 20 cases

This retrospective study describes the surgical outcomes of our first 20 transgender women to undergo feminization thyroid laryngochondroplasty (FLC) by a direct transvestibular FLC (DTV-FLC) approach from December 2019 to October 2023. The medical records of all patients were retrieved and reviewed. Data on the operative, postoperative, and follow-up courses, complications, and functional and cosmetic outcomes were retrieved. The cosmetic results were evaluated by four independent facial plastic surgeons. Thirteen patients underwent DTV-FLC combined with genioplasty or genioplasty with mandibular angle reduction and seven underwent isolated DTV-FLC. DTV-FLC was feasible in all planned cases. Complications (skin flap perforation, thyroid cartilage fracture, mental hypoesthesia, hematoma, dehiscence of the vestibular incision, vestibular scar adhesions, and anemia) were minor and resolved spontaneously. The preoperative grade of thyroid cartilage protrusion was 1.9 ± 0.9 on a scale from 1 to 3. The postoperative cosmetic results of 18 patients were judged as having improved (a score of 2.1 ± 0.8 on a scale from −1 to 3). Eighteen patients were satisfied with the cosmetic result, one was dissatisfied (the revision surgery patient), and one was lost to follow-up. In conclusion, DTV-FTLC is a valid surgical approach for FLC, yielding high patient satisfaction and good cosmetic results.

Autopsy-Based Study of Non-accidental Violent Neck Asphyxia in Jordan: A Retrospective Study.

Background There is a global increase in the number of deaths caused by violent neck asphyxia, which includes both suicides and homicides. This research presents autopsy-based findings and analytical demographic data that are pertinent to significant medicolegal cases. Methods A retrospective examination of 113 autopsy reports of non-accidental violent neck asphyxia reported to the forensic pathology department of Al-Balqa Governorate in Jordan within the period from January 2010 to March 2023. Age, gender, and autopsy results were documented, along with medicolegal records that included toxicology reports. Conversely, information on the manner of death was derived from police inquest records. For the purpose of this research, all the cases of throttling and ligature strangulation have been determined to be homicidal, and all cases of hanging were classified as suicide. Results Males were predominant in hanging (72%), while females were predominant in ligature strangulation (82%). The mean age group in hanging was 21-35 years (51%), while the range for throttling was 36-50 years, and that in strangulation was 2-20 years. Most hanging and throttling cases showed typical external neck findings. Seventy-two percent of hanging cases (n = 68) did not exhibit any internal neck findings, while all throttling cases yielded positive results. Both hanging and strangulation by ligature cases exhibited an absence of thyroid cartilage fracture (83%). Eighty-nine cases (95%) of hanging did not exhibit any injuries to the rest of the body. However, all cases of throttling and ligature strangulation had an almost positive external body injury. In all cases of throttling and ligature strangulation, ocular petechial hemorrhage was present, whereas one-third of the hanging cases had it. Conclusion The forensic doctor must observe the pattern of ligature marks and other signs of physical assault found on the neck, meticulously examine the rest of the body, rule out other causes of death, and cooperate with the legal authorities regarding the collection of the history and death scene findings to accurately determine the manner and mechanism of death in cases of violent neck asphyxia.

External laryngotracheal trauma: a case series and an algorithmic management strategy

ObjectivesExternal laryngotracheal trauma (ELT), blunt or penetrating, is a rare but potentially life-threatening injury. Immediate care in the emergency department can be challenging because it requires managing a potentially unstable airway and may have associated vascular injuries with massive bleeding. Here, we look at the details of injury, treatment measures, and outcomes in patients following ELT.MethodsWe retrospectively analyzed 22 patients treated at our center for ELT from January 2005 up to December 2021 with varying grades of injury. We looked at their status at presentation, management strategy and functional status.ResultsIn our report, we include 18 men and 4 women having varying Schaefer injury grades. Eight patients had tracheostomy at presentation and eight had vocal fold immobility. Two patients were treated endoscopically, 12 had open surgery and 8 received no treatment. Of the patients undergoing open surgery, thyroid cartilage fracture was seen in 9 patients, thyroid plus cricoid fracture and cricotracheal separation were seen in 3 patients each. All patients were safely decannulated and spontaneous recovery of vocal cord palsy was seen in some patients.ConclusionThe success of managing ELT relies on fast decision-making, correct patient evaluation, securing the airway and maintaining the hemodynamic stability. Early surgical intervention must be aimed at optimally treating the larygotracheal injuries to prevent long-term disastrous consequences.

