Evaluating micro-computed tomography for investigation of the pediatric hyoid-larynx complex.

Background: Conventional CT imaging has limitations in detecting subtle fractures or soft tissue hemorrhages of the pediatric hyoid-larynx complex due to its largely unossified, cartilaginous structure, creating a diagnostic gap in forensic investigations.

Objective: To explore the feasibility of micro-computed tomography (micro-CT) and diffusible iodine-based contrast-enhanced computed tomography (diceCT) as high-resolution imaging techniques for detailed forensic and developmental assessment of the pediatric hyoid-larynx complex.

Materials and methods: Five pediatric hyoid-larynx complex samples were obtained during forensic autopsies. Specimens were excised, fixed in formaldehyde, and scanned using micro-CT. Subsequently, samples were stained with buffered Lugol's solution and rescanned for diceCT. Imaging was performed with voxel sizes between 12-35 µm. Scans were assessed by a trained analyst and two experienced forensic (pediatric) radiologists.

Results: All five samples were successfully imaged using micro-CT and diceCT. Ossification increased with age: the youngest sample showed minimal ossification, while the oldest showed ossification of the hyoid lesser horn and thyroid cartilage. Anatomical variants included bilateral triticeal cartilages and ossified stylohyoid ligament fragments. DiceCT enabled detailed soft tissue visualization and revealed hyperdense bundles and ossification centers within the thyroid cartilage. Staining was complete in smaller samples but limited in the largest. No traumatic injuries were detected on imaging or autopsy.

Conclusion: Micro-CT and diceCT offer high-resolution visualization of both ossified and soft tissue structures in the pediatric hyoid-larynx complex. These methods overcome limitations of conventional CT, demonstrating strong potential to enhance forensic evaluation of pediatric neck trauma.