Radiological morphometric study of the hyoid bone using three-dimensional computed tomography (3D-CT) scans / Estudio morfométrico radiológico del hueso hioides mediante tomografía computarizada tridimensional (3D-CT)

SUMMARY: Hyoid bone measurements have been proposed to vary between different genders and age groups. The aim of the study is to study hyoid morphometrics among Jordanian patients. 3D-CT scans of 637 patients were analyzed. Ten parameters of hyoid bone were measures, including the anteroposterior length, length of greater horns (right and left), height of greater horns (right and left), width of hyoid body, height of hyoid body, the distance between the midpoints of the posterior ends of the greater horns of the hyoid bone, the angle between right and left greater horns, and the distance of the hyoid bone to the vertebral column. Also, vertebral level, fusion rank, morphology of hyoid body lingula, and shape of hyoid bone were documented. All hyoid dimensions were longer in males, but greater horns angle was wider in females. In patients younger than 30 years, the parameters are the smallest with the widest angle. The distance from hyoid to vertebral column is higher in males (30-49) years of age. No fusion between hyoid body and greater horns was observed in patients younger than 10 years, but fusion (unilateral or bilateral) was found in only 73.2 % of patients ≥ 70 years. The hyoid was mostly at vertebra C3 level and "U" shaped. The lingula shape was mostly "Scar" in males (especially ≥ 50 years) and "Nothing" in females (especially < 50 years). The maximum growth of hyoid dimensions is before age of 30 years. Fusion between hyoid body and greater horns was not seen in patients younger than 10 years. Otherwise, the hyoid features failed to predict age or gender in our sample. Furthermore, 3D-CT scan is an excellent tool to assess the anatomy of head and neck region.

Se ha propuesto que las medidas del hueso hioides varían entre los diferentes sexos y grupos de edad. El objetivo del estudio fur estudiar la morfometría del hueso hioides en pacientes jordanos. Se analizaron tomografías computarizadas en 3D de 637 pacientes. Se midieron diez parámetros del hueso hioides, incluyendo la longitud anteroposterior, la longitud de los cuernos mayores (derecho e izquierdo), la altura de los cuernos mayores (derecho e izquierdo), el ancho del cuerpo hioides, la altura del cuerpo hioides, la distancia entre los puntos medios de los extremos posteriores de los cuernos mayores del hueso hioides, el ángulo entre los cuernos mayores derecho e izquierdo, y la distancia del hueso hioides a la columna vertebral. Además, se documentaron el nivel vertebral, el rango de fusión, la morfología de la língula del cuerpo hioides y la forma del hueso hioides. Todas las dimensiones del hioides fueron más largas en los hombres, pero el mayor ángulo de los cuernos fue más ancho en las mujeres. En pacientes menores de 30 años, los parámetros son los más pequeños con el ángulo más amplio. La distancia del hioides a la columna vertebral es mayor en el sexo masculino (30-49) años. No se observó fusión entre el cuerpo hioides y los cuernos mayores en pacientes menores de 10 años, pero se encontró fusión (unilateral o bilateral) en solo el 73,2 % de los pacientes ≥ 70 años. El hioides estaba mayormente al nivel de la vértebra C3 y en forma de "U". La forma de la língula era mayoritariamente "Cicatriz" en los hombres (especialmente ≥ 50 años) y "Nada" en las mujeres (especialmente < 50 años). El máximo crecimiento de las dimensiones del hioides es antes de los 30 años. La fusión entre el cuerpo hioides y los cuernos mayores no se observó en pacientes menores de 10 años. No obstante, las características del hueso hioides no pudieron predecir la edad o el sexo en nuestra muestra. Además, la tomografía computarizada 3D es una herramienta excelente para evaluar la anatomía de la región de la cabeza y el cuello.

