A 21-year-old collegiate football player sustained a hit to his anterolateral neck by another player's helmet during a full-contact football practice session. When the collision occurred, the injured player had his appropriately fitted football helmet fully secured with a chin strap. There was immediate anterior neck pain, but the player was able to finish the practice. Later that evening, he developed progressive dysphagia, odynophagia, and voice changes, which led him to report the incident to athletic trainers. The player denied shortness of breath or dyspnea but reported mild hemoptysis, labored swallowing, and increased anxiety. He denied headaches, loss of consciousness, upper extremity weakness, and paresthesia. He was taken to the emergency department, where he underwent further evaluation.
Physical examination revealed normal vital signs, including respiratory rate, no stridor or anterior cervical ecchymosis, normal oral cavity, symmetrical uvula and palate, and normal results from nasal and mandibular examination with diffuse right-side anterior neck tenderness. Findings from cranial nerve examination were normal.
Imaging included 2 cervical spine octagonal radiographs, which revealed normal results. Cervical computed tomography (CT) angiography revealed normal extracranial carotid and vertebral arteries and a fracture of the right greater horn of the hyoid bone (cornua majora). There was mild diastasis of the right hyoid synchondrosis, with a subtle effacement of the right paralaryngeal fat adjacent to the fracture, suggestive of soft tissue edema (Figure 2). Because of ongoing vocal changes and dysphagia, the player underwent nasopharyngoscopy demonstrating normal endolarynx without lacerations, swelling, or hematoma.
The player was admitted for 48 hours of observation on liquid diet and gradually progressed. He was restricted at practice for 11 days, allowing only running, conditioning, and noncontact drills. On postinjury day 14, he was symptom free and cleared for full participation.