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A comparative study of the hyoid bone (os hyoides) of 6 ruminant species (Ruminantia Scopoli, 1777).

The shape, position and measurements of the hyoid bone of 6 small and medium-sized European ruminant species of different feeding types as classified by Hofmann (1976), (rose deer, mouflon, sheep, red deer, fallow deer and goat) were fully described. A comparison with other domestic species was carried out, the most characteristic species differences were shown and the results were expressed in 9 Figs. and 1 Table. The basic structural plan of the hyoid bone is found to be similar in all species studied; there are, however, distinct species variations.

Animals↗

Carotodynia exposed: hyoid bone syndrome.

The hyoid bone syndrome, first described in 1954, is manifested by tenderness near the greater horn of the hyoid bone. In 1968, the syndrome was reported to be a form of insertion tendinosis, and injection of procaine HCl with corticosteroid at the tip of the greater horn was found to provide temporary relief of pain. I report 50 patients with the hyoid bone syndrome who had excision of the involved greater horn after one month of conservative medical treatment failed to relieve the pain. Operation promptly relieved pain in 45 (90%) of the patients. An understanding of the close relationship between the greater horn of the hyoid and the posterior pharynx and carotid sinus is important in detecting the hyoid bone syndrome.

Adult↗

Morphological classification and sexual dimorphism of hyoid bone: new approach.

Hyoid bone is a part of viscerocranium placed between the tongue root and thyroid cartilage to which it is connected by thyrohyoid membrane. Widely accepted morphological classification does not exist. Sexual dimorphism was analysed in this study and new guidelines for anatomical classification of hyoid bones based on anthropometric parameters were given. Total number of analysed bones was 70. The bones were classified into three groups: symmetrical U-type, symmetrical V-type and asymmetrical type according to the angle between greater horns and the proportion of greater horns length. In the females incidence of asymmetrical type is considerably higher than in the males, while the incidence of symmetrical V-type is lower The angle value that is on average higher in males may be the parameter indicating that in puberty hyoid bone, still not completely ossified, to some extent follows development of thyroid cartilage because of their close anatomical relation.

Adolescent↗

Forensic significance of the polymorphism of hyoid bone shape.

The reasons why some hyoids fracture in strangulation and others do not may relate to anatomic features of the hyoid bone. On this basis, we studied the dimensions and shape of hyoid bones (n = 100) originating from the Terry collection, National Museum of Natural History, Smithsonian Institution. The hyoid bones were extensively polymorphic in both dimensions studied, the span or breadth, and the length of the cornua. There was no linear relationship between the breadth and length dimensions of the bone. Based on qualitative assessment, hyoid bones could be classed as either hyperbolic (55%) or parabolic (45%) in shape. Hyperbolic hyoid bones could be distinguished from hyoid bones with a parabolic configuration on the basis of the metric data although there was considerable overlap in the dimensions of hyoid bones of both configurations. Female hyoid bones tended to be smaller in both dimensions than male hyoid bones. The metric parameters of fractured hyoid bones from 10 cases (8 female, 2 male) of strangulation were compared with the dimensions of hyoid bones in this study. The metric features of the fractured hyoid bones were attributable to the predominance of females in the group of fractured hyoid bones studied, an observation that is anticipated because the majority of strangulations involve female decedents. On this basis, we conclude that variables other than the shape and dimensions of the hyoid bone are more relevant in determining if hyoid fracture occurs during strangulation.

Adult↗

Age and ossification of the hyoid bone: forensic implications.

Hyoid bones from a medical examiner population were visually and radiographically examined to determine the presence or absence of bony fusion of the greater cornua to the central body. Fusion was found to increase in frequency with age. Hyoid bones fused more frequently in males than in females. Females showed an especially high frequency of unilateral nonfusion.

Adolescent↗

[Injury pattern of the hyoid bone].

