Damage to the pharynx with fractures of the hyoid bone: causes, symptoms, diagnosis, treatment

The hyoid bone refers to the unpaired bone structures of the skeleton of the neck. It is located in the middle of the neck, below and behind the chin and immediately above the thyroid cartilage. The hyoid bone is horseshoe shaped, convex forward, concave - back, consists of the middle part (body), located a large axis across the neck, and two pairs of horns - small and large, directed with their apophyses posteriorly. The hyoid bone develops from the fusion of the second visceral and the first branchial arches. The imperfection of this emiogenetic process leads to some anomalies in the development of the hyoid bone with the preservation of its cartilaginous and bony remains in the palatine tonsils and surrounding tissues. Points of ossification in the body and large horns of the hyoid bone appear on the 8-10th month of intrauterine life. In small horns, these points occur only in the 1st or 2nd year of life. The fusion of parts of the hyoid bone is completed by 30-40 years.

The hyoid bone is suspended directly to the skull by the shilo-lingual ligaments attached to it from both sides and the muscles of the same name, as well as by the two-abdominal muscles. Ahead of the muscle group (chin-sublingual and maxillo-hyoid), the hyoid bone is fixed to the lower jaw; these muscles are involved in the movements of the lower jaw in the horizontal plane. The hyoid bone serves as the place of attachment of the muscles of the tongue (sublingual-lingual, part of the fibers of the chin-lingual and long upper and lower muscles of the tongue). On the hyoid bone finds a point of support part of the pharyngeal musculature, for example, the average throat compressors. From below to the hyoid bone come a series of muscles, the contractions of which lead to the lowering of the bone and the larynx suspended from it (scapula, shield and sternum-like muscles). With all these muscles, the hyoid bone is held in a stable medial position, the reciprocity and coordination of the function of these muscles is provided by innervation of the fibers of V, VII and XII pairs of cranial nerves, as well as from the cervical plexus. Many functional disorders of the consistency of the action of these muscles and impaired function of the pharynx arise because of the organic lesions of these nerves and their centers, as well as various pathological influences on these centers of the overlying brain structures. If one of these nerves is damaged, the coordinated activity of the muscular apparatus of the hyoid bone is broken, which entails a change in the position of the tongue and soft palate, voice and speech, swallowing and chewing.

Symptoms of pharyngeal damage in hypogloss fractures. Fractures of the hyoid bone are rare and occur with blunt injuries of the submandibular region with a direct mechanical impact on the body of the hyoid bone, sometimes they occur when hanging, strangling, and rarely - from the impact of muscle traction.

Clinically, a fresh fracture of the hyoid bone is manifested by severe pain in all acts accompanied by the movement of the hyoid bone. On the site of the fracture there are noticeable hematomas outside, with palpation - crepitation and mobility of fragments. At fractures of the hyoid bone with rupture of the mucous membrane of the pharynx, heavy bleeding from the mouth is observed, caused by damage to the branches of the lingual and upper thyroid arteries.

Treatment of pharyngeal damage in hypogloss fractures is to remove the displacement of fragments and their immobilization. The reposition of the fragments is achieved by the palpation method from the oral cavity and from the outside. Immobilization of the head and neck is achieved with the help of a special cervico-brachial corset (collar) or the imposition of a plaster "crib" on the neck and shoulders. Retention of fragments in the correct position in most cases is possible only by surgical repositioning and stitching by access type of transverse phantom pharyngotomy. The pharyngeal bleeding is stopped either by non-operative methods (cold, activation of the blood coagulation system, pharyngeal tamponade after intubation of the larynx), or by dressing the external carotid artery.

The prognosis in the first hours after the injury is doubtful because of the possibility of asphyxiation, and with a rupture of the pharynx - and considerable blood loss. Often, death occurs before the arrival of emergency specialized care or on the way to a medical institution. If there are signs of asphyxia and bleeding at the scene, intubation of the trachea and pharyngeal tamponade should be made and only after these manipulations should the injured be delivered to a specialized department.

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