Figure 1 - available via license: Creative Commons Attribution 3.0 Unported
Content may be subject to copyright.
Anatomy of hyoid bone and new parameters. A. Schematic of the hyoid bone and attachment sites with the upper airway pharyngeal muscles. B. Axial image of the hyoid bone on a computed tomographic (CT) scan. Parameters that were measured are indicated on the CT image and include the following: LH-d, distance between the bilateral lesser horns; GH-d, distance between bilateral greater horns; AP, distance from the most anterior end of hyoid arch to GH-d; H-angle, angle made by bilateral extension lines between greater and lesser horn; GH-LH, distance between greater and lesser horns.
Source publication
We hypothesized that the size of the hyoid bone itself may affect the severity of sleep apnea. The aim of this study was to identify the relationship between hyoid bone dimensions and the severity of sleep apnea using computerized tomography (CT) axial images.
We retrospectively measured the hyoid bone in axial images of neck CTs and correlated the...
Similar publications
Introduction Obstructive Sleep Apnea (OSA) is characterized by repeated episodes of upper airway obstruction during sleep.
Objective The objective of this study is to verify the craniofacial characteristics and craniocervical posture of OSA and healthy subjects, determining possible relationships with the apnea/hypopnea index (AHI).
Methods This ca...
Introduction Since oropharyngeal surgery alone is often insufficient to treat obstructive sleep apnea (OSA), advances have been developed in hypopharyngeal surgery.
Objective To assess hyoid suspension surgery as part of a multilevel OSA surgery, also including palatal surgery.
Methods The study included patients with OSA symptoms with apnea hypopn...
Citations
... Inferiorly positioned HB has been associated with the OSA syndrome in the literature [17]. Also, Ha et al. [24] reported a significant inverse correlation between the OSA severity and distance between the greater horns. Besides these, damage to the larynx and HB has been described as a common finding Fig. 7 a Distribution of hyoid types according to hyoid bone level relative to the cervical vertebra with no statistically significant association (p > 0.05), b distribution of hyoid bone relative to cervical vertebra in hanging and strangulation. ...
Objectives
We aimed to explore the position, morphological, and morphometric properties of the hyoid bone (HB) and to investigate the effect of HB on the pharyngeal airway (PA) volume and cephalometric measurements.MethodsA total of 305 patients with CT images were included in the study. DICOM images were transferred to the InVivoDental three-dimensional imaging software. The position of the HB was determined based on the cervical vertebra level and in volume render tab, the bone was classified into six types after all structures around the HB were removed. Also, final bone volume was recorded. In the same tab, the pharyngeal airway volume was divided and measured in three groups (nasopharynx–oropharynx–hypopharynx). The linear and angular measurements were performed on the 3D cephalometric analysis tab.ResultsHB was most commonly located in C3 vertebra level (80.3%). While B-type was found to be the most frequent (34%), V-type was the least frequent (8%). The volume of the HB was found to be significantly higher in male (3205 mm3) than female (2606 mm3) patients. Also, it was significantly higher in the C4 vertebra group. The vertical height of the face was positively correlated with the HB volume, C4 level position, and increased oro-nasopharyngeal airway volume.Conclusion
The volume of the HB is found to differ significantly between genders and can potentially serve as a valuable diagnostic tool for understanding respiratory disorders. Its morphometric features are associated with increased face height and airway volume; however, are not related with the skeletal malocclusion classes.
... On physical examination of patients with OSA, signs such as an increase in waist or neck circumference accompanying obesity or overweight can be observed [40]. A deviated nasal septum, hypertrophy of the turbinate, and a vertically low position of the hyoid bone are also related to the severity of OSA [41]. In addition, the size of the tonsils or upper airway restriction can be confirmed using the Mallampati score or Friedman stage evaluation method [42,43]. ...