Thyroid cartilage fracture following sneezing as a cause of spontaneous pneumomediastinum

To evaluate the possible etiological factors of spontaneous pneumomediastinum and to describe a case that was unusual in its etiology: a thyroid cartilage fracture as a result of sneezing. Six patients (four male, two female, aged 16-82 years) were hospitalized with spontaneous pneumomediastinum diagnosed with a chest X-ray in five patients and 100% with computed tomography. Treatment was symptomatic. The commonest symptoms (cough, shortness of breath, hoarseness) were in four patients. Spontaneous pneumomediastinum developed in three cases as a result of bronchospasm during an attack of bronchial asthma, in one patient after exercise, in one after fibrogastroscopy, in one after sneezing. We report a 30-year-old man who presenting subcutaneous emphysema on the neck, hoarseness, pain when swallowing, hemoptysis developed after sneezing. His computed tomography revealed a pneumomediastinum due to fistula of the fracture of the thyroid cartilage following sneezing while simultaneously obstructing both nostrils. At laryngoscopy, there was a linear hematoma in the resolution stage on the anterior wall of the larynx. He was treated conservatively and recovered rapidly. There are no previous published reports of spontaneous pneumomediastinum following fracture of the thyroid cartilage. Fracture of the thyroid cartilage as a result of a sharp rapid increase in airway pressure during a sneeze with blocked nasal passages can be one of the rare causes of spontaneous pneumomediastinum. Avoid closing both nostrils at the same time when sneezing.

Hyoid Bone and Thyroid Cartilage Fractures at Forensic Autopsies.

Fractures of the hyoid bone (HB) and thyroid cartilage (TC) are important findings in emergency medicine and forensic pathology. This study aimed to determine the occurrence and anatomical localization of HB and TC fractures and to evaluate the etiological and risk factors.A total of 315 patients with HB and/or TC fractures were included over a 3-year period. Data regarding the incident type, cause of death, age, sex, body mass index, regional trauma findings, location of fractures, resuscitation, and toxicological analyses were collected. Injury severity scores were calculated using the Abbreviated Injury Scale.The study found that HB and TC fractures were associated with trauma severity. The hanging cases exhibited the highest number of fractures. A significant association was observed between neck trauma localization and HB and TC fractures. Fractures of the HB and TC horns were more commonly associated with neck trauma than fractures of the corpus. Hyoid bone and TC fractures can occur without direct trauma, emphasizing the importance of thorough examination and diagnosis, particularly after cardiopulmonary resuscitation.This study provides valuable insights into HB and TC fractures and contributes to the understanding and identification of these fractures in forensic autopsies and clinical settings.

Odynophagia in individuals with neck pain: the importance of differential diagnosis in physiotherapy practice.

Odynophagia refers to painful swallowing caused by various underlying factors that must be excluded to determine the best treatment approach. Neck pain is a debilitating condition requiring treatment in rehabilitative settings. There are several circumstances in which odynophagia and neck pain coexist, such as tendinitis of the longus colli muscle and paravertebral calcification, prevertebral and retropharyngeal abscess, esophageal perforation, aortic dissection, thyroid cartilage fracture, thyrohyoid ligament syndrome, pneumomediastinum and subcutaneous emphysema, and after physical exercise. Physiotherapists are professionals most likely to encounter individuals with neck pain and provide interventions such as massage, manual therapy, exercise, and electrotherapy. Therefore, it is important to recognize that neck pain can stem from different clinical conditions that require interventions other than physiotherapy. A differential diagnosis is crucial to ensure appropriate referrals for therapeutic interventions.

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.

Homicide by Hanging: a Comprehensive Review of Published Literature

Homicide by hanging is a rare incident and, in contrast to suicidal hanging cases, only limited number of homicidal hanging cases have been reported. This comprehensive review is conducted to summarize the published forensic pathology evidence in homicide by hanging. A systematic search in five journal databases resulted in 12 case reports. All articles passed the selection criteria and were appraised using JBI critical appraisal worksheet for case reports. Fourteen victims were reported which in most of the cases psychosocial background were reported. Household conflict was the common background. Reef knot was the majority knot being used. The autopsy findings vary in the studies, some of which reported intact larynx, thyroid, and hyoid cartilage. Only one case mentioned thyroid cartilage fracture. In addition to the ligature mark, other violence findings include bruises, abrasions, stab wounds, and sexual violence. Toxicological analysis was limited, only 3 case reports reported alcohol in the victim’s serum. There are no distinguishing features in the external or internal neck injuries attributable to homicidal hanging. A thorough autopsy and holistic approach should be considered. They are including demographic characteristics, location of the victim, social and psychiatric history, ligature’s characteristic, signs of violence and toxicological analysis.

