Working Diagnosis:
Hyoid Bone Fracture

Treatment:
The athlete was allowed to continue to play without restrictions or additional padding.

Outcome:
Symptoms improved, and he experienced less frequent neck clicking when he swallowed.

Author's Comments:
The hyoid bone is a horseshoe-shaped structure located in the anterior aspect of the neck at level C3-4. Hyoid fractures are very rare and mainly seen with direct trauma (e.g., strangulation and motor vehicle accidents). These fractures are difficult to diagnose. They may initially be asymptomatic, and patients may develop symptoms such as anterior neck pain, dysphagia, voice changes, and hemoptysis 4-6 hours later. Therefore, athletes should be monitored for delayed symptoms after any anterior neck trauma.

Editor's Comments:
The complex anatomy of the pharynx and larynx make diagnosis of potential pathologies difficult. Physical exam findings may be helpful and include an expanding ecchymoses indicating hematoma, stridor in the setting of laryngeal compromise, or difficulty breathing with tracheal injuries. Timing of symptom onset is also useful as chronic or slowly progressive complaints are more often associated with tumors and autoimmune conditions, while acute problems are associated with trauma and infection/inflammation.
Diagnosis of acute neck pain can be aided by ultrasound or contrast-enhanced CT. In the case of trauma, clinicians should bear in mind the possibility of a pseudoaneurysm or arteriovenous fistula due to the abundant vascular supply of the pharynx and larynx.

References:
A. Cutuk, B. Bissell, P. Schmidt, and B. Miller. Isolated Hyoid Bone Fractures in Collegiate Football Players. Sports Health 2012. Jan; 4(1): 51-56.

R. Chowdhury, A. Crocco, H. El-Hakim. An isolated hyoid fracture secondary to sport injury: A case report and review of literature. International Journal of Pediatric Otorhinolaryngology 2005. Mar: 69(3): 411-414.

Haynes J, Arnold KR, Aguirre-Oskins C, Chandra S. Evaluation of neck masses in adults. Am Fam Physician. 2015 May 15;91(10):698-706.

Return To The Case Studies List.