Obstructive sleep-related breathing disorder (SRBD) is an umbrella term that encompasses various types of upper airway dysfunctions during sleep characterized by increased respiratory effort secondary to snoring and/or increased upper airway resistance and pharyngeal collapse. Obstructive sleep apnea (OSA) is a representative SRBD that involves a significant decrease in or cessation of airflow despite the presence of respiratory effort. While snoring is considered a normal condition, it can cause serious noise disturbance to sleep partners and is considered a predictor of OSA. Snoring and OSA are highly correlated with obesity. SRBDs can lead to cardiovascular disease, hypertension, decreased quality of life, decreased work efficiency, daytime sleepiness, decreased neurocognitive activity, and psychological impairments. In dentistry, research on sleep problems has focused on temporomandibular disorder (TMD)/orofacial pain. The relationship between OSA and TMD/orofacial pain has been reported, but it is not clear whether it is a simple correlation or a causal relationship. Therefore, we aimed to review the causes of SRBDs including snoring and OSA and to review and infer the relationship between these SRBDs and TMD/orofacial pain. The effects of snoring and OSA extend beyond sleep disturbances and are worthy of future research, especially with regard to TMD.
... The hyoid bone thrives from the branchial arches and arch cartilages [4] . It is a solitary bone without any bony articulations [5,6] . It has muscles, ligaments and fascia attachments from cranium, mandible and pharynx that provide physiological functions; including speaking, breathing, swallowing and keeping the upper airway open during sleep [4,[7][8][9] . ...
Background:
The aim of the study was to determine sex and age from hyoid bone morphology on cone-beam computed tomography (CBCT).
Materials and methods:
The study sample compromised 130 CBCT images. Eight different measurements were performed for each hyoid bone. Fusion conditions were assigned to each side of the hyoid bone separately as; unfused, partially fused, and total fused.
Results:
The Hyoid length (Hyd-L), width of the left proximal end (LP-W) and stature variables showed sexual dimorphism in all hyoid fusion types (p < 0.05). In young adult age group, a significant difference was found between sex and fusion types (p = 0.025). The body length (B-L) (81.35%) and stature measurements (76.25%) contributed most significantly to sex estimation.
Conclusions:
Patient's CBCT scans which enable reproducible and reliable measurements for bone tissues, can be used for forensic procedures. Hyoid bone measurements with CBCT are useful methodology for age and sex estimation in forensic sciences with high accuracy predictive rates.
... bone plays an important role in supporting the functions of respiration, mastication and deglutition, and speech. Throughout the course of the human lifespan, the hyoid bone descends with the hyoid body ultimately fusing with the greater cornua, although the timing and extent of fusion vary among individuals (Devlin, 2002;Fisher et al., 2016;Ha et al., 2013;O'Halloran & Lundy, 1987). Deviations in the placement of the hyoid bone relative to other functionally related structures can have ramifications on one or more of the aerodigestive and vocal tract functions (Harun, Zainul et al., 2007;Kanetaka, Shimizu, Kano, & Kikuchi, 2011;Vieira et al., 2014). ...
The hyoid bone and the hyomandibular complex subserve the functions of respiration, deglutition, and speech. This study quantified the growth of the hyoid bone and the hyomandibular relationships in males and females from birth to 19 years. Using 97 computed tomography (CT) scans, from a previous study (Kelly et al., 2017) on mandibular growth from 49 individuals (16 with longitudinal scans), landmarks were placed on 3D CT models and used to calculate four distance, and three angular measurements. A general increase in growth trend was observed in hyoid bone linear measurements—length, width, and depth—as well as relational mandible‐to‐hyoid distance, throughout the developmental ages examined in both males and females, with most variables having larger measurements for females up to age 10 years. A general decrease in all three angular measurements was observed in both males and females up to approximately age 12 years, at which time male angular measurements gradually increased with significant sexual dimorphism emerging after age 15 years. As expected, postpubertal males had greater hyoid angle than females; they also had greater hyoid angle of inclination than mandible body inclination (with inclination relative to the anterior–posterior nasal plane), likely related to hyo‐laryngeal descent. This study contributes to normative data on hyoid bone and hyomandibular relational growth in typically developing individuals and provides a baseline against which structural and functional influences on anatomic growth may be examined by clinical disciplines that address the aerodigestive and speech functions, as well as the fields of anatomy, forensics, and anthropology.