Based on the classification of hyoid bone into hyperbola-, parabola-, and horseshoe-shaped types, conditions were stimulated under planar and punctiform ventral force as well as in case of strangulation in photoelastic experiment. The results thus obtained were compared to those from former investigations in the field of bone tissue density. Hence, each hyoid type shows characteristic patterns of lesion of its own. The patterns of fractures and localizations which had been expected theoretically could be verified when compared to lesions that occurred in vital state. Then it turned out that horizontal fractures were typical of lesions of hyperbolic hyoid bones and vertical fractures of the cornu maius typical of lesions of parabolic hyoid bones.

Asphyxia↗

Hyoid bone insertion tendinitis: clinicopathologic correlation.

Hyoid bone insertion tendinitis is often not taken into consideration in clinical practice and neglected in the differential diagnosis while evaluating patients with chronic neck pain. One of the main important reasons why physicians do not bear this entity in mind is that it has not been well described histopathologically. Two patients, who had been diagnosed and treated surgically for hyoid bone insertion tendinitis, were presented in this study. Microscopically, degenerative changes in the striated muscle tissue, which are characterized by myocyte necrosis, atrophy along with fibrosis and calcification in some foci, were observed. These findings provide evidence for the clinical picture of hyoid bone insertion tendinitis.

Adult↗

[Hyoid bone position and airway accompanied with influence of head posture].

The position of hyoid bone has been analyzed using roentgenogram. But, due to the great variability with the change of head posture, the position could not be determined correctly. In the present study, we investigated the influence of head posture to the position of hyoid bone. Subjects consisted of 32 Japanese males, those mean age was 25.8 years. Lateral cephalograms had been taken for each subjects at 5 different head posture. The findings were as follows. 1. Superimposed on SN plane, hyoid bone moved along the line of menton to 4th cervical vertebrae (C4) with the change of head posture. The hyoid bone moved in parallel with the line of 3rd cervical vertebrae (C3) to C4 (cervical plane). In spite of these movements, RH kept an uniform ratio. 2. The distances between sella turcica and hyoid bone and between C3 and hyoid bone, and the angle between menton, porion and hyoid bone, were at constant value. 3. Some measurements included the distance between hyoid bone and menton and the angle between nasion, sella turcica, hyoid bone showed very high correlation with the change of head posture. 4. EpPW1 (the width of airway) and the distance from C4 to hyoid bone showed almost the same change. It means the position of hyoid bone has a great influence on airway.

Adult↗

The shape and size of the human hyoid bone and a proposal for an alternative classification.

Human hyoid bones, according to the main characteristics of their shape, studied in 76 bones, may be classified into five types, in the following order of frequency:D-type 29%, B-type 26.5%, H-type 21%, U-type 18.5%, and V-type 5.0%. The frequency of the types is to a certain (but not statistically significant) degree sex-related. In 60% of the cases the shape of the hyoid bone does not belong to any of the shapes that are conventionally described. Almost half of the hyoid bones are asymmetric and/or anisometric. According to their width the hyoid bones may be designated as narrow (45%), intermediate (34%) and wide (21%). There is no standard correlation of the distance between the tubercles of the greater horns to the distance between the lesser horns in the same hyoid bone. On the contrary, with the exception of the horseshoe-shaped bones, the former distance almost coincides to the length of the major transverse axis of the same bone. The two dimensional size of the hyoid bone, which is of importance to the vital space of the superior opening of the lower respiratory tract, varies greatly, and to a certain degree it is related to the hyoid shape.

Biometry↗

Age and sex-related variation in hyoid bone morphology.

Although the relationship between hyoid bone shape and fracture pattern figures prominently in forensic investigations of strangulation, few quantitative data exist on age and sex differences in hyoid morphology. An image analysis system was used to take a series of 30 measurements on digitized radiographs of 315 hyoid bones from people of known age and sex. The degree of fusion of the greater cornua to the hyoid body was also recorded. Statistical analysis of these data shows that there is a continuous distribution of hyoid bone shapes and the most bones are highly symmetrical. Based on smaller samples, previous researchers have suggested that non-fusion is more common in women than in men. In contrast, our data suggest that men and women have similar non-fusion rates. Analysis of sexual dimorphism shows that the greatest length differences are in the greater cornua. There are also significant sex differences in hyoid shape. For example, the distal ends of the greater cornua of women are significantly longer than those of men.