Hyoid displacement patterns in healthy swallowing

ABSTRACT Objective To describe the patterns of displacement of the hyoid bone in healthy individuals, considering their displacements during swallowing of different consistencies. Methods Two hundred one swallowing videofluoroscopy exams of 67 adult and elderly individuals without swallowing disorders were analyzed. Descriptive analysis was performed to identify and describe the patterns of displacement of the hyoid bone. Results Seven types of displacement of the hyoid bone were found: H1 (horizontal), H2 (short vertical and long horizontal), H3 (vertical and diagonal to upper), H4 (long vertical and short horizontal), H5 (vertical), H6 (diagonal), and H7 (brief). The standards were maintained in different consistencies. The most frequent pattern of displacement was type H2. The distribution of the types of displacement of the hyoid was different among men and women. Conclusion Seven patterns of displacement of the hyoid bone during swallowing of normal adults and older people have been described. The most frequent pattern of displacement was horizontal, with variations in distribution between men and women. The displacement pattern was maintained during the swallowing of the three different consistencies (thin, pasty and solid liquid).

Adult Age Estimation of CT Image Reconstruction of the Laryngeal Cartilages and Hyoid Bone Based on Data Mining / 法医学杂志

Objective To explore the feasibility of the CT image reconstruction of laryngeal cartilage and hyoid bone in adult age estimation using data mining methods. Methods The neck thin slice CT scans of 413 individuals aged 18 to <80 years were collected and divided into test set and train set, randomly. According to grading methods such as TURK et al., all samples were graded comprehensively. The process of thyroid cartilage ossification was divided into 6 stages, the process of cricoid cartilage ossification was divided into 5 stages, and the synosteosis between the greater horn of hyoid and hyoid body was divided into 3 stages. Multiple linear regression model, support vector regression model, and Bayesian ridge regression model were developed for adult age estimation by scikit-learn 0.17 machine learning kit （Python language）. Leave-one-out cross-validation and the test set were used to further evaluate performance of the models. Results All indicators were moderately or poorly associated with age. The model with the highest accuracy in male age estimation was the support vector regression model, with a mean absolute error of 8.67 years, much higher than the other two models. The model with the highest accuracy in female adult age estimation was the support vector regression model, with a mean absolute error of 12.69 years, but its accuracy differences with the other two models had no statistical significance. Conclusion Data mining technology can improve the accuracy of adult age estimation, but the accuracy of adult age estimation based on laryngeal cartilage and hyoid bone is still not satisfactory, so it should be combined with other indicators in practice.

Análisis craneocervical en sujetos con respiración oral y nasal / Craneocervical analysis in subjects with oral and nasal breathing

La influencia de la función respiratoria en el desarrollo de estructuras orofaciales y postura craneocervical ha sido ampliamente discutida. El objetivo del estudio fue comparar valores cefalométricos de la región craneocervical e hioidea en sujetos con respiración nasal y oral. Se incluyeron sujetos de entre 18 y 27 años, de ambos sexos, donde 20 presentaban diagnóstico de respiración oral y 20 no presentaban esta alteración; mediante telerradiografía lateral de cabeza y cuello se realizó análisis cefalométrico craneocervical de Rocabado y aplicación de la técnica de Penning, obteniendo medidas craneocervicales e hioideas, dimensión anterior nasofaríngea y curvatura cervical. Para el análisis estadístico se utilizó la prueba de normalidad Shapiro-Wilk y la prueba T para muestras independientes, considerando un valor de p <0,05 para obtener diferencias significativas; en aquellos parámetros en donde no se presentó distribución normal se aplicó la prueba U de Mann-Whitney. No se encontraron diferencias significativas entre los grupos de estudio y los valores cefalométricos analizados, a excepción de la distancia entre la base del hueso occipital y el arco posterior del atlas (p=0,03). Existen limitadas diferencias cefalométricas entre sujetos con respiración oral y respiración nasal, no asociándose el espacio aéreo nasofaríngeo con las modalidades de respiración estudiadas. Deben ser consideradas condiciones de morfología facial o mandibular, para determinar más adecuadamente la influencia de los parámetros cefalométricos en el diagnóstico del modo respiratorio en estudios futuros.

