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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 7  |  Issue : 1  |  Page : 22-25

Bilateral hyoid bone fracture associated with panfacial trauma - A rare intity


1 Postgraduate Student, Department of Oral and Maxillofacial Surgery, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
2 Professor, Department of Oral and Maxillofacial Surgery, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
3 Reader, Department of Oral and Maxillofacial Surgery, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
4 Senior Lecturer, Department of Oral and Maxillofacial Surgery, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
5 Postgraduate, Department of Oral and Maxillofacial Surgery, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India

Date of Submission06-May-2022
Date of Acceptance15-Jun-2022
Date of Web Publication30-Jun-2022

Correspondence Address:
Dr. Satish Kumar Ram
Department of Oral and Maxillofacial Surgery, Awadh Dental College and Hospital, Danga, P. O.-Bhilaipahari, Jamshedpur - 831 012, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmo.ijmo_6_22

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  Abstract 


Fractures of hyoid bone resulting from trauma other than strangulation are very rare; hyoid bone fracture associated with panfacial trauma is even rarer. They occur more frequently in young individuals and in men more than in women. We report a comprehensive review of a case of bilateral hyoid bone fracture-associated panfacial trauma.

Keywords: Bilateral hyoid bone, hyoid bone fracture, panfacial trauma


How to cite this article:
Ram SK, Jain NK, Dutta A, Nishant, Panda P. Bilateral hyoid bone fracture associated with panfacial trauma - A rare intity. Int J Med Oral Res 2022;7:22-5

How to cite this URL:
Ram SK, Jain NK, Dutta A, Nishant, Panda P. Bilateral hyoid bone fracture associated with panfacial trauma - A rare intity. Int J Med Oral Res [serial online] 2022 [cited 2022 Dec 4];7:22-5. Available from: http://www.ijmorweb.com/text.asp?2022/7/1/22/349245




  Introduction Top


Injuries to the hyoid bone are rare. The most commonly reported injury is fracture, yet this is often a postmortem finding, with an incidence of between 17% and 76%, in victims of strangulation and hanging. In survivors, it is more often associated with a trauma other than manual strangulation. The fracture of this bone is very rare accounting for only 0.002% of all fractures. The hyoid bone is a U-shaped mobile bone situated in the anterior portion of the neck at the level of the C3 vertebra, in the angle between the mandible and the thyroid cartilage. Its name originated from the Greek word hyoeides, which means “shaped like the letter upsilon” which represents the 20th letter in the Greek alphabet. It is composed of a body, two greater and two lesser horns and is a unique bone which is articulated to other bones by muscles or ligaments. The greater and lesser cornua fuse to the body of hyoid bone between 40 and 60 years of age although nonfusion has been found even after the age of 60 years.[1],[2],[3] The primary function of the hyoid bone is to provide attachment to the tongue, the larynx, and the pharynx. Because of its morphology and its position among the other anatomical structures of the neck, it is associated not only with the sound production and the fully articulate human speech but also with the smooth function of the airway and possibly with the normal swallowing. The following article presents a thorough review of two cases of bilateral hyoid bone fracture associated with panfacial trauma in a 55-year-old male and 34-year-old male.


  Case Reports Top


Case 1

A 55-year-old male patient was admitted to the Department of Oral and Maxillofacial Surgery of Awadh Dental College and Hospital, Jamshedpur, following panfacial trauma [Figure 1]. He had a complaint of pain and swelling in the facial region after a road traffic accident. The mechanism of injury was collision of bicycle with four-wheeler car. According to the patient, he became unconscious just after the collision for 3–5 min. He also gave history of bleeding from nose and mouth. Based on the clinical extraoral examinations, the patient had the signs of local tenderness and swelling on his right side of the facial region with no respiratory distress. Bilateral periorbital ecchymosis was also observed, depressed nasal bridge, deviated nasal septum, unilateral perioral ecchymosis right side, telecanthus was seen about 45 mm and right enophthalmos, and subconjunctival hemorrhage right side of the eye seen. Based on palpatory findings, tender on palpation was observed on the right infraorbital margin, nasal bridge, right zygoma, right temporomandibular joint (TMJ), and right parasymphysis of the mandible.
Figure 1: Preoperative picture of case 1

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On intraoral examination, occlusion was deranged with a maximal mouth opening of 10 mm the mouth over this limit was painful. There was a detectable mobility between the upper central teeth segment, ecchymosis over palate (Guerin's sign), and sublingual hematoma seen.

