Traumatic thyrohyoid membrane rupture with hyolaryngeal separation due to strangulation injury

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.