To commence the conservative treatment, hyoid bone was palpated digitally as advised by Brown. The patient was given local lignocaine plus steroid injections weekly for 1 month on the tip of the affected cornua. However, patient reported with no relief. Thereafter, the patient was planned for surgical resection of greater cornua under general anesthesia. An informed written consent was obtained from the patient for the surgery.
Superior limb of Mcfee incision was given. Skin, subcutaneous tissue, platysma were incised. Blunt dissection was done through deep cervical fascia. Middle pharyngeal constrictor was bluntly dissected from the greater cornua to expose it [ Figure 4 ]. After the exposure, greater cornua was resected from its junction to the body [ Figure 5 ]. Layer wise closure was done. The patient was followed up with an uneventful healing with complete resolution of clicking and pain [ Figure 6 ].
The hyoid is horseshoe shaped bone which is suspended from the tips of the styloid processes of the temporal bones, straddled by the stylohyoid ligaments. It consists of five segments. These constitute a body, two greater cornua, and two lesser cornua. The hyoid is ossified from six centers: Two for the body and one for each cornua.
Ossification commences in the greater cornua toward the end of fetal life, in the body shortly afterward, and in the lesser cornua during the 1 st or 2 nd year after birth. The hyoid bone forms a movable base for the tongue and its varied movements and is held in position by a large number of muscles. The hyoid bone has connections with muscles to the mandible mylohyoid , tongue hyoglossus , skull stylohyoid , thyroid cartilage thyrohyoid , sternum sternohyoid , to the medial border of the scapular notch omohyoid , and to the pharyngeal median raphe middle pharyngeal constrictor muscle.
Diagnostic testing included digital or bimanual palpation with the index finger on the greater cornua of the nonaffected side. This procedure directed the entire hyoid toward the surface of the skin of the affected side, with the thumb stabilizing the affected cornua at the site of injury, as recommended by Brown. The anomalies of hyoid bone are of congenital as well as acquired variety [ Table 1 ]. Since these are infrequently encountered in clinical practice, only a few anomalies of hyoid bone and its associated structures has been reported in the literature so far.
In the present case, the condition was of acquired variety. However, there was no history of trauma or inflammation which could be suspected for condition. Congenital enlargement of hyoid bone was reported by Morrissey and Alun-Jones[ 4 ] in The patient reported with the chief complaint of pain on swallowing in addition with jaw locking.
Radiographic examination revealed large and splayed greater horns impinging inside of the mandible. The author stated that partial excision of bilateral greater cornua of hyoid provide complete resolution of the problem. A similar case of painful clicking was documented by Makura and Nigam,[ 5 ] where patient was diagnosed as clunking neck with characteristic finding of noisy painful neck movements.
Greater horn of hyoid was found to be enlarged, and complete resolution of symptoms was achieved by surgical excision of greater cornua of hyoid bone. Another milestone of painful clicking was added in the literature by Ilankovan. The hyoid was normal with no previous history of trauma.
However, on further detailed examination, an accessory abnormal bone was found. Initially, the patient was managed conservatively. However, the symptoms worsened. Hence, on surgical exploration, a long bone articulating by synovial joint with superior cornua of thyroid cartilage and greater cornua of hyoid bone. In the present study, the patient denied of any previous history of trauma. However, on palpation, greater horn of hyoid bone was found to be enlarged.
In the 17 th century, stylohyoid ossification was diagnosed as a result of the great work of Marchetti of Padua. Stylohyoid ligament ossification has been documented by Demanchetis in Pharyngeal transit was complete when the tail of the bolus was fully within the UES.
Pharyngeal transit time can be divided into an oropharyngeal and a hypopharyngeal phase by the arrival of the bolus in the vallecula BV. If the bolus bypassed the vallecula, the time when the bolus passed the level of the base of the vallecula was designated BV. Hyoid movement relative to the onset of bolus pharyngeal transit H1-B1 and relative to the arrival of the bolus in the vallecula H1-BV can be calculated.
Maximal opening of the UES was measured at the narrowest part of the upper esophagus between C4 and C6 during maximal distension. We believe that this point best defines the location of the UES. It is also reliably identified on a dynamic swallow study, as opposed to a measurement made from the often poorly defined top of the air column in the trachea.
The data from the measured variables were averaged across subjects according to bolus size. Patient means were then compared with the means from dynamic videofluoroscopic swallow studies performed on 60 volunteers without dysphagia aged 18 to 62 years, and with the means from studies performed on 23 older volunteers without dysphagia aged 67 to 83, using 1-way analysis of variance.
Posttests were done to evaluate differences between individual pairs of groups. A Bonferroni correction was applied to take into account that multiple comparisons were performed. The overall P values, the uncorrected P values determined from comparisons between groups, and the Bonferroni corrected P values are reported.
The younger control group consisted of 30 men and 30 women. There were 10 men and 13 women in the older control group. None of the control subjects had symptoms of dysphagia or gastroesophageal reflux disease, a history of central nervous system or craniofacial abnormalities, or other medical problems. They took no medications. All of the controls were respondents to advertisements asking for volunteers to participate in the study.
