• Tamara Braut, Matej Maršić, Iva Ravlić, Diana Maržić, Blažen Marijić, Goran Malvić, Ilinko Vrebac, and Marko Velepič.
• Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia.
• Medicine (Baltimore). 2021 Oct 29; 100 (43): e27618e27618.

RationaleThe aim of this case is to emphasize the need to include nerve traction in the differential diagnosis of nerve deficits associated with Vernet syndrome. This mechanism of injury has been described only once, but must not be overlooked and should be considered and included as a possible cause in diagnostic algorithms.Patient ConcernsA patient presenting with dysphagia, extreme hoarseness, and limited shoulder movement after head injury was admitted to the emergency department.DiagnosesMultidisciplinary evaluation was performed, and nerve traction-induced Vernet syndrome was established as a running diagnosis.InterventionsIntensive swallowing and speech exercises, assisted by a specialist, were performed.OutcomesSwallowing and speech exercises significantly and objectively improved the patient's swallowing and voice, with mild hoarseness of voice remaining as the main symptom. Spectral acoustic analysis went from a voice pitch of 163.77 Hz to normal (187.77 Hz), jitter improved from 17.87% to 0.86% and shimmer values decreased from 39.86% to 19.60%. Breathiness during phonation measuring 2.91% was reduced to 1.08% and appropriate average intensity of voice (63.95 dB) was achieved. Initial dysphagia and fluid retention in the right piriform sinus, along with tracheal aspiration, were not observed in control fiberoptic endoscopic evaluation of swallowing.LessonsAccording to our knowledge and literature data, this is the second reported case of posttraumatic Vernet syndrome without radiologically confirmed jugular foramen fracture, induced by nerve traction. Such patients need a prompt multidisciplinary approach in diagnosis and timely posttraumatic rehabilitation therapy for favorable clinical evolution and retrieval of nerve function.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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