Greater Cornu Research Articles

Sexing of hyoid bone based on shapes

Introduction: The present study is to identify the sex of hyoid bone by studying various shapes of hyoid bone, and weight before and after defatting, were taken. Material: The material used in the present study includes 100 hyoid bones of adult male and female of 15-75 years of age group, procured from the cadavers brought to mortuaries for post mortem to Govt. General Hospitals of Hyderabad, and photographs of dried bone, to compare the shapes. Method: The bone was weighed with the help of chemical balance. The various shapes of the hyoid bone were noted and photographed individually and in groups. The readings were tabulated. Result: It was noticed that all the measurement were greater in males than in females. Males have mostly v shaped hyoid bone and females have mostly u shaped hyoid bone. Our findings co-related well with earlier workers, from diverse population groups. Conclusion: Data acquired by this study will contribute to the knowledge available about anthropometric parameters of South Indian population and may hopefully help in racial and medico-legal applications. Keywords: Hyoid Bone, Greater Cornu, Lesser Cornu, Defatting, Anthropometry

The Gender Based Hyoid Silhouette–A Metric Study in North Indians

Background: The human hyoid bone is a part of viscerocranium and is susceptible to fracture during manual strangulation. A hyoid bone’s shape may influence its susceptibility to fracture. The present study aims to create a metric gender based profile for the hyoid in North Indians. It is envisaged that the silhouette created will provide inputs vital in comprehending bone morphology patterns for males and females. Methods: Paucity of comprehensive gender based hyoid morphometric studies in local population prompted the authors to format the present study. The measurements were taken on 500 hyoid bones of North Indian subjects with a special emphasis on sexual dimorphism (Male Female ratio 1:1). Results: Most hyoid dimensions are significantly larger in men with some measurements more sexually dimorphic than others, there exists 100% dimorphism for hyoid lengths and selective dimorphism as far as hyoid widths are concerned in North Indian population. When the greater cornua dimensions as measured for right and left side in same sex were compared they came out to be statistically insignificant (p>0.05). This reported insignificance for the same sex is an indirect pointer towards the dimorphic predisposition of hyoid bone. Conclusion: The study establishes the dimorphic silhouette for hyoid bone in North Indians. It also quantify the percentage sexual dimorphism for various morphometric parameters.

The use of computed tomography in determining development, anomalies, and trauma of the hyoid bone.

Recognition of injury to the hyoid bone is intrinsic to post-mortem examination. Given its superficial location in the neck hyoid fractures are generally associated with some form of compressive neck force although they are well recognized in the peri-mortem period, in the context of manual handling and resuscitation. Hyoid fractures are variably reported to occur in manual strangulation and during hanging. In this study Computer Tomography (CT) scans of the head and neck of 431 deceased persons (235 males and 196 females) between the ages of 1 day and 100 years of age (mean age 35.93 ± 24.15) and including 25 victims of hangings were examined to reveal the pattern of age-related change and the types of injury that occurred. Hyoid variants were also documented. The synchondroses between greater cornua and body were found to progressively fuse with age although in the current sample 20% non-fusion was observed beyond 65 years of age. Sex differences were evident in adult hyoid bones and discriminant function analysis correctly confirmed sex in 74.7% of cases. The greatest age-related changes occurred from puberty to post-adolescence and a linear regression equation successfully assessed age into three general categories in 87.7% of cases. Hyoid fractures were documented in 24% of victims of hangings and while previous reports indicate these are more likely in older age, when synchondroses are fused, in this study the average age of victims with fracture was 27 ± 10 years. In the majority of cases the site of ligature was below the hyoid bone and in only one on the hyoid body.

Surgical management of parapharyngeal space infections

Parapharyngeal space (PPS) infections often arise from pharyngeal or dental infections and, if left untreated, can result in serious complications such as mediastinitis, Lemierre syndrome, and death. The PPS is an inverted triangle spanning the skull base to the greater cornu of the hyoid, the inferior constrictor medially, and the ramus of the mandible laterally with many vital structures contained within. Treatment begins with assessing the airway, considering the need for computed tomography or magnetic resonance imaging with intravenous contrast and broad-spectrum antibiotics. With evidence that a PPS infections has resulted in an abscess or there is failure of conservative management with 24-48 hours of intravenous antibiotics or in severe cases, surgical drainage is performed. This is done via the traditional transcervical route or, if the abscess is medial to the great vessels, a transoral approach. Complications of surgery are rare, and resolution of symptoms with prompt antibiosis and surgical treatment prevents the possibility of infectious spread and its dangerous sequelae.