Screening of prospective participants was carried out to ensure they fit the study criteria. Each volunteer was examined to rule out potential anatomic abnormalities in the head and neck region. The relationship of specific swallowing gestures to one another in individual patients was analyzed using linear regression. Any abnormality in the opening size of the UES was noted for each patient and was defined as less than 2 SDs from the mean of the younger controls.
Fisher exact test contingency tables were used to analyze the relationship between UES opening size and duration of hyoid elevation. During the study, dynamic swallow studies were performed. Of those, The diagnostic categories in the patient population are listed in Table 1. Only patients in the first category, nonspecific dysphagia, were included in the study.
When subsequent studies in the same individuals were excluded, the final number of patients included in the study was 65 age range, years.
Not all patients had complete data available for analysis. Hyoid displacement data were often available for only one bolus size per patient. Reported results include the number of patients with data available for each measured variable. A swallow study variable was defined as normal if it was within 2 SDs of the normal mean.
For ease of comparison, results from control subjects are reported in the tables alongside those from the patients. A list of abbreviations used in the text is provided in Table 2 for reference. Differences in the timing and extent of hyoid bone elevation between the patient population and younger controls were identified in this study. However, when the data from the patient population were compared with those from the older controls, more subtle differences were identified.
The onset of hyoid elevation H1 relative to the onset of bolus pharyngeal transit B1 was delayed in the patient population compared with the younger controls for both bolus categories.
H1 was also delayed in the older control group, but not to the extent found in the patient group Table 3. The point at which the hyoid reached maximal elevation H2 and the point at which the hyoid began its descent back to a resting position H3 were similarly delayed in the patient population compared with the younger controls. Again, the timing of these events relative to the onset of bolus pharyngeal transit was delayed in the older controls compared with the younger controls, but not to the extent found in the patient group Table 4 and Table 5.
Some delay in the timing of hyoid movements is expected in older persons. Although the difference in data between the patient group and the older controls did not reach statistical significance, a trend toward greater delays in the patient population was identified. To evaluate the coordination of hyoid movement with the position of the bolus in the pharynx, H1 was compared with BV.
In younger persons without swallowing abnormalities, the hyoid begins to elevate just after the arrival of the bolus in the vallecula.
For the mL bolus in the patient group, the hyoid bone began to elevate early relative to the arrival of the bolus in the vallecula Table 6. To summarize, coordination of hyoid elevation with the position of the bolus in the pharynx was normal or slightly early in the patient population.
Once hyoid elevation began, the time required for the hyoid to reach maximal elevation H2-H1 was prolonged in the patient population relative to the younger controls for both bolus categories. When the patient population was compared with the older controls, no difference in H2-H1 was identified Table 7. It's suspended just beneath the mandible.
You can feel your own hyoid bone here, and you can move it from side to side. Together with its attached muscles, the hyoid bone has two important functions: it holds up the tongue, which sits above it, and it holds up the larynx, which hangs below it.
It also transmits the force of muscles that help to open the jaw. This broad central part is the body. The backward facing lower surface of the body is deeply concave.
On each side this long slender part of the hyoid bone is the greater horn or greater cornu. The greater horn is attached to the body by a small synovial joint, which gives it a little mobility. This is due to its location, which generally protects the bone from all but direct trauma.
The hyoid bone provides a place of attachment for several anterior front neck muscles. The muscles that attach onto the hyoid bone include, but are not limited to, the:. These and other anterior neck muscles play a role in swallowing and may be affected in cases of neck injuries or misalignment. The hyoid bone is located above the Adam's apple in men and below the tonsils and the epiglottis.
While not technically a part of the larynx, at the top, the two structures are very close. The hyoid provides an attachment site for muscles that control movements of the larynx. Since the hyoid functions as an attachment point for the larynx, it's involved in any function that the larynx is involved in.
The larynx is the area above your windpipe, aka trachea, that helps protect you from choking on foreign objects. Perhaps the most well-known example of this is when food "goes down the wrong pipe. The larynx does its primary job of protecting you from choking by quickly closing off the opening to the trachea when a foreign object tries to enter.
Remember, the windpipe is built for air, not things. Another thing the larynx does is produce sound; singers and speakers often refer to the larynx as the voice box. The larynx is also responsible for coughing, which is part of the choking protection mechanism function mentioned above. The larynx has a few other purposes, as well, including playing a role in ventilation and functioning as a sensory organ. A second function of the hyoid bone is to provide a foundation or base from which the tongue can move.
Finally, the hyoid bone is involved in respiration it plays a role in keeping the airway open. That important not only for breathing but for sleep and sleeping disorders, such as sleep apnea.
The hyoid bone is small, and it functions as an attachment point for many muscles involved in swallowing, jaw movements, and respiration. Swallowing function may be impaired due to problems such as stroke, neck injuries, or jaw and neck cancers. If that occurs, working with a specialist like a speech pathologist may be useful.
Your speech therapist may perform specific exercises to help you swallow better, and these may involve getting familiar with your hyoid bone.
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