Adolescent↗

Age-related morphological changes in the human hyoid bone.

OBJECT: Age-related morphological changes in the human hyoid bone were investigated radiographically and histologically. MATERIALS AND METHODS: Thirty-two measurements were performed on radiographs of 238 hyoid bones from autopsy cases of known age and sex. Thirty-one hyoid bones that were studied by radiography were also examined histologically in horizontal sections. RESULTS: Analysis of the length and width of the hyoid bone revealed significant increases in the body and the anterior part of the greater cornu and a significant decrease in the posterior part of the greater cornu with aging. Most measurements of the body and the greater cornu revealed differences between male and female hyoid bones. The outer margins of the body and the greater cornu were situated further outside in older males compared with females. The breadth of the joint space showed a significant age-related decrease, and the degree of fusion showed a significant age-related increase. Histological findings showed ossified or calcified fusion, with osteoclasts in the marginal area of the joint space. CONCLUSIONS: Increasing age induces fusion of the body and the greater cornu. The morphometric changes in the shape of the hyoid bone may represent functional adaptation to articulation fixation.

Adult↗

[The hyoid bone in reconstructive laryngeal and cervical surgery].

The hyoid bone, with its complex system of connected muscles, ligaments and membranes, provides a highly resistant anchor point in all cases of larynx tumour surgery requiring a "pexy" to reconstruct the upper respiratory tract. This bone can also be important in reconstructive cervical surgery employing myocutaneous flaps, especially after extensive tissue removal, such as in locally advanced larynx tumours (primary T4 lesions or recurrences after partial or subtotal operations) and some primary or recurring malignant cancers of the thyroid, parathyroid or pharyngoesophageal tract involving the larynx. In this study the importance is underlined of preserving the hyoid bone in all cases of cervical surgery in which a strong anchor is needed for repair, due to the radical nature of intervention. The clinical-surgical data are reported of 39 patients, 38 of whom affected with epidermoid carcinoma of the larynx with various degrees of differentiation and 1 with "tall cell" papilliferous thyroid carcinoma, observed and treated over the last three years. In horizontal supraglottic laryngectomy (HSL), but particularly in subtotal larynx surgery with cricohyoidoepiglottopexy (CHEP) and cricohyoidopexy (CHP), the hyoid bone allows a sort of anastomosis to be performed, using residual cartilage to make a "neo-larynx". In reconstructive cervical surgery after extensive tissue removal, such as in forward widened total laryngectomy (FWTL), the hyoid bone offers an excellent anchor for myocutaneous pedunculate "repair" flaps, which may be thoraco-dorsal or free revascularized, to ensure continuity between the muscle tissue of the base of the tongue and of the flap itself. The hyoid bone and connected structures thus provide a real support apparatus whose great versatility, due to its resistance and extreme mobility, makes it particularly useful during the reconstructive phase of cervical surgery.

Adult↗

Hyoid bone fracture with pharyngeal lacerations.

Four cases of hyoid bone fracture with laceration of the pharynx are presented. The emergency treatment must aim at an exploration of the neck in an attempt to suture the lacerations of the pharyngeal mucosa. The fractured hyoid bone may be left untouched in most cases. The most common causes of fractures of the hyoid bone were previously considered to be violent strangulation and hanging. In the last two decades, however, road accidents seem to have become the most important cause in patients who survive the initial impact of collision. The biodynamics of injury to the pharynx and larynx in road accidents have been adequately described by Nahum and Siegel (1967). The concluded that the driver was the most frequent victim and the steering wheel was the object with which the neck most commonly collides. It is very easy to miss a fractured hyoid bone during the urgent admission of a patient injured in a traffic accident, since the more dramatic injuries are treated first and a treacheostomy is often performed to provide an airway.

