Reading:: Isolated Hyoid Bone Fracture

Self-induced Vomiting as a Probable Mechanism of an Isolated Hyoid Bone Fracture

By Joseph K. White DO and John Carver MD, JD

Only 0.002% of all fractures in the United States occur in the hyoid bone, which is a U-shaped bone located in the upper neck. When fracture does occur it is most often associated with manual strangulation, choke-holds, or neck hyperextension. Most hyoid fractures have a great deal of forensic value because they are usually associated with the cause and/or manner of death. This article, however analyzes the occurrence of an isolated hyoid fracture that was not associated with the manner or cause of death. This case involves a 37-year-old woman who died from acute ethanol intoxication complications.

The decadent’s boyfriend found her lying in bed unresponsive, pulseless and apneic (no spontaneous breathing). EMS was called to the scene and transported the patient to the nearest hospital where severe anoxic brain injury was assessed. Her condition did not improve and care was withdrawn with consent from family members. The boyfriend reported that she had been drinking heavily all day and that he had seen her alive 20 to 40 minutes before realizing she had stopped breathing.

The woman’s medical history included bipolar disorder and multiple suicide attempts. She had a history of alcohol abuse, drug use, and tobacco use. 8 days prior to her death she was admitted to the hospital for dysfunctional vaginal bleeding. The physical examination reported facial petecheia and subconjunctival hemorrhaging from self-induced vomiting, which she committed in an attempt to lose weight. 2 days before her death she was treated for altered mental status and the petecheia and hemorrhaging was reported again.

Her records show no evidence of any head or neck trauma that could have caused her hyoid to fracture. If a strangulation had occurred bruising would be present as well as damage to the surrounding tissue of the neck and probably defensive wounds on forearms or wrists. However, none of the previous signs presented in her autopsy. The authors referred to a case study in which a “28-year-old man who noted a clicking sensation in his throat after induced vomiting and was found to have a nondisplaced fracture of the hyoid bone.” (White & Carver 2010.) The hyoid bone is connected to the skull by the stylohyoid ligament at the styloid process. Apparently, violent muscular contractions such as those from the act of vomiting can indeed cause stress fractures in the hyoid bone, regardless of the person’s age.

This article concludes by restating the fact that hyoid bone fractures are often valuable in determining the manner and or cause of death. Occurrences of isolated hyoid fractures are extremely rare and the case study presented in this article is an example of such. Previous case reports of stress fractures suggest that that is a likely cause of the isolated fracture in this case. And since the decadent admitted to inducing vomiting only days before her death the authors feel strongly that it is the cause of the hyoid fracture in this woman.

Reference:

White, Joseph K. DO & Carver, John MD, JD (2010). Self-induced Vomiting as
           a Probable Mechanism of an Isolated Hyoid Bone Fracture. American 
           Journal of Forensic Medicine and Pathology; XX(X); 1-3. Retrieved from: http://ovidsp.tx.ovid.com/sp-3.4.1b/ovidweb.cgi?WebLinkFrameset=1&S=KBAAFPNMLMDDJADLNCCLPCJCBNKLAA00&returnUrl=ovidweb.cgi%3fMain%2bSearch%2bPage%3d1%26S%3dKBAAFPNMLMDDJADLNCCLPCJCBNKLAA00&directlink=http%3a%2f%2fgraphics.tx.ovid.com%2fovftpdfs%2fFPDDNCJCPCDLLM00%2ffs046%2fovft%2flive%2fgv023%2f00000433%2f00000433-900000000-99859.pdf&filename=Self-induced+Vomiting+as+a+Probable+Mechanism+of+an+Isolated+Hyoid+Bone+Fracture.&navigation_links=NavLinks.S.sh.15.1&link_from=S.sh.15%7c1&pdf_key=FPDDNCJCPCDLLM00&pdf_index=/fs046/ovft/live/gv023/00000433/00000433-900000000-99859&link_set=S.sh.15%7C1%7Csl_10%7CresultSet%7CS.sh.15.16%7C0