Figure - available from: International Journal of Legal Medicine
This content is subject to copyright. Terms and conditions apply.
X-ray views of hyoid bone with fractures after fatal trauma on the neck. (A) Fracture of the greater horn on both sides with minimal dislocation (arrows). Bilateral fusion between hyoid bone body and greater horn (asterix). (B) Dislocation between the greater horn and body of the hyoid bone on the right side and a fracture halfway the greater horn on the opposite site (arrows). (C) Fracture of the greater horn on both sides with dislocation and medial angulation (arrows). (D) Fracture of the greater horn on the left and a visible joint apparent between the greater horn and hyoid body bilaterally (arrows)
Source publication
Purpose:
Fatal trauma on the neck occurs frequent in forensic cases and often results in fractures of the hyoid-larynx complex. The aim of the present study is to provide an overview of fractures in the hyoid-larynx complex that occur due to fatal trauma on the neck and can be observed by radiological evaluation.
Methods:
Radiological images fro...
Similar publications
Radiological findings of natural causes of death in adults in postmortem imaging are of enormous value for medicolegal investigation. Postmortem computed tomography (PMCT) in particular is increasingly used as a triage tool after external inspection and before a full autopsy.
Forensic pathologists and radiologists commonly deal with a wide variety...
PurposeFatal trauma on the neck occurs frequent in forensic cases and often results in fractures of the hyoid-larynx complex. The aim of the present study is to provide an overview of fractures in the hyoid-larynx complex that occur due to fatal trauma on the neck and can be observed by radiological evaluation.Methods
Radiological images from a for...
Citations
... Since the father of the deceased woman stated that his daughter had committed suicide by hanging, it was mandatory to collect evidence useful in identifying any asphyxia-related injuries, in order to confirm or refute the account given by the victim's father. To achieve this, the 'forensic asphyxia protocol' proposed by de Bakker et al has been adopted [6]. The protocol involves four main steps: a PMCT, a forensic autopsy, and, if there is suspicion of neck trauma, the removal of the HLC, which contains hyoid bone, thyroid bone, and direct surrounding structures. ...
... In line with other reports [2,7,8,17,18], most fractures were in the thyroid cartilage and vertical in orientation, over half of the cricoid fractures were in conjunction with a thyroid fracture, in older patients and with greater dislocation and airway obstruction. Isolated hyoid bone fractures were scarce. ...
Purpose
Laryngeal fracture is a rare but potentially life-threatening trauma. Fractures vary from mild to dislocated and extensive with risk of severe complications. This study investigated the occurrence, clinical characteristics and management of laryngeal fractures in the last 15 years.
Material and methods
A retrospective population-based cohort study reviewing all laryngeal fractures at the Helsinki University Hospital in 2005–2019. Patient records and imaging studies were systematically reviewed for mode of injury, fracture type, secondary complications, treatment modality, possible airway management, length of stay, and mortality. Results were compared with corresponding data from 1995 to 2004.
Results
Overall 80 fracture patients were recorded (5.3/year); 79% were men and mean age was 42 years (range 18–78). Altogether 91% were closed and 9% open. While unintentional traumas were most common (54%), an increasing proportion were from intentional injury (10%) or Schaefer Gr IV in severity (35%). Altogether 46% had compromised airway and 21% needed airway intervention; airway narrowing was more common with cricoid (p = 0.042) and multiple fractures (p = 0.07) and correlated positively with amount of dislocation (p = 0.001) and number of fracture lines (p = 0.006). Surgery was performed for 33%, of which 46% were Schaefer Gr IV and 62% from intentional trauma. Mortality was 1.4%.
Conclusions
Deliberate and violence-related laryngeal fractures have increased. These often result in more extensive injuries predisposing to compromised airway and requiring surgical intervention and longer treatment. Most fractures are still treated conservatively with good long-term outcomes. An observation period of 24 h is recommended to detect any delayed complications. Mortality remains low.