A Comparative Observational Study of Postmortem Computed Tomography and Traditional Forensic Autopsy Findings in Hanging Cases

Background: The use of advanced radiological techniques is rising in the field of forensics to supplement and validate the evidence. Postmortem Computed Tomography (PMCT) is now used as a standard procedure in many institutions to augment traditional autopsy findings. The application of PMCT in hanging cases will greatly reduce the number of invasive traditional autopsies, as hanging is the most common method of suicide in Northern parts of India. Therefore this observational study was conducted to compare PMCT with traditional autopsy in fifty hanging cases. Result: Out of 50 cases, the age of the subjects ranged between 14 years and 70 years. PMCT with the help of 3D reconstruction was able to detect external ligature marks on the neck in 92% (N=46) of cases giving a sensitivity of 92% (CI = 80.77% to 97.78%). Skin and subcutaneous tissue desiccation were identifiable in 96% (N=48) by PMCT, giving a sensitivity of 96% (CI= 86.29% to 99.51%). The muscle hemorrhage was identified in 4% (N=2) of the cases in traditional autopsy while the authors found difficulty in interpreting the muscle hemorrhage in PMCT. In detecting thyroid cartilage fracture, the sensitivity of PMCT was found to be 100% (CI= 15.81% to 100.00%) and specificity of 100% (CI=92.60% to 100.00%). In detecting hyoid bone fracture, the sensitivity was 100% (CI= 2.50% to 100.00%), and specificity of 100% (CI=92.60% to 100.00%). In addition, there was a great degree of agreement between the two observers for these findings suggesting the reproducibility of the result. Conclusions: A consistency in findings of both the PMCT and traditional autopsy was found. However, CT was unable to detect muscle hemmorhages, compared to traditional autopsy. Authors suggest the use of CT angiography to overcome this shortcoming, till then CT can only augment invasive autopsy findings not replace it

Pain in the neck: Bench press injury.

A 49-year-old man with a history of hepatitis C infection presented to the emergency department with neck pain and hoarseness immediately after a blunt neck injury. He was bench pressing a 100 kg barbell when the safety bar broke. The bar slowly landed on his neck and remained there for a few seconds. On examination, his vital signs were normal except for hypertension, 167/106 mm Hg. His neck was tender to palpation, without swelling or ecchymosis. He had hoarseness, but the airway was patent without stridor. He showed no signs of respiratory distress. Computed tomography (CT) scan showed thyroid cartilage fracture and right arytenoid hematoma (Figure 1). Flexible fiberoptic laryngoscopy performed in the emergency department confirmed a right arytenoid hematoma with intact airway (Figure 2). Platelet count and prothrombin time-international normalized ratio were normal. Due to concerns of an impending airway emergency from the hematoma, he stayed in the observation unit for 12 hours. A second fiberoptic laryngoscopy on the next day showed no enlargement of the hematoma. He was discharged with close follow-up and recovered without any adverse events. Blunt laryngeal trauma is a rare but potentially life-threatening condition often caused by motor vehicle collisions, sport-related injuries, physical assaults, and strangulation. Clinically, it can cause neck pain, hoarseness, dyspnea, stridor, ecchymosis, crepitus, and airway obstruction.1 The first step in management is to assess and, if necessary, secure the airway. CT scan and flexible fiberoptic laryngoscopy are the key diagnostic tests for suspected laryngeal injury.2 A high index of suspicion and judicious use of diagnostic modalities are required as some patients with significant injuries may not have obvious signs of trauma, as in this case. Patients with high-grade injuries may require surgical intervention.3 Early intervention is the key to a good functional outcome.4

Larynx and thyroid cartilage fracture after work accident and forensic medical evaluation

Laryngeal injuries are rare but can be fatal. Depending on the type and severity of the trauma, thyroid and laryngeal cartilage fractures, full-thickness mucosal tears, tracheolaryngeal separation, and injuries leading to pneumomediastinum may be observed. Laryngeal traumas can occur either bluntly or penetratingly. Blunt traumas typically result from traffic accidents, falls, and sports injuries, while penetrating injuries are often caused by gunshot wounds or sharp objects. In this particular case study, the case was a 24-year-old male who was brought to the emergency room after being struck by a forklift at In his physical examination, a 10x1 cm wound was observed on his right scapula, along with subcutaneous emphysema in the subclavicular region. As a result of the examinations, the patient was found to have fractures of the larynx, thyroid cartilage, 8th rib and pneumomediastinum. In this study, it was thought that the thyroid and larynx cartilage fractures occurred as a result of hyperflexion/hyperextension of the neck without a direct blow to the neck region. This case is being presented because it is a rare occurrence in the literature, primarily due to its unique mechanism of injury.

