Working Diagnosis:
Left thyroid laminar fracture with supraglottic edema

Treatment:
The patient was admitted to the hospital trauma service. He was treated with intravenous dexamethasone 8 milligrams every eight hours for three doses. In the morning, repeat bronchoscopy showed improved edema, and the patient reported improved symptoms. He was discharged and instructed to abstain from contact sports for six weeks. At a four-week follow-up clinic appointment, flexible laryngoscopy showed no evidence of edema or residual fracture.

Outcome:
The patient was cleared to return to contact sports at six weeks with follow up as needed.

Author's Comments:
Pressure on the anterior neck pins the thyroid cartilage against the cervical spine, invariably resulting in damage to the thyroid cartilage. It is unclear why this patient had a delayed symptom presentation, though it may have been due to increasing soft tissue edema from the fracture.

Editor's Comments:
Anterior neck trauma is concerning as this region contains numerous critical anatomical structures including the carotid arteries, jugular veins, trachea, larynx, thyroid, and esophagus. The vagus and recurrent laryngeal nerves are also in this area. A thorough physical exam of the anterior neck should include evaluation of cervical spine motion; neck and upper extremity strength, sensation, and reflexes; swallowing; tongue movement; and phonation. Palpation of the bony and soft tissues of the neck, including the thyroid, is necessary. Tenderness to palpation is appropriately evaluated with computed tomography. Thyroid cartilage fracture and hemorrhage are rare in sports but have been described in case reports, usually as the result of blunt trauma. Strangulation is another recognized cause of injury to this area.

References:
Decker JE, Hergenroeder AC. Evaluation of the child or adolescent athlete with neck pain or injury. UpToDate.com. Retrieved from the World Wide Web on June 25, 2021.
Trinidade A, Shakeel M, Stickle B, Ah-See KW. Laryngeal Fracture Caused by a Lacrosse Ball. J Coll Physicians Surg Pak. 2015 Nov;25(11):843-4.
Pollanen MS, McAuliffe DN. Intra-cartilaginous laryngeal haemorrhages and strangulation. Forensic Sci Int. 1998 Apr 22;93(1):13-20.

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