The influence of respiratory function on the development of orofacial structures and craniocervical posture has been widely discussed. The objective of the study was to compare cephalometric values of the craniocervical and hyoid region in subjects with nasal and oral respiration. Subjects between 18 and 27 years of age, of both sexes, were included, where 20 presented oral breathing diagnosis and 20 did not present this alteration; using lateral telerradiography of the head and neck, craniocervical cephalometric analysis was performed of Rocabado and Penning technique was applied, obtaining craniocervical and hyoid measurements, anterior nasopharyngeal dimension and cervical curvature. For the statistical analysis we used the Shapiro-Wilk normality test and the T test for independent samples, considering a value of p <0.05 to obtain significant differences; in those parameters where no normal distribution was presented, the MannWhitney U test was applied. No significant differences were found between the study groups and the cephalometric values ??analyzed, except for the distance between the base of the occipital bone and the posterior arch of the atlas (p=0.03). There are limited cephalometric differences between subjects with oral breathing and nasal breathing, with no association of the nasopharyngeal air space with the breathing modalities studied. Conditions of facial or mandibular morphology should be considered in order to determine more adequately the influence of cephalometric parameters in the diagnosis of the respiratory mode in future studies.

Anatomy description of cervical region and hyoid apparatus in living giant anteaters Myrmecophaga tridactyla Linnaeus, 1758 / Descrição anatômica da região cervical e aparato hioide em espécimes vivos de tamanduá-bandeira, Mymercophaga tridactyla Linnaeus, 1758

The giant anteater has specific anatomical adaptations resulting from its ant and termite feeding habits. The unique arrangement of its hyoid apparatus is essential for the ingestion of food. However, its description in the literature is based on fragments and fossils, making it difficult to determine existing anatomical details in live animals. Imaging techniques, which enable the topographical anatomy of animals to be examined noninvasively, provide essential information for the diagnosis and prognosis of diseases. The aim of this study is to describe the bone contours in the hyoid apparatus of the giant anteater by means of radiographic and tomographic images. Giant anteaters of varying ages from the Wild Animal Screening Center (CETAS-GO) were used, seven for X-ray exams and two adults for CT exams. The hyoid elements in all the animals were evaluated using the two imaging techniques, and were visualized in the cervical region of C2 to C6, which comprises three paired bones (stylohyoid, epihyoid, ceratohyoid) and one unpaired bone (basihyoid). The presence of air in the oropharynx enabled the assessment of soft tissue structures in this region, such as the epiglottis and the soft palate. CT axial sections are of limited usefulness for evaluating the hyoid bones, but enable assessments of the basihyoid bone and its characteristic V-shape. Thus, to analyze the hyoid region in anteaters based on radiographic and tomographic images, one must keep in mind that the stylohyoid, epihyoid and ceratohyoid bones are situated ventrally to the C2 to C5 vertebrae and that the basihyoid at the level of C5-C6 demarcates the transition between the nasopharynx and the trachea. The nasopharynx and oropharynx extend from C1 to C5, and the trachea begins at the level of C6.(AU)

