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Vol. 36. Issue 1.
Pages 52-54 (January 2000)
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Vol. 36. Issue 1.
Pages 52-54 (January 2000)
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Fractura de hioides y enfisema cervical subcutáneo traumático por intento de ahorcamiento. A propósito de un caso
Hyoid bone fracture and subcutaneous emphysema due to trauma from attempted hanging: a case report
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M.A. Cañizares*, A. Arnau, A. Fortea, V. Zarzuela, P. Martínez-Vallina, A. Cantó
Servicio de Cirugía Torácica. Hospital General Universitario. Valencia
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Presentamos el caso de un paciente con antecedentes psiquiátricos que, tras un intento de autólisis mediante ahorcamiento, fue remitido a nuestro centro. Se apreciaba un gran enfisema subcutáneo facial, palpebral y cervical, con disfonía, disfagia y discreta dificultad respiratoria. La fibrobroncoscopia demostró obstrucción de las vías altas por edema, con integridad de la vía aérea. Varias TAC cervicales sucesivas evidenciaron, además del enfisema subcutáneo y el neumomediastino correspondiente, la existencia de una fractura de hioides, así como la existencia de un laringocele. Ante la persistencia de la disfagia, se realizaron pruebas de función esofágica, demostrándose una alteración funcional del esfínter esofágico superior. Una cervicotomía suprasternal, para el drenaje del neumomediastino, y una microcirugía laríngea, para el tratamiento el laringocele, solucionaron el problema.

Palabras clave:
Enfisema subcutáneo
Fractura de hioides
Disfagia

We describe a patient with a history of psychiatric disorder who was brought to our hospital after attempted suicide by hanging. Severe subcutaneous facial, palpebral and cervical emphysema was present, with dysphonia, dysphagia and slight respiratory difficulty. Fiberoptic bronchoscopy revealed upper airway obstruction due to edema in an intact airway. Successive CAT scans gave evidence of hyoid fracture and laryngocele, in addition to the corresponding emphysema of the subcutaneous area and pneumomediastinum. Given the persistence of dysphagia, we ordered esophageal tests, which showed functional alteration of the upper esophageal sphincter. Suprasternal cervicotomy to drain the pneumomediastinum and laryngeal microsurgery to treat the laryngocele resolved the problem.

Key words:
Subcutaneous emphysema
Hyoid fracturel Dysphagia
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Bibliografía
[1.]
I.J. Witterick, P.J. Gullane, J.C. Irish.
Trauma of the larynx.
Thoracic Surgery, pp. 1535-1541
[2.]
G.J. Jurkovich, C.J. Carrico.
Trauma: management of the acutely injured patient.
Textbook of surgery: the biological basis of modern surgical practice, 15.ª, pp. 300-303
[3.]
M. Hussarek, G. Wolf.
Subcutaneous emphysema of neck and larynx following attempted strangulation.
Z Rechtsmed, 68 (1971), pp. 41-44
[4.]
W. Van der Horst, H. Nier, W. Meyer.
Traumatic mediastinal emphysema.
Arch Orthop Trama Surg, 97 (1980), pp. 17-19
[5.]
M.S. Granich, R.E. Klotz, R.H. Lofgren, R.C. Partlow Jr., L.I. DiGregorio.
Spontaneous retropharyngeal and cervical subcutaneous emphysema in adults.
Arch Otolaryngol, 109 (1983), pp. 701-704
[6.]
A.C. Ralph-Edwards, F.G. Pearson.
Atypical presentation of spontaneous pneumomediastinum.
Ann Thorac Surg, 58 (1994), pp. 1758-1760
[7.]
W.D. Rose, J.S. Veach, J. Tehranzdeh.
Spontaneous pneumomediastinum as a cause of neck pain, dysphagia and chest pain.
Arch Intern med, 144 (1984), pp. 392-393
[8.]
H. Seiler, W. Hackstein, L.P. Graf.
Fractures of the upper cervical spine.
Indications for treatment. Unfallchirurg, 96 (1993), pp. 410-415
[9.]
W. Maier, M. Fradis, S. Malatskey, A. Krebs.
Diagnostic and therapeutic management of bilateral carotid artery occlusion caused by nearsuicidal hanging.
Ann Otol Rhinol Laryngol, 108 (1999), pp. 189-192
[10.]
J.G. Soto-Campos, E. García-Díaz, T. Elías.
Pulmonary edema and mediastinal emphysema caused by strangulation.
Arch Bronconeumol, 41 (1995), pp. 488
[11.]
J. Zapatero, J. Flandes, R. Peñalver, L. Madrigal, J. Lago, S.D. Reboiras, D. Saldaña, I. Muguruza, J. Candelas.
The treatment of tracheobronchial ruptures: a review of 6 cases.
Arch Bronconeumol, 32 (1996), pp. 222-224
[12.]
P. García-López, E. Fernández-Vázquez, A. Cueto.
Tracheal rupture caused by strangulation.
Arch Bronconeumol, 34 (1998), pp. 166-167
[13.]
J. Huh, J.C. Milliken, J.C. Chen.
Management of tracheobronchial injuries following blunt and penetrating trauma.
Am Surg, 63 (1997), pp. 896-899
[14.]
Y. Asai, M. Kaneko, H. Imaizumi, K. Kobayashi, M. Hamamoto, R. Takada, et al.
Traumatic cervical tracheal disruption: report of two cases.
Surg Today, 26 (1996), pp. 353-356
[15.]
N. DiNunno, F. Constantinides, P. Bernasconi, S. Lombardo.
Radiographic magnification in the diagnosis of traumatic lesions of the hyoid-larynx complex.
Int J Legal Med, 111 (1998), pp. 38-42
[16.]
M.E. Tobias, A.D. Sack, G. Carter, W.A. McIntosh.
Cricotracheal separation in blunt neck injury.
The sign of hyoid bone elevation. A case report. S Afr J Surg, 27 (1989), pp. 189-191
[17.]
C. Graf.
Laceration of the pharynx with fracture of the hyoid bone: report of a case and discussion.
J Trauma, 9 (1969), pp. 812-818
[18.]
P.T. Yen, H.Y. Lee, M.H. Tsai, S.T. Chan, T.S. Huang.
Clinical analysis of external laryngeal trauma.
J Laryngol Otol, 108 (1994), pp. 221-225
[19.]
J. Freixinet, F. Lorenzo, J. Hernández Gallego, F. Rodríguez Castro, J. Sole.
Bilateral traumatic hypoglossal nerve paralysis.
Br J Oral Maxillofac Surg, 34 (1996), pp. 309-310
[20.]
M.D. Paley, G.A. Wood.
Traumatic bilateral hypoglossal nerve palsy.
Br J Oral Maxillofac Surg, 33 (1995), pp. 239-241
[21.]
C.B. Shaw, R. Bawa, G. Snider, M.K. Wax.
Traumatic retropharyngeal hematoma: a case report.
Otolaryngol Head Neck Surg, 113 (1995), pp. 485-488
[22.]
B.D. Birt.
Dysphagia due to simultaneous laryngocele and Zenker's diverticulum.
Laryngoscope, 95 (1985), pp. 1-2
[23.]
J. Ogawa, T. Minami, S. Yamada, M. Iwazaki, I. Suzuki, J.H. Inoue, A. Shohtsu.
Traumatic transection of the left main bronchus and laryngeal fracture resulting form blunt trauma. A successful case of emergency operation.
Rinsho Kyobu Geka, 9 (1989), pp. 498-501
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