Adult↗

Positional change of the hyoid bone at maximal mouth opening.

The positional change of the hyoid bone in both closed and maximal mouth-opening positions of the mandible was investigated by cephalometric measurements. The following results were obtained: (1) With the increase in mouth opening the hyoid bone moved downward and backward. At maximal mouth opening the head posture changed posteriorly compared with that of occluded mouth position. (2) By superimposing films of the S-N plane, it became apparent that the hyoid bone was displaced downward by sagittal opening movement of the mandible and backward by the posterior change of the head posture. (3) Significant correlations were found between the degrees of sagittal rotation of the mandible and the position of the hyoid bone. (4) These results suggest that the posterior change of the head posture and inferior shift of the hyoid bone with mouth opening are important factors in obtaining maximal mouth opening.

Adult↗

Fracture of the hyoid bone in strangulation: comparison of fractured and unfractured hyoids from victims of strangulation.

The hyoid is the U-shaped bone of the neck that is fractured in one-third of all homicides by strangulation. On this basis, postmortem detection of hyoid fracture is relevant to the diagnosis of strangulation. However, since many cases lack a hyoid fracture, the absence of this finding does not exclude strangulation as a cause of death. The reasons why some hyoids fracture and others do not may relate to the nature and magnitude of force applied to the neck, age of the victim, nature of the instrument (ligature or hands) used to strangle, and intrinsic anatomic features of the hyoid bone. We compared the case profiles and xeroradiographic appearance of the hyoids of 20 victims of homicidal strangulation with and without hyoid fracture (n = 10, each). The fractured hyoids occurred in older victims of strangulation (39 +/- 14 years) when compared to the victims with unfractured hyoids (30 +/- 10 years). The age-dependency of hyoid fracture correlated with the degree of ossification or fusion of the hyoid synchondroses. The hyoid was fused in older victims of strangulation (41 +/- 12 years) whereas the unfused hyoids were found in the younger victims (28 +/- 10 years). In addition, the hyoid bone was ossified or fused in 70% of all fractured hyoids, but, only 30% of the unfractured hyoids were fused. The shape of the hyoid bone was also found to differentiate fractured and unfractured hyoids. Fractured hyoids were longer in the anterior-posterior plane and were more steeply sloping when compared with unfractured hyoids. These data indicate that hyoids of strangulation victims, with and without fracture, are distinguished by various indices of shape and rigidity. On this basis, it may be possible to explain why some victims of strangulation do not have fractured hyoid bones.

Adult↗

Osteoradionecrosis of the hyoid bone: a report of 3 cases.

PURPOSE: Osteonecrosis of the hyoid bone is an uncommon disease that has only been described occasionally in the literature. MATERIALS AND METHODS: We report 3 cases of osteonecrosis of the hyoid bone after radiation therapy for carcinoma at various sites in the head and neck region. RESULTS: Imaging computed tomography (CT) scans were performed for all 3 cases and did aid in the diagnosis. In 1 case, a 201thallium scintigraphy and a bone scan (99mtechnetium-diphosphonate) were performed and this confirmed the diagnosis of osteoradionecrosis. CONCLUSION: Osteoradionecrosis of the hyoid bone may be misdiagnosed as recurrent neoplasm. Although recurrent or persistent neoplastic disease must initially be ruled out, it is subsequently important to correctly identify osteonecrosis of the hyoid bone, because its surgical treatment is simple and the prognosis is good.

Adult↗

Isolated hyoid bone fracture. Review of an unusual entity.

Fractures of hyoid bone resulting from trauma other than strangulation are very rare, isolated hyoid bone fractures are even rarer, and occur more frequently in young individuals, and in men more than in women. A comprehensive review of the world literature, also two rare cases of isolated hyoid bone fractures induced by direct trauma onto the anterior neck are presented. Additionally, a table summarizing 31 cases from 1954 to 2003, is included. Mechanism of injury, diagnosis, complications, prognosis, and treatment are discussed.

Adult↗