A Study of Postmortem Findings of Asphxial Deaths Due to Hanging in a Semi Urban Region of Karnataka

Hanging, a method of deliberate & intentional self-harm amounts for a major proportion of autopsies whichmedicolegal experts encounter in their clinical tenure at various hospitals pan India. A retrospective study wasconducted in the Department of Forensic Medicine and Toxicology, Kanachur Institute of Medical Sciences,Mangalore from Jan 2016 to June 2022, with an objective to study the post mortem findings in autopsy casesof hanging. Out of 306 autopsies, 14.38 % cases were that of hanging with a female to male ratio being 3:1.Most cases were atypical (81.81%,36) and partial hanging (72.72%, 32) with the ligature mark situated abovethe thyroid cartilage. 86.36 % of cases (38) had dried salivary stain at the angle of mouth and one case showedinvoluntary discharge. The incidence of fracture of hyoid bone and thyroid cartilage not observed in any cases

Isolated Thyroid Cartilage Fracture Caused by Neck Hyperextension During Motor Vehicle Accident with Atypical Neck Pain (Case Report)

Isolated Thyroid Cartilage Fracture Caused by Neck Hyperextension During Motor Vehicle Accident with Atypical Neck Pain (Case Report)

Management of Laryngotracheal Trauma During the COVID 19 Pandemic: Our Experience.

Objective To study the outcomes in terms of airway, voice and swallowing as well as the economic impact of the trauma on patients' finances and the constrained health infrastructure due to the pandemic. Materials and methods Study design Retrospective study. Setting: Tertiary care teaching hospital. Subjects and methods: A retrospective study was done of the 19 subjects who sustained acute laryngotracheal trauma during the SARS CoV-2 pandemic and was managed at our institution from January 2020 to September 2021. Results Change in voice was the most common presenting symptom and thyroid cartilage fractures were the commonest cartilage injury noted. It was found that 93% (decannulated) of the patients had good functional outcome and 90% of them required financial support to meet the medical expenses. Conclusion During the COVID 19 pandemic, it was not only, early presentation, timely detection and intervention by the treating team, but also the multidisciplinary teamwork and the support system that facilitated the recuperation and restoration of these traumatized individuals back into society with good laryngeal function.

Successful treatment with femoro-femoral venovenous extracorporeal membrane oxygenation in traumatic tracheal injury: a case report

BackgroundTraumatic tracheal injury is a rare type of trauma. In this type of injury, catastrophes may occur owing to a failure to secure the patient's airway. Extracorporeal membrane oxygenation (ECMO) is rescue therapy available for the treatment of urgent cardiorespiratory distress until the patient's vital signs have stabilized. The various applications of ECMO configurations have expanded the scope for this therapy.Case presentationWe describe the case of a 66-year-old man with tracheal rupture with thyroid cartilage fracture due to cultivator handle who was treated with veno-venous ECMO. This case reflects the role and limitations of veno-venous ECMO, in which patient survival was possible with a bi-femoral configuration while also ensuring a clear airway.ConclusionWe shared our experience with bi-femoral veno-venous ECMO as a therapeutic option to contribute to choosing an appropriate approach. Based on our review of the literature, the present case was an uncommon report of survival after tracheal rupture due to trauma without other complications.

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.

Zlomenina kostry hrtanu – kazuistika

Laryngeal injury is a rare condition that may threaten the patient’s life with airway obstruction. Early dia­gnostics is the key management factor. Schaefer’s classification is the most commonly used classification to assess the extent of the injury. Based on this classification, a recommended management of therapy has been developed. There are several opinions on securing the airway by the orotracheal intubation. The authors present a case report of a 40-year-old male with thyroid cartilage fracture caused by a punch to the neck. The patient did not show signs of dyspnoea, had swollen neck and subcutaneous emphysema. Imaging by computed tomography showed a laryngeal fracture. A reconstruction of the thyroid cartilage and a tracheostomy in general anaesthesia were performed. Postoperative course was propitious, and the patient could be decannulated. It is important to consider a laryngeal injury in patients with external neck trauma. The key elements are early dia­gnosis and therapy, in which securing the airway is the crucial step. Further an effort should be made to create conditions for preserving laryngeal functions (respiration, phonation, and swallowing). Key words laryngeal injury – laryngeal fracture – larynx – tracheostomy

Facilitation of endotracheal intubation using a bougie in a patient with unilateral vocal cord due to a traumatic thyroid cartilage fracture

Facilitation of endotracheal intubation using a bougie in a patient with unilateral vocal cord due to a traumatic thyroid cartilage fracture