... The hypostasis-free areas located on both wrists also suggested that the hands leaned on the edge of the storage compartment. Furthermore, with the application of a high-resolution radiological technique, such as micro-CT [12], which is useful to identify microfractures, we could additionally examine the upper airway without any risk of iatrogenic damage occurring during dissection, excluding injuries to the horns of the larynx or the hyoid bone, usually detected in cases of manual strangulation [13][14][15]; considering the abovementioned autopsy findings, indeed, compression of the neck seemed highly probable [16]. Cervical compression could have induced a loss of consciousness mediated by carotid baroreceptors causing bradycardia and reduction of arterial flow to the brain [17,18]. ...
Herein, we present an uncommon forensic case of death by asphyxia. The victim was a woman whose body at death scene investigation (DSI) was discovered beside an ottoman storage bed. According to the rescue team, who had moved the body before our arrival, the body was originally found in the prone position and stuck with the neck, thorax and arms within the bed. Examination of the body showed hypostasis that was mainly distributed to the face and the lower chest while sparing the neck and the upper chest. The face was markedly swollen, and the eyes were congested with blood. Dissection and histology revealed pulmonary oedema and emphysema of both lungs. Integrating circumstantial, radiology and autopsy data, it was established that the victim, while trapped between the mattress and the edge of the ottoman storage bed, died by mechanical asphyxia due to cervical-thoracic compression and postural asphyxia acting simultaneously.
... Recently, postmortem CT has shown unique advantages in detecting distinct injuries of the neck by diminishing the processing time and preserving the original injuries. In addition, this novel application can reliably illuminate the direction of a fracture, which helps us to discover the causal mechanism of injury [10,11]. ...
Delayed subglottic stenosis (SGS) is an unusual complication. Here, we report a particular case of delayed SGS. A 17-year-old female suffered extensive injuries including severe neck trauma in a car accident, and complained of dyspnea after 30 days. Tracheal stenosis was observed by fiber optic bronchoscopy, but no specific treatment was administered to the patient. While being transferred to a tertiary hospital 3 days later, the patient fell into deep coma due to hypoxia, and died of hypoxic-ischemic encephalopathy and severe pulmonary infection in the intensive care unit (ICU) 58 days later. Postmortem autopsy and pathological investigation revealed tracheal stenosis 3.0 cm below the vocal cords with a diameter of 0.5 cm, which was caused by a cricoid cartilage fracture, fibrous tissue proliferation and inflammatory cell infiltration. We believed that external forces caused the cricoid fracture and mucosal damage, and after a month of fibrous repair, scar tissue formed the stenosis and caused her death. This report describes a rare condition in which slowly progressive intralaryngeal stenosis formation after external neck trauma could cause asphyxial death in a previously asymptomatic adult.
... Nowadays, images can be acquired using an array of modalities and techniques [8][9][10]: X-rays, fluorescent imaging, nuclear medicine, ultrasound imaging, tomography, and magnetic resonance imaging, among others. Mammography, in particular, can be used to recognize a wide range of anatomic anomalies and traumatic lesions that cannot be adequately detected through direct inspection, microdissection, or conventional radiographic study of the corpse [2,11]. Moreover, these 'soft rays' are the ideal means to study bones with incomplete ossification (e.g., the hyoid bone in young people), because the low-energy X-rays allow better evaluation of soft tissue and structures with the low calcium content. ...
... The use of mammography in post-mortem imaging is poorly documented and probably underestimated in its real diagnostic potential. Indeed, only a few studies are available in the scientific literature on the advantageous application of radiographic magnification by dedicated mammographic equipment of the hyoid-larynx complex [2,3], which has been more frequently examined by conventional X-rays and CT-scan [11]. ...
... In the forensic field, the radiographic study of the hyoid bone is useful in case of death by manual strangulation, due to its susceptibility to fracture [11]. This kind of lesion is related both to the cause of death and to the age of the victim, being more frequent in older victims than in young ones. ...