... Multiple cephalometric studies have shown that the hyoid bone is more inferior and posterior in OSA patients, [10][11][12] predisposing to pharyngeal wall collapse and obstruction at the retrolingual hypopharynx. In addition, shorter AP length or lateral width of the hyoid bone 13 and longer distance between the hyoid and mandible have been shown to be associated with more severe OSA. 14,15 Recognizing the relation of the hyoid to hypopharyngeal airway dimensions, surgical procedures have been developed to augment and stabilize the hyoid. ...
Objective(s)
Obstructive sleep apnoea is characterized by repetitive obstruction of the upper airway during sleep. These repeated oxygen desaturations increase cardiovascular and cerebrovascular morbidity and mortality significantly. Upper airway surgery is an option for patients who fail continuous positive airway pressure therapy. Airway collapse is usually multilevel and hypopharyngeal collapse is a challenging area to address. It is hypothesized that hyoid expansion with hyomandibular suspension can potentially increase upper airway dimensions at the hypopharynx. This study aims to document the effect of hyoid expansion using titanium plate and screws with hyomandibular suspension on hypopharyngeal airway dimensions. It is an anatomical feasibility study performed using 10 human cadaver heads.
Methods
The hyoid bone is trifractured. The expanded hyoid is then suspended to the mandible. Computed tomography (CT) scans were performed on the cadavers to measure the airway dimensions before and after the procedure.
Results
This procedure resulted in statistically significant increase in airway dimensions at the level of the hypopharynx in all 10 human cadaver heads. Increase in cross‐sectional area correlated significantly with increase in 3‐dimentional (3D) volume.
The mean area of the airway at the level of the hyoid increased from 999.3 ± 193.0 mm² to 1241.4 ± 103.2 mm². Statistically significant increase in upper airway volume based on 3D reconstruction was also noted. Upper airway volume increased from 6.94 ± 6.46 mL to 13.58 ± 8.29 mL.
Conclusion
Airway dimensions increased with hyoid expansion and hyomandibular suspension in our cadaveric study measured using CT scans. Further studies are needed to see if this technique can be translated to clinical use in live patients.
Level of evidence
NA.
... Ambos artículos (189,190) detallan aspectos anatómicos de la VAS y el esqueleto facial que se relacionan con el SAHOS. Los resultados del artículo de Chi y otros (190) corroboran el resultado del artículo de Neelapu y otros (181) referente a cefalometría sobre TAC o teleradiografía lateral de cráneo, en cuanto a la relación de un plano oclusal acentuado y el riesgo de SAHOS. ...
In November 2014 the Spanish Society of Otolaryngology, the Spanish Sleep Society and the Spanish Society of Maxillofacial Surgery proposed and endorsed the development of a Clinical Practice Guideline on the physical examination of the upper airway in patients with Obstructive Sleep Apnoea.
The Guideline strictly followed the recommendations of the manual for the preparation of clinical practice guidelines of the National Health System 2007 and 2009 and the manual of the Scottish Intercollegiate Guidelines Network (SIGN) 2015.
The final document could be highly useful for the purposes that were originally proposed: to act as a reference to unify the regions that should be explored in patients with OSAHS, the type of examination and how to grade it, and specific to all the care areas to which these patients have access.
The conclusions and recommendations are based on a thorough and up-to-date review of the literature with a high level of evidence, as well as the experience and knowledge demonstrated by all the members of the drafting group.
This group was formed bearing in mind at all times the transversality of the project, and, therefore, specialists from all the involved areas participated (maxillofacial surgery, family medicine, pneumology, clinical neurophysiology, odontology and otolaryngology). The external reviewers of the final text were selected along the same lines.
... The OSA patients have smaller hyoid and hence smaller airway size compared to normal individuals, and severity of OSA is related to the area within the hyoid bone. 43 In a small case series of hyoid expansion 44 and a cadaveric study, 45 studying hyoid expansion showed increase airway dimension. Future studies may be needed to prove their clinical use. ...
... Ambos artículos (189,190) detallan aspectos anatómicos de la VAS y el esqueleto facial que se relacionan con el SAHOS. Los resultados del artículo de Chi y otros (190) corroboran el resultado del artículo de Neelapu y otros (181) referente a cefalometría sobre TAC o teleradiografía lateral de cráneo, en cuanto a la relación de un plano oclusal acentuado y el riesgo de SAHOS. ...
