Fracture of the hyoid bone associated with atlantoaxial subluxation: a case report and review of the literature.

Hyoid bone fractures secondary to blunt trauma other than strangulation are rare. Only 27 cases have been reported in the literature. They have few, if any, complications, such as dysphagia, hypoxia, cardiorespiratory collapse, laceration of the pharynx, mandibular fracture, thyroid cartilage fracture, and facial fracture. No report of hyoid bone fracture associated with spinal column injury was reported in the English literature. The authors reported a 46-year-old male patient who complained of neck pain and odynophagia after a traffic accident. After systemic examination and cervical CT scan, the diagnosis of hyoid bone fracture at the right great horn and atlantoaxial subluxation was made. The patient was observed in ICU for 48 hours. A nasogastric tube was inserted for feeding. Fifteen milligrams of dexamethasone was given once a day for 3 days to reduce the swelling and pain. We performed a cutaneous traction for the subluxation and carefully watched the hyoid bone and the patient's respiration. No lethal complications occurred. Two weeks later, the patient was allowed to ambulate with cervical collar protection and to resume oral intake. Three months later, he was asymptomatic. This case, with hyoid fracture and atlantoaxial subluxation, is the only case reported in the literature. The importance of hyoid fracture, however, rests not with the rarity of it, but with the lethal potential of missing diagnosis. Nonsurgical management may be effective in most of the cases.