26. Chondrosarcoma of the hyoid bone

Chondroid tumours of the hyoid bone are extremely rare; only 16 cases have been reported in the literature. Most have been described as low grade chondrosarcomas, and a few cases have been described as chondromas. The diagnosis of low grade chondrosarcoma is challenging for both radiologists and pathologists. Moreover, determining what is ‘adequate’ treatment is challenging for clinicians. We present a case of chondrosarcoma arising in the greater cornu of the hyoid bone along with its radiological features, histological features and its treatment. We also present a literature review of the entity and discuss the clinicopathological features of low grade chondrosarcoma arising from the hyoid bone compared to low grade chondrosarcoma of other sites. The pathogenesis of chondrosarcoma in this unusual site is also discussed.

Correlation between three-dimensional morphological changes of the hyoid bone with other skeletal maturation methods in adolescents

The study compares growth changes of hyoid bone in cone-beam computed tomography (CBCT) with conventional skeletal maturation methods to examine their potential implications in the development of a three-dimensional method. Subjects (n=62, 11-17 years of age) were exposed to CBCT at a six-month interval (T1/T2/T3). Ten-hyoid distances were compared with age, hand wrist skeletal maturation index (SMI), and cervical vertebral maturation stage (CS). The length of greater cornua (GC) was most frequently, moderate to highly correlated with age (right: 0.57/0.53/0.58; left: 0.45/0.50/0.48), SMI (right: 0.52/0.40/0.45; left: 0.42 at T3), and CS (right: 0.52 at T1), followed by the length of the hyoid bone with age (right: 0.50/0.49/0.47; left: 0.44/0.47 at T1/T2), SMI (right: 0.45/0.41 at T1/T2), and CS (right: 0.48 at T1). The width of body of the hyoid (HB) width was correlated with age (0.43/0.44/0.44). The GC-HB gap was correlated with age (right:-0.41 at T3) and SMI (right:-0.42 at T1). Peripubertal hyoid maturation did not yield sufficient diagnostic information for considerations in the development of a 3D-skeletal maturation method.

Determination of sex from an autopsy sample of adult hyoid bones

Determination of sex is the first and crucial step in the process of identifying human remains in forensic casework. Sex determination from skeletal remains is well studied and an extensively documented subject. The hyoid bone, however, has drawn less attention in studies of this nature. The present study was designed to derive a model for the determination of sex from the adult hyoid in a sample of the Indian Bengali population using discriminant function analysis on 50 adult bones (38 men and 12 women). The following discriminant function was obtained: DF = 0.103W + 0.118AP + 0.130CR + 0.483AW + 0.117DR - 20.64. Overall, 90% of the cases could be correctly classified into the two sexes by means of five predictors (overall width, length of the greater cornu, anteroposterior length, width of the body of hyoid and the distance between the lesser cornua) in the model. Cross-validated results showed correct classification in 90% of the cases. The results of this preliminary study show that these variables contribute to discrimination between the two sexes in the study population. Sexing of the adult human hyoid bone is thus possible with reasonable accuracy using the discriminant function on a sample obtained from the same population.

Unusual variation of the hyoid bone: bilateral absence of lesser cornua and abnormal bone attachment to the corpus

The hyoid bone is a horseshoe-shaped and a solitary bone located at the neck just above the thyroid cartilage. It consists of a body, two greater cornua and two lesser cornua. In this report, we demonstrated an extra bone variation which is attached to the hyoid bone and located at the left side of its corpus. In addition to this abnormal bone attachment to the corpus, lesser cornua were absent bilaterally. Abnormal bone attachment was approximately 3.79-cm long and 0.38-0.50-cm wide and heads toward the upper left of the hyoid bone. We believe that clinicians should be aware of such abnormalities of the hyoid bone because of the functional and clinical importance of its variations and abnormal relations within nearby structures. These abnormalities have a great importance for the surgical operations and radiological studies of the neck region and for the forensic medicine because of the susceptibility of the hyoid bone to the fractures in relation to the strangulation cases.

Radiologic Findings and Outcomes of Hyoid Compression Syndrome

Radiologic Findings and Outcomes of Hyoid Compression Syndrome

Predictors of hyoid fracture in hanging: Discriminant function analysis of morphometric variables

Hyoid is a U-shaped bone present in the ventral aspect of neck at the level of fourth cervical vertebra. It is a small bone placed between the root of tongue and the thyroid cartilage. Fracture of hyoid has great significance and importance in forensic pathology. It is well documented that fracture of hyoid is a recognized finding and indicator of strangulation (more common in manual or throttling than by ligature). Fracture of hyoid is less frequently reported in hanging. Discriminant function analysis was used with all predictors (width of hyoid, antero-posterior length of hyoid and length of greater cornu) were entered together. The analysis showed that 96.0% of original grouped cases could be correctly classified.