... Some authors have not found a statistically significant difference between the classes, 22,23 whereas others have reported that Class II subjects showed lower volumes when compared with Class I and Class III subjects, with statistically significant differences. 24,25 Furthermore, another study comparing male and female Class I and Class III subjects showed a statistically significant difference in pharyngeal volumes only among the female subjects. 4 In our research, a statistically significant difference was found between Class I and Class III subjects, with higher volume values in Class III subjects. ...
... These have found that the smaller the measurement, the more severe the obstructive sleep apnea. [24][25][26] In our study, we measured the distance of greatest constriction in the pharyngeal space. The results showed that these measurements were smaller in Class II mesofacial and dolichofacial patients. ...
Introduction:
The purpose of this article was to evaluate the pharyngeal space volume, and the size and shape of the mandible and the hyoid bone, as well as their relationships, in patients with different facial types and skeletal classes. Furthermore, we estimated the volume of the pharyngeal space with a formula using only linear measurements.
Methods:
A total of 161 i-CAT Next Generation (Imaging Sciences International, Hatfield, Pa) cone-beam computed tomography images (80 men, 81 women; ages, 21-58 years; mean age, 27 years) were retrospectively studied. Skeletal class and facial type were determined for each patient from multiplanar reconstructions using the NemoCeph software (Nemotec, Madrid, Spain). Linear and angular measurements were performed using 3D imaging software (version 3.4.3; Carestream Health, Rochester, NY), and volumetric analysis of the pharyngeal space was carried out with ITK-SNAP (version 2.4.0; Cognitica, Philadelphia, Pa) segmentation software. For the statistics, analysis of variance and the Tukey test with a significance level of 0.05, Pearson correlation, and linear regression were used.
Results:
The pharyngeal space volume, when correlated with mandible and hyoid bone linear and angular measurements, showed significant correlations with skeletal class or facial type. The linear regression performed to estimate the volume of the pharyngeal space showed an R of 0.92 and an adjusted R2 of 0.8362.
Conclusions:
There were significant correlations between pharyngeal space volume, and the mandible and hyoid bone measurements, suggesting that the stomatognathic system should be evaluated in an integral and nonindividualized way. Furthermore, it was possible to develop a linear regression model, resulting in a useful formula for estimating the volume of the pharyngeal space.
... It has been reported that the size of the hyoid bone and mandible play a role in sleep apnea syndrome (SAS). Ha et al. (2013) found that, in subjects with severe SAS, the angle of the two greater horns (in this study angle a) and the width between the greater horns (in this study width H) were both smaller than in normal subjects. Chi et al. (2011) found that the length of the mandible (in this study length T) was larger in male subjects with SAS, and the width of the mandible (in this study width V) was shorter in female subjects with SAS. ...
The aim of this study is to obtain a quantitative anatomical description of the hyoid bone and mandible using three-dimensional computed tomography. Hyoid bones were obtained from a total of 101 cadavers varying in age from 67 to 102 years. The percentage of symmetrical U-type and asymmetrical-type hyoid bones was low compared with symmetrical V type (14.9, 15.8, and 69.3 %, respectively), and no significant sex difference was observed. We found bilateral nonfusion in cadavers of advanced age at a rate of 22.7 % and bilateral complete fusion at a rate of 51.5 %. There were significant differences in metric variables (length and width) between males and females, but no significant differences in width among the different fusion types. There was no significant interaction effect of sex and degree of fusion. Strong significant associations were observed between size (length and width) of the hyoid bone and mandible in the nonfusion group, while the complete fusion group revealed a moderate correlation. We also investigated the hypothesis that the junction between the hyoid body and greater horn plays an important role in the movement of bones that have not yet ossified. However, no statistical difference was observed in the width between the two greater horns. The degree of fusion of the greater horn with the hyoid body may also affect relations of interdependencies between the hyoid bone and mandible, an important component to consider when assessing risk factors in the development of masticatory and swallowing function.