O Tamanduá-Bandeira possui adaptações anatômicas específicas, devido aos hábitos alimentares de ingestão de formigas e cupins. O arranjo singular do aparato hioide dos tamanduás é fundamental para a ingestão de alimentos. Sua descrição na literatura é baseada em peças e fósseis, o que dificulta a determinação de detalhes anatômicos existentes em animais vivos. As técnicas de imagem permitem a avaliação da anatomia topográfica dos animais, de maneira não invasiva, e o conhecimento desta é fundamental para o diagnóstico e prognóstico de afecções. O objetivo desse trabalho foi descrever o contorno ósseo do aparato hioide do tamanduá-bandeira, por meio de imagens radiográficas e tomográficas. Foram utilizados tamanduás-bandeiras provenientes do Centro de Triagem de Animais Silvestres (CETAS-GO), sendo sete, de variadas idades, para os exames radiográficos e dois adultos para os tomográficos. Os elementos hioideos foram avaliados em todos os animais por meio de ambas as técnicas de imagem, sendo visibilizados na região cervical, de C2 até C6, composto por três elementos pares (estiloioide, epioide, ceratioide) e um elemento ímpar (basitireoide). A presença de ar na orofaringe permitiu a avaliação das estruturas de tecidos moles desta região, como a epiglote e o palato mole. Os cortes tomográficos axiais têm importância limitada na avaliação dos hioides, mas permitem a avaliação do basitireoide e de seu formato característico (V-bone). Desta forma, para avaliar a região hioidea por meio dos exames radiográficos e tomográficos em tamanduás-bandeira, deve-se considerar que os ossos estiloioide, epioide e ceratioide localizam-se ventral às vértebras C2 até C5 e o basitireoide, em C5-C6, delimita a transição entre a nasofaringe e a traqueia. A orofaringe e a nasofaringe estendem-se de C1 a C5, e a traqueia inicia-se a partir de C6.(AU)

Localization of the carotid bifurcation according to hyoid bone and mandibular angle / Localización de la bifurcación carotídea según el hueso hióides y el ángulo mandibular

The aim of this study was to determine the carotid bifurcation level in relation with the hyoid bone and mandibular angle. Common carotid artery is the largest artery in the neck, and it gives off two terminal branches, namely external and internal carotid arteries. The bifurcation level of it shows variations, however it is usually situated at the level of C4 vertebra or at the upper border of thyroid cartilage. On the other hand, carotid bifurcation may be situated as low as T3 vertebra, or as high as the level of hyoid bone. In this study, conventional angiographic images of 112 patients were used. The distances of carotid bifurcation to hyoid bone and mandibular angle were measured on those images. In addition, right and left side difference was determined. The distance of carotid bifurcation level to the mandibular angle was measured as 21.26 ± 8.57 mm on the right and 20.25 ± 8.75 mm on the left side in males, and 19.72 ± 8.89 on the right, and 18.5 ± 9.25 mm on the left side in females. Distance between the carotid bifurcation level and hyoid bone ranged 1.94 ± 12.69 mm in female and 3.04 ± 9.00 mm in male on the left side. Having information about the level of carotid bifurcation is important in surgical and radiological procedures for determining the appropriate surgical procedure, and to prevent complications. We believe that the results of this study will shed light to planning of all interventions concerning common carotid artery.

El objetivo de este estudio fue determinar el nivel de bifurcación carotídea en relación con el hueso hioides y el ángulo de la mandíbula. La arteria carótida común es la arteria más grande del cuello, y tiene dos ramas terminales, las arterias carótidas externa e internas. El nivel de bifurcación muestra variaciones, sin embargo suele situarse a nivel de la cuarta vértebra cervical o en el margen superior del cartílago tiroideo. Por otro lado, la bifurcación carotídea puede estar situada tan baja como a nivel de la tercera vértebra torácica, o tan alta como a nivel del hueso hioides. En este estudio se utilizaron imágenes angiográficas convencionales de 112 pacientes. Se midieron las distancias de la bifurcación carotídea con el hueso hioides y el ángulo de la mandíbula en esas imágenes. Además, se determinó la diferencia entre los lados derecho e izquierdo. La distancia entre el nivel de bifurcación carotídea y el ángulo de la mandíbula se midió, siendo de 21,26 ± 8,57 mm a la derecha y 20,25 ± 8,75 mm en el lado izquierdo, en los hombres, y 19,72 ± 8,89 a la derecha y 18,5 ± 9,25 mm a la izquierda en mujeres. La distancia entre el nivel de bifurcación de la carótida y el hueso hioides osciló entre 1,94 ± 12,69 mm en mujeres y, 3,04 ± 9,00 mm en hombres, en el lado izquierdo. La información sobre el nivel de bifurcación carotídea es importante en los procedimientos quirúrgicos y radiológicos para determinar el procedimiento quirúrgico apropiado y prevenir complicaciones. Creemos que los resultados de este estudio arrojarán luz a la planificación de las intervenciones relacionadas con la arteria carótida común.