Preoperative computed tomography (CT) scan radiography revealed the fracture of NOE displaced right parasymphysis fracture, right zygomaticomaxillary complex (ZMC) and infraorbital rim fracture, palatal, and zygomatic arch fracture. Interestingly, the fracture of bilateral hyoid bone was observed [Figure 2].
Figure 2: The preoperative coronal computed tomography scan view of the bilateral hyoid bone fracture

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Therefore, the patient was admitted in the Oral and Maxillofacial Surgery Department for observation and treatment. The informed consent was obtained, and the surgical procedure and the treatment plan were explained for the patient and his family.

Then, open reduction and internal fixation with fracture plates, arch bars, and maxillomandibular fixation were performed for the right parasymphysis mandibular fractures under general anesthesia, without any complications during intubation.

Since the hyoid bone fracture was left untreated because the patient was asymptomatic regarding fracture bilateral hyoid bone symptoms and no postoperative complication was detected in follow-up sessions.

Case 2

A 32-year-old male reported to the Department of Oral and Maxillofacial Surgery of Awadh Dental College and Hospital, Jamshedpur, with a road traffic accident [Figure 3]. On extraoral examination, he had a laceration on the left side of the forehead, periorbital ecchymosis on the left eye with subconjunctival hemorrhage, and depressed nasal bridge. Based on palpatory findings, tender on palpation was observed on the left infraorbital margin, nasal bridge, left zygoma, left TMJ, and right parasymphysis of the mandible.
Figure 3: Preoperative picture of case 2

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Preoperative CT scan radiography revealed the fracture of left ZMC, left subcondyle, and right parasyphysis fracture along with bilateral hyoid bone fracture [Figure 4] and [Figure 5].
Figure 4: The preoperative 3D CT showing left hyoid bone fracture with other fractured facial bone

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Figure 5: The pre operative 3D CT showing right hyoid bone fracture with other fractured facial bone

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Therefore, the patient was admitted in the Oral and Maxillofacial Surgery Department for observation and treatment. The informed consent was obtained, and the surgical procedure and the treatment plan were explained for the patient and his family.

Then, the same open reduction and internal fixation with titanium plates and screw, arch bars, and maxillomandibular fixation were performed for the right parasymphysis mandibular fractures under general anesthesia, without any complications during intubation.

In both of these cases, the hyoid bone fracture was left untreated because the patient was asymptomatic regarding fracture bilateral hyoid bone symptoms and no postoperative complication was detected in follow-up sessions.


  Discussion Top


A hyoid bone fracture due to trauma other than hanging or strangulation is rare. The low incidence of hyoid fracture in conjunction with maxillofacial injuries may be due to its protected position relative to the mandible and cervical spine.[4] The clinician must be alert to the possibility of a hyoid bone fracture or other laryngeal injury in patients who have suffered maxillofacial trauma.[6] To the best of our knowledge, there are limited case reports about the hyoid bone fractures associated with maxillomandibular fractures following trauma.[1],[2],[3],[4],[5],[7],[8],[9]Most of these cases were related to high-energy traumatic maxillofacial injury patterns such as motor vehicle accidents and falling downs.[1],[2],[3],[4],[5],[7],[8],[9]

Anatomy

The hyoid bone is located in the anterior neck at the level of the C3 vertebra between the thyroid cartilage and the mandible.[10] It is suspended by the stylohyoid ligaments as well as muscles attaching to the mandible, styloid processes, thyroid cartilage, manubrium, and scapulae.[10],[11] The hyoid is composed of five sections; the body, two greater, and two lesser cornua [Figure 6].[10],[11]
Figure 6: Schematic diagram depicting hyoid bone composition and weak areas of hyoid bone leading to fracture (arrow marks)