In forensic cases where standard macroscopic examination and conventional radiological analysis are inconclusive, mammography can be a useful technique. This applies especially when bodies are found in an advanced state of decomposition, with the dissolution of the soft tissues, and with fragile skeletal structures. This study proposes the use of soft X-rays (i.e., mammography) in particular cases for forensic evaluation, with specific regard to the cause of death, age estimation, and body identification. Here we report three cases in which mammography was particularly useful to obtain fundamental medico-legal information. The first case involved a body that had reached the mummification stage, the second a woman who died from asphyxiation by strangulation, and the last a charred femur found in a field. Mammography uses low-energy X-rays. This technique provides increased image quality through better contrast and higher definition. In the first case, it highlighted a complete fracture of the thyroid cartilage; in the second, it revealed a complete fracture of the horn of the hyoid bone; in the last, it showed rarefaction of the reticular substance of the charred bone. As shown in this study, in selected cases, mammography is a useful tool for post-mortem imaging.
... mandibular fractures, extensive LeFort fractures and laryngeal injuries. Most reported cases are forensic cases and the results of postmortem analysis [5,6]. Most publications revolve around the changes of the hyoid bone and the larynx after hanging [2,[4][5][6]. ...
... Most reported cases are forensic cases and the results of postmortem analysis [5,6]. Most publications revolve around the changes of the hyoid bone and the larynx after hanging [2,[4][5][6]. ...
... Although combined hyoid bone and larynx fractures are rare, but they represent an important differential diagnosis in trauma patients with dysphagia, dysphonia or dyspnea [6,[8][9][10]. Our case demonstrates that the clinic and the symptoms can vary, from having no symptoms to dysphagia, dysphonia or dyspnea. ...
Introduction and importance
Reports about laryngeal trauma and fractures of the hyoid bone are rare in the literature. Most cases are forensic cases and the results of postmortem analysis. Traumatic larynx and hyoid bone fractures represent a rare but important differential diagnosis of the common symptom hoarseness.
Case presentation
A 60-year-old female patient presented with unclear dysphonia and globus sensation following intubation for a surgical treatment for a lower leg fracture after a bicycle accident two months ago. Endoscopy and the computed tomography (CT) of the neck revealed a fixed and immobile fractured piece of the larynx, a hyoid bone fracture and a pseudarthrosis between the greater horn of the hyoid bone and the upper edge of the thyroid cartilage. The hyoid bone fracture led to a distortion of the supraglottis. After surgical removal of the fractured part of the hyoid bone and the pseudarthrosis separation, the supraglottis appeared symmetrical again. Four weeks after surgery the patient was symptom-free.
Clinical discussion
Though combined hyoid bone and larynx fractures after traumatic injuries are rare, they represent an important differential diagnosis in trauma patients with dysphagia or dysphonia. The clinical symptoms can vary and occur immediately or within a latent period taking weeks or months until the proper diagnosis. Depending on the symptoms, surgical management can be effective.
Conclusion
An isolated partial resection of the hyoid bone with separation of the pseudarthrosis is a reasonable therapeutic option and can led to completely resolving symptom. Preoperatively, a CT provides further valuable information.
... As noted above, throat trauma can result in fracture of the hyoid bone, and thyroid and cricoid cartilage and/or bone [69,70]. Of these three structures, the hyoid and thyroid are most commonly affected. ...
In their analysis of recovered human remains, forensic anthropologists encounter structures of the throat (hyoid bone, thyroid cartilage/bone, cricoid cartilage/bone) that may present evidence of trauma. The recent published literature provides guidelines for the detection and interpretation of fractures in these tissues. Such traumatic injury frequently is associated with victims of hanging and strangulation, but many other causes have been recognized. Survey of the forensic reports of an experienced forensic anthropologist reveals that although the hyoid is not always recovered in skeletonized remains, it can reveal evidence of perimortem trauma and must be interpreted appropriately.
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.
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.