Triángulo hioides en niños con diámetro faríngeo superior disminuido / Hyoid bone triangle in children with reduced upper pharyngeal diameter

Introducción: el hueso hioides es un hueso único, medio y móvil, ubicado entre la cintura escapular y la cara, brinda inserción a la musculatura supra e infrahioidea. Objetivo: el propósito de este trabajo es evaluar el triángulo hioideo en niños con IRN y diámetro faríngeo superior disminuido. Material y método: estudio descriptivo, transversal. Se estudiaron las telerradiografías de 80 pacientes que asistieron a la carrera de especialización en ortodoncia y ortopedia funcional de la Universidad Kennedy, entre 5 y 13 años sin tratamiento previo con aparatología de ortopedia y/u ortodoncia. La evaluación se realizó sobre telerradiografía de perfil. Se procedió a trazar el triángulo hioideo. Resultados: se encontró que el 46,25 por ciento de los pacientes presentaron el triángulo hioideo positivo. Conclusión: el resultado de este estudio manifiesta que existe una variabilidad en la posición, en sentido vertical, del hioides en pacientes con diámetro faríngeo disminuido.

Estudo das alterações volumétricas faríngeas após cirurgia ortognática em pacientes classe III e sua influência no desenvolvimento da apneia obstrutiva do sono / Study of pharyngeal volumetric changes after orthognathic surgery in class III patients and its influence in obstructive sleep apnea

A cirurgia ortognática para correção da maloclusão dentária classe III gera modificações na via aérea faríngea (VAF) que podem predispor à Síndrome da Apneia Obstrutiva do Sono (SAOS). O objetivo deste estudo foi avaliar, através de tomografia computadorizada por feixe cônico, as modificações imediatas na VAF de pacientes classe III submetidos à cirurgia ortognática, verificando sua influência no desenvolvimento da SAOS, e correlacionando o movimento do osso hióideo com as modificações na VAF. Foi utilizado para diagnóstico da SAOS o questionário de Berlim, a escala de Sonolência de Epworth e alguns sintomas sugestivos através de 2 entrevistas, uma antes e outra 6 meses após a cirurgia. Realizou-se um estudo prospectivo com 33 pacientes divididos em 3 grupos: recuo de mandíbula isolado (9 pacientes), cirurgia maxilomandibular (18 pacientes) e avanço de maxila isolado (6 pacientes). As medidas obtidas da VAF no pré e no pós-operatório foram comparadas utilizando o teste t pareado, enquanto a correlação entre osso hióideo e as modificações da VAF foram analisadas através do coeficiente de correlação de Spearman. O grupo de pacientes submetidos ao recuo de mandíbula isolado apresentou alterações morfológicas mais pronunciadas, com redução no volume total da VAF, no volume da hipofaringe e na área de maior constrição (p<0,05). Observou-se uma correlação positiva forte entre o deslocamento horizontal do osso hióideo e a diminuição da área de maior constrição (r=0,712). O exame clínico não diagnosticou a SAOS em nenhum dos pacientes após 6 meses da cirurgia. O estudo não encontrou evidências de que a cirurgia ortognática para correção da maloclusão classe III predispõe à SAOS.