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The lesser cornua are attached to the body through fibrous tissue and in some cases by a synovial joint. The lesser cornua itself can remain a cartilaginous structure well into adulthood.[10] Functionally, the hyoid provides a movable base for the tongue, attachment points for the middle pharynx, and maintains patency of the pharynx, required during swallowing and respiration.[10] In males, the greater and lesser cornua fuse to the body of the hyoid bone unilaterally at 38.25 and bilaterally at 53.16 years of age, respectively, while females achieve boney fusion unilaterally and bilaterally at 38.00 and 48.50 years of age, respectively.[12]

Mechanism of injury

Fracture of the hyoid is rare and its rarity of this condition is due to the protection it receives from the mandible as well as from its mobility.[1],[11] In situations, where hyperextension is induced, the hyoid bone is exposed and may be at greater risk for blunt trauma.[1] This position also places many of the muscles attaching to the hyoid bone under tension, decreasing the mobility of the hyoid, and potentially reducing its mobility and thus its ability to absorb forces.

The age at which the hyoid bone fuses has been suggested as another protective factor.[1],[12] Before fusion, the elastic cartilaginous structure of the hyoid may offer protective mobility when exposed to trauma.[1] The average age of presentation for a hyoid bone fracture has been reported to range from 15 to 55 with an average age of 35. A much higher prevalence in men than women has been identified.[1]

The age of the patient would suggest a possible protective effect due to the absorption of force afforded by the elastic cartilaginous hyoid.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dalati T. Isolated hyoid bone fracture. Review of an unusual entity. Int J Oral Maxillofac Surg 2005;34:449-52.  Back to cited text no. 1
    
2.
Keerthi R, Quadri A. Hyoid bone fracture: Associated with head and neck trauma – A rare case report. J Maxillofac Oral Surg 2016;15:249-52.  Back to cited text no. 2
    
3.
Erdogan B, Erdogan MO, Colak S, Kibici O, Bozan K, Alper B. An isolated hyoid bone fracture caused by blunt trauma to the neck. J Pak Med Assoc 2015;65:1233-4.  Back to cited text no. 3
    
4.
Ramchand T, Choudhry OJ, Shukla PA, Tomovic S, Kuperan AB, Eloy JA. Management of hyoid bone fractures: A systematic review. Otolaryngol Head Neck Surg 2012;147:204-8.  Back to cited text no. 4
    
5.
Porr J, Laframboise M, Kazemi M. Traumatic hyoid bone fracture – A case report and review of the literature. J Canad Chiropr Assoc 2012;56:269.  Back to cited text no. 5
    
6.
Whyte AM. Fracture of the hyoid bone associated with a mandibular fracture. J Oral Maxillofac Surg 1985;43:805-7.  Back to cited text no. 6
    
7.
Kuo LC, Lin HL, Chen CW, Lee WC. Traumatic hyoid bone fracture in patient wearing a helmet: A case report. Am J Emerg Med 2008;26:251.e1-2.  Back to cited text no. 7
    
8.
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;69:411-4.  Back to cited text no. 8
    
9.
Bagnoli ML, Leban SG, Williams FA. Isolated fracture of the hyoid bone: Report of a case. J Oral Maxillofac Surg 1988;46:326-8.  Back to cited text no. 9
    
10.
Moore KL, Dalley AF. Clinically Oriented Anatomy. 5th ed. Baltimore: Lippincott Williams & Wilkins; 2006.  Back to cited text no. 10
    
11.
Olmstead EG. Fractures of the hyoid bone; presentation of two cases, with a review of the literature. Arch Otolaryngol (1925) 1949;49:266-74.  Back to cited text no. 11
    
12.
Gupta A, Kohli A, Aggarwal NK, Banerjee KK. Study of age of fusion of hyoid bone. Leg Med (Tokyo) 2008;10:253-6.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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