title: Hyoid bone fracture identified only with nasal Valsalva manoeuvre.
abstract: OBJECTIVE
  We present two cases of a hyoid bone fracture identified through careful clinical examination with a Valsalva manoeuvre during nasendoscopy.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otorhinolaryngology, Raigmore Hospital, Inverness, Old Perth Rd, Inverness IV2 3UJ Scotland, UK. patrickspielmann@nhs.net
authors.forename: P M
authors.initials: PM
authors.lastname: Spielmann
authors.forename: I F
authors.initials: IF
authors.lastname: Hathorn
authors.forename: J K V
authors.initials: JK
authors.lastname: Clarke
authors.forename: S
authors.initials: S
authors.lastname: Denholm
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods*; D050723:Fractures, Bone / Q000175:diagnosis*; D006801:Humans; D006928:Hyoid Bone / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D014057:Tomography, X-Ray Computed; D014636:Valsalva Maneuver