{"title":"Traumatic thyrohyoid membrane rupture with hyolaryngeal separation due to strangulation injury","authors":"Anna Lawrence , Shannon Kraft","doi":"10.1016/j.tcr.2024.101085","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Cervical injuries due to hanging have a high mortality rate. Survivors may present for care with subtle symptoms that belie potentially life-threatening injuries to vital structures of the neck.</p></div><div><h3>Case report</h3><p>We report a case of a 39-year-old male admitted to the Intensive Care Unit following attempted self-strangulation. Alert and clinically stable, his primary symptoms were pain and voice changes. His external exam was remarkable only for a cervical ligature mark and subcutaneous emphysema on palpation. CT imaging demonstrated disruption of the infrahyoid strap muscles and displacement of the hyoid and epiglottis superiorly. Subsequent flexible laryngoscopy by the Otolaryngology-Head & Neck Surgery (OTO-HNS) team revealed avulsion of the epiglottis from the thyroid cartilage and disruption of the aryepiglottic folds/false cord mucosa, resulting in an open wound into the soft tissues of the anterior neck. The airway was secured in the operating room via fiberoptic nasotracheal intubation. A tracheostomy was performed. Neck exploration revealed transection of the anterior strap muscles and thyrohyoid membrane. The wound was repaired in layers via a modified thyrohyoidopexy. At one-month follow-up, the patient was successfully decannulated and tolerating a regular diet.</p></div><div><h3>Conclusion</h3><p>Evaluation and management of head and neck trauma requires a systematic approach and thorough evaluation, as potentially life-threatening injuries can present subtly. Swift establishment of safe airway, when needed, and prompt repair of laryngeal injuries is essential to optimal functional recovery.</p></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352644024001080/pdfft?md5=70d32b7b35ba1f47b9fc92e58bbdb826&pid=1-s2.0-S2352644024001080-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Trauma Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352644024001080","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
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Abstract
Background
Cervical injuries due to hanging have a high mortality rate. Survivors may present for care with subtle symptoms that belie potentially life-threatening injuries to vital structures of the neck.
Case report
We report a case of a 39-year-old male admitted to the Intensive Care Unit following attempted self-strangulation. Alert and clinically stable, his primary symptoms were pain and voice changes. His external exam was remarkable only for a cervical ligature mark and subcutaneous emphysema on palpation. CT imaging demonstrated disruption of the infrahyoid strap muscles and displacement of the hyoid and epiglottis superiorly. Subsequent flexible laryngoscopy by the Otolaryngology-Head & Neck Surgery (OTO-HNS) team revealed avulsion of the epiglottis from the thyroid cartilage and disruption of the aryepiglottic folds/false cord mucosa, resulting in an open wound into the soft tissues of the anterior neck. The airway was secured in the operating room via fiberoptic nasotracheal intubation. A tracheostomy was performed. Neck exploration revealed transection of the anterior strap muscles and thyrohyoid membrane. The wound was repaired in layers via a modified thyrohyoidopexy. At one-month follow-up, the patient was successfully decannulated and tolerating a regular diet.
Conclusion
Evaluation and management of head and neck trauma requires a systematic approach and thorough evaluation, as potentially life-threatening injuries can present subtly. Swift establishment of safe airway, when needed, and prompt repair of laryngeal injuries is essential to optimal functional recovery.
期刊介绍：
Trauma Case Reports is the only open access, online journal dedicated to the publication of case reports in all aspects of trauma care and accident surgery. Case reports on all aspects of trauma management, surgical procedures for all tissues, resuscitation, anaesthesia and trauma and tissue healing will be considered for publication by the international editorial team and will be subject to peer review. Bringing together these cases from an international authorship will shed light on surgical problems and help in their effective resolution.
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