A 21-year-old collegiate football player sustained a direct blow to the anterior neck in a collision with another player while standing on the sideline. His helmet was unsecured when another player collided with him, forcing his face mask down into his anterior neck. He immediately experienced anterior neck pain, voice changes, hoarseness, and difficulty swallowing.
Immediate physical examination revealed normal vital signs without stridor, anterior cervical ecchymosis, or crepitus. He had a normal oral cavity, symmetrical uvula/palate, and nontender mandible/maxilla. He had diffuse right-side anterior neck tenderness with normal cranial nerves. He did not have hemoptysis but reported odynophagia and labored swallowing of liquids. Because of voice changes, persistent odynophagia, and labored swallowing, he was taken to the emergency department for further evaluation.
Two octagonal soft tissue neck radiographs did not demonstrate prevertebral soft tissue swelling or retropharyngeal gas. He had a widely patent airway with a vertical lucency through the hyoid bone, representing a hyoid fracture (Figure 3).
Cervical CT angiography demonstrated a fracture through the right greater horn (cornua majora) of the hyoid bone with inferomedial angulation of the more posterior fragment (Figure 4). There was slight diastasis of the synchondrosis between the hyoid body and the right greater horn without significant surrounding soft tissue edema.
Flexible laryngoscopy was performed because of ongoing dysphagia, odynophagia, and vocal changes, and it showed normal vocal cords, patent subglottis, and normal supraglottic structures.
He was admitted for 24 hours for observation and progressed from a liquid diet. After 3 days of rest, he began running and noncontact drills. After 6 days, he was cleared to full-contact practice and was completely symptom free on day 7.