Fracture patterns of the hyoid-larynx complex after fatal trauma on the neck: retrospective radiological postmortem analysis of 284 cases

Abstract

Purpose

Fatal trauma on the neck occurs frequent in forensic cases and often results in fractures of the hyoid-larynx complex. The aim of the present study is to provide an overview of fractures in the hyoid-larynx complex that occur due to fatal trauma on the neck and can be observed by radiological evaluation.

Methods

Radiological images from a forensic radiological database created in –BLINDED- were used for analysis. Hyoid-larynx complexes were explanted in 284 individuals who accordingly to the forensic pathologist allegedly died from fatal trauma on the neck. These explants were imaged with conventional X-rays in eight directions and a CT scan. Radiological images were analyzed for fractures, dislocations, joints, and anatomical variations by a trained analyst and a radiologist.

Results

In 281/284 cases, the hyoid bone and, in 252/284 cases, the thyroid cartilage could be assessed. In 56 victims (20%), the hyoid bone was fractured, 55 times in the greater horn, 1 fracture in the body. The calcified superior horn of the thyroid showed a fracture in 101 victims (40%). The calcified cricoid cartilage was fractured in one case. Multiple fractures were found in 31/284 cases (11%). Joints between the greater horn and body of the hyoid were present in 74%.

Conclusion

Trauma on the neck leads most frequently to fractures of the superior horn of the thyroid cartilage and second most to fractures in the greater horn of the hyoid bone. (Forensic) radiologists should be aware of uncommon fracture locations, anatomical variations, and dislocations in the hyoid-larynx complex.

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Abbreviations

CT:

Computed tomography

GH:

Greater horn

XXX:

BLINDED-

HLC:

Hyoid-larynx complex

MRI:

Magnetic resonance imaging

XXX:

BLINDED-

TC:

Thyroid cartilage

TBCT:

Total body computed tomography

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Acknowledgments

We thank the pathologists, pathology assistants, and management from the NFI and the radiologists and forensic radiographers from the GHH for their continuous professional and pleasant cooperation.

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Correspondence to Bernadette S. de Bakker.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The used forensic database contained completely anonymized patient data, as previously described [28]. Institutional review boards of the –BLINDED- and –BLINDED- agreed to the collection and scientific use of data. According to the Dutch law, review by an ethical committee for research on anonymous retrospective data is not required.

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Key points

1. Thyroid cartilage superior horn fractures are most frequently found in fatal trauma on the neck.

2. Hyoid bone fractures most frequently occur in the greater horns.

3. Joints between the greater horn and the body of the hyoid bone were found in 74% of 281 cases.

4. Dislocations of hyoid joints are rare in fatal trauma on the neck victims (2,5%).

Henri M. de Bakker and Moritz V. Warmbrunn shared first authors

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de Bakker, H.M., Warmbrunn, M.V., van den Biggelaar, P. et al. Fracture patterns of the hyoid-larynx complex after fatal trauma on the neck: retrospective radiological postmortem analysis of 284 cases. Int J Legal Med 134, 1465–1473 (2020). https://doi.org/10.1007/s00414-019-02241-8

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Keywords

  • Hyoid-larynx complex
  • Forensic radiology
  • Hyoid fracture
  • Thyroid fracture
  • Postmortem computed tomography