FRACTURE OF THE HYOID BONE. 
21 
this title. Marked swelling of the loose sublingual connective tissue is 
often mistaken for the condition in question. Such swelling frequently 
accompanies cellulitis at the base of the tongue or in the pharynx. 
A flaccid swelling containing blood-stained or yellowish fluid is then 
found under the tongue. 
Prognosis is favourable, though simply laying the cyst open is 
ineffective, as it always fills again. But this can easily be prevented 
by removing the thin wall with scissors and forceps. Ellingei has 
employed injections of pilocarpine with success. Stockfleth has 
described as ranula in cattle an entirely different condition, which takes 
a much more troublesome course, and must be regarded as a malignant 
inflammation of the submaxillary lymph glands (compare with affections 
of lymph glands). Hohenleitner states having seen two cases of ranula 
caused by actinomyces. The ranula disappeared after painting with 
iodine, though stiffness of the tongue persisted. 
(F) FRACTURE OF THE HYOID BONE. 
On account of its sheltered position, fractures of the hyoid bone aie 
rare, but have nevertheless been observed. In horses and cattle they 
are produced by thrusts with the horns, and blows with the feet, or even 
by violent traction on the tongue. In dogs they result from the animal 
being roughly seized by the throat, as is sometimes done by the police in 
securing stray animals. 
The Symptoms comprise salivation, prolapse of the tongue, difficulty 
in eating and especially in swallowing, accumulation of food in the 
mouth and swelling in the throat. In complicated fractures there 
may also be bleeding from the mouth, possibly of a seveie chaiactei. 
Crepitation on moving the tongue can seldom be detected. 
Union of subcutaneous fractures is usually complete in four weeks. 
But it not infrequently happens that fragments of bone perforate the 
mucous membrane. Intense inflammatory swelling then develops, which 
may quickly prove fatal (Herraud) \ or mastication and swallowing may 
be interfered with, and death occur from inanition, or the patients may 
require to be slaughtered. Fatal bleeding sometimes lesults fiom sphnteis 
of bone injuring neighbouring blood-vessels. Rupprecht relates that the 
broken hyoid of a horse perforated the guttural pouch and caused death 
by lacerating a large vessel. Asphyxia caused by such bleeding occuning 
into the larynx and trachea is spoken of by Bolle. But even cases 
complicated by exfoliation of large pieces of the hyoid may recover in 
from six to eight weeks, as Schade’s experience shows. 
Treatment in simple fracture is confined to supplying suitable food 
which must be easily digestible and require little mastication. At the 
