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Hyoid bone fracture identified only with nasal Valsalva manoeuvre

Published online by Cambridge University Press:  23 November 2009

P M Spielmann ,
I F Hathorn ,
J K V Clarke  and
S Denholm
P M Spielmann*
Affiliation:
Department of Otorhinolaryngology, Raigmore Hospital, Inverness, Scotland, UK
I F Hathorn
Affiliation:
Department of Otorhinolaryngology, Raigmore Hospital, Inverness, Scotland, UK
J K V Clarke
Affiliation:
Department of Otorhinolaryngology, Raigmore Hospital, Inverness, Scotland, UK
S Denholm
Affiliation:
Department of Otorhinolaryngology, Raigmore Hospital, Inverness, Scotland, UK
*
Address for correspondence: Mr P M Spielmann, Department of Otolaryngology, Raigmore Hospital, Old Perth Rd, Inverness IV2 3UJ, Scotland, UK. E-mail: [email protected]
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Abstract

Objective:

We present two cases of a hyoid bone fracture identified through careful clinical examination with a Valsalva manoeuvre during nasendoscopy.

Method:

Case reports and review of the literature, with emphasis on technique during nasendoscopy.

Results:

The first patient had sustained a blow to the neck with a stick, six months prior to presentation with a globus sensation. External examination and standard nasendoscopy were unremarkable. The second patient had been struck across the neck by a wire whilst riding a motorbike at low speed. Endoscopy revealed swelling of the supraglottis. He recovered and was asymptomatic at review one month later. Computed tomography scans on both patients were unremarkable. During nasendoscopy, both patients were asked to forcibly expire with their mouths closed (the so-called nasal Valsalva manoeuvre), and the hyoid bone was seen to swing into view on the side where the first patient complained of symptoms, and in the second case where swelling had been noticed previously.

Conclusion:

We would not ordinarily have reached a diagnosis in these patients, as radiography and examination were otherwise unremarkable. The use of the nasal Valsalva manoeuvre during routine nasendoscopic examination is recommended, as unusual pathology may be demonstrated and the need for direct laryngoscopy under general anaesthesia may, in some instances, be avoided.

Keywords

HyoidFractureDiagnosisEndoscopyValsalva Manoeuvre
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 4 , April 2010 , pp. 431 - 432
Copyright
Copyright © JLO (1984) Limited 2009

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References

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