The orthognathic surgery for correction class III malocclusion, generates changes in the pharyngeal airway space (PAS) which may predispose to obstructive sleep apnea syndrome (OSAS). The objective of this study was to evaluate, through cone beancomputed tomography, theimmediate changes in the PAS in Class III patients submitted to orthognathic surgery, evaluating the influence of surgery in the development of OSAS, and correlating the position of the hyoid bone with measurements of PAS.For diagnosis of OSAS, Berlin questionnaire, Epworth Sleepiness Scale, and some characteristics symptoms, were searched through 2 interviews, one before surgery, and another 6 months after.This prospective study included 33 patients divided into 3 groups: mandibular setback surgery (9 patients), bimaxillary surgery (18 patients) and maxillary advancement surgery (6 patients). The measures obtained from the PAS pre- and postoperatively were compared using paired t test, and the correlation between the hyoid and PAS measurements, using the Spearman correlation coefficient. Patients undergoing mandibular setback surgery showed more pronounced morphological changes,with a decrease in the total volume of the PAS, in the volume of the hypopharynx, and in minimum cross-sectional area (p <0.05). There was a strong correlation between the horizontal displacement of the hyoid bone and reduction ofminimum cross-sectional area (r = 0.712). Clinical analysis did not diagnose OSAS in any patients 6 months after surgery. There was no evidence that orthognathic surgery, for correction of malocclusion class III, predispose to OSAS.

X-cephalometric study of different parts of the upper airway space and changes in hyoid position following mandibular fractures / Estudio cefalométrico con rayos X de diferentes partes del espacio de las vías respiratorias superiores y cambios en la posición hioidea tras fracturas mandibulares

OBJECTIVE: This study analyses the different parts of the upper airway space and the changes in hyoid position. The results provide a clinical reference for developing timely and effective treatment programmes for patients with mandibular fractures caused by maxillofacial trauma. METHODS: Standard X-cephalometric measurements of the lateral skull of 210 subjects were taken. The subjects were divided into four fracture groups: condylar, mandibular angle, mandibular body, and parasymphyseal. RESULTS: The radiographs of the mandibular fracture groups were compared with the normal occlusion group to analyse the upper airway space and the changes in hyoid position. Different types of fractures have different effects on the upper airway space. Bilateral mandibular body fracture and the parasymphyseal fracture have a significant influence on the lower oropharyngeal and laryngopharyngeal airway spaces, with serious obstructions severely restricting the ventilatory function ofpatients. CONCLUSIONS: Fractures at different parts of the mandibular structure are closely related to the upper airway and hyoid position.

OBJETIVO: Este estudio analiza las diferentes partes del espacio de las vías respiratorias superiores y los cambios de posición hioidea. Los resultados proporcionan una referencia clínica para desarrollar programas de tratamiento oportuno y eficaz para los pacientes con fracturas de la mandíbula, causadas por trauma maxilofacial. MÉTODOS: Se hicieron mediciones X-cefalométricas estándares del cráneo lateral a 210 sujetos. Los sujetos fueron divididos en cuatro grupos de fractura: ángulo mandibular, condilar, cuerpo mandibular y parasinfisaria. RESULTADOS: Las radiografías de los grupos de fractura mandibular fueron comparadas con el grupo de oclusión normal para analizar el espacio de las vías respiratorias superiores y los cambios de posición hioidea. Diferentes tipos de fracturas tienen diferentes efectos sobre el espacio de las vías respiratorias superiores. La fractura de cuerpo mandibular bilateral y la fractura de parasinfisaria tienen una influencia significativa en los espacios de las vías respiratorias orofaríngea y laringofaríngea inferiores, con serios obstáculos restringiendo severamente la función respiratoria de los pacientes. CONCLUSIONES: Las fracturas en diferentes partes de la estructura mandibular se hallan estrechamente vinculadas a las vías respiratorias superiores y a la posición hioidea.

Radiological, light and electron microscopic study of the ossification process within the hyoid bone synchondrosis and it's relation to age and sex

The radiological study has revealed that the timing of fusion of the hyoid bone synchondrosis was influenced by sex. Unilateral fusion of the hyoid bone synchondrosis was first observed at age of 19 years in males and 23 years in females and it was common in older females than males. Bilateral fusion was first observed in males at the age of 36 years, while in females, it occurred later at the age of 43 years. The fusion of the hyoid synchondrosis did not occur at any particular age but it was usually completed between the ages 36-45 years in males and 43-56 years in females. Electron microscopic study revealed that there was no difference in the morphology of bone and cartilage cells from the hyoid bone synchondrosis and those of the epiphyseal cartilage of the long bones