Complete hyolaryngeal separation: A case report

Penetrating neck injuries are surgical emergencies because of the high concentration of vital structures, and hyolaryngeal separation following sharp neck trauma is a rare but potentially fatal condition due to airway compromise and delayed recognition of phonatory dysfunction. We report the case of a 60-year-old male who presented with a self-inflicted incised wound over the anterior neck (zone II) caused by a kitchen knife; primary wound closure done at a peripheral facility masked the underlying laryngeal injury, and the patient subsequently developed hoarseness of voice. Emergency surgical exploration revealed a disrupted thyrohyoid membrane with complete hyolaryngeal separation, transected strap muscles, and epiglottic injury, while major vascular structures, the trachea, and the esophagus were preserved. Definitive airway control was achieved via tracheostomy, followed by single-stage laryngo-hypopharyngeal reconstruction using thyrohyoidopexy under general anesthesia and was managed postoperatively in the intensive care unit with multidisciplinary support. He showed progressive recovery of phonation and swallowing during hospitalization. This case highlights the diagnostic challenges associated with occult laryngeal trauma, emphasizes strict adherence to ATLS-based airway assessment, and demonstrates that early surgical exploration with meticulous anatomical reconstruction can yield favorable functional outcomes even in severe self-inflicted laryngeal injuries.