舌骨症候群例

We describe the case of a 25-year-old man with pain on turning his head to either side attributable to a malformation of the hyoid bone. When the neck was turned further to the left, the greater cornu slipped over the tuberculum anterius of the processus transversus, and locked in front of the tuberculum posterius. At the same time the thyroid cartilage caused an upward movement and separated the locked greater cornu. At the moment of this separation, a clicking sound was produced. Diagnosis was established using 3-dimensional reconstruction of CT imaging. The greater cornu of the hyoid bone was noted to be elongated and malformed, and the left greater cornu was obviously blocked by the processus transversus of cervical vertebra V. Excision of both greater cornua relieved the symptoms.

Hyoid bone involvement by squamous cell carcinoma: clinical and pathological features.

The incidence of hyoid bone involvement by neoplasia is undetermined, despite its importance in hyoid-preserving surgery. Eleven (1.46%) of 755 whole-organ laryngeal specimens examined demonstrated hyoid bone infiltration. These included 6 cases originating from the larynx, 3 from the vallecula, and 1 case each from the pyriform fossa and tongue base. Clinically, vallecular involvement was helpful in determining hyoid invasion; however, computed tomography (CT) was disappointing. The greater cornu was the sole site of invasion in six cases. Ten of 11 cases were secondary to direct tumor spread. All carcinomas were advanced, with variable differentiation. Vascular and neural invasion was a prominent feature. Hyoid bone invasion is rare, and associated with a poor prognosis. Hyoid bone preservation is feasible in a majority of patients.

Near-total laryngectomy with epiglottic reconstruction

Glottic carcinomas too extensive to be adequately resected by standard vertical partial laryngectomy may be amenable to surgical cure by near-total laryngectomy with epiglottic reconstruction. This technique permits resection of all of the larynx save only the body of one arytenoid and cartilage struts posteriorly to connect the greater and lesser cornua. The defect is reconstructed in one stage without stenting by mobilizing the epiglottis as a sliding flap and suturing it to the cricoid cartilage and remaining strips of thyroid cartilage. This approach has permitted long-term cure rates comparable to those achieved by hemilaryngectomy in appropriate lesion, with few complications and no failures of extubation or the inability to eat without aspiration.

A case of jaw locking

An unusual case of symptomatic enlargement of the hyoid bone is reported. The patient's main complaint was of pain on swallowing and opening of the jaw. Partial excision of the greater cornu of the hyoid on each side, resulted in a complete remission of the symptoms.

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.

Hyoid bone elevation: a sign of tracheal transection.

Evaluation of traumatic neck injuries should include analysis of the position of the hyoid bone on the lateral radiograph. Location above the level of the third cervical body or a greater cornu located less than 2 cm from the angle of the mandible, or both, coupled with the finding of cervical soft-tissue air, should alert the radiologist that tracheal transection is likely and that immediate surgical exploration is required. Five cases of severe neck injury are presented.

Expansion hyoidplasty: A potential surgical procedure designed for selected patients with obstructive sleep apnea syndrome. Experimental canine results

Some patients with "idiopathic" obstructive sleep apnea syndrome have an inspiratory, circumferential, passive collapse of the hypopharyngeal lumen as the mechanism of airway obstruction. Permanent tracheotomy has offered documented dramatic resolution of the airway obstruction with reversal of the associated cardiopulmonary sequelae. Tracheotomy is not, however, without psychological and physical complications detracting from its use. In hope of developing a surgical alternative, the expansion hyoidplasty was conceived. The hyoid bone is transected just medial to each lesser cornu. The trisected hyoid bone is then held in an expanded position by a permanent stainless steel brace. The greater cornua with attached middle constrictor and hyoglossus are moved laterally, while the body of the hyoid with attached geniohyoid and genioglossus shift the base of tongue anteriorly. The procedure is potentially reversible. Twenty dogs were studied pre and posthyoid expansion. Superior hypopharyngeal pressure-volume and closing pressures were obtained on 10 dogs. The pressure-volume studies demonstrate a consistent expansion of the superior hypopharynx. The average drop in pressure varied from 2.9 to 12.4 cm H2O in different animals. All posthyoid expansion dogs showed an average increase in closing pressure ranging from -4.4 to -28.3 cm H2O. Deglutition and laryngeal competence were not grossly effected. These results support the continued experimentation towards implementation of the expansion hyoidplasty in humans.

Some observations on the development of the human hyoid bone.

Investigations on the human hyoid bone in several developmental stages reveal that with the chondrification of the mesenchymal blastema a typical interzone between the body and the greater cornua is formed. This disc of closely packed blastemal cells, distinct and broad in the earlier stages, is reduced in thickness in the course of further development. In fetuses between 5 and 6 months old and in newborns the formation of joint cavities can be seen in some cases. In other cases, however, a small transverse line of cells persists between the two cartilaginous elements. These findings are interpreted as different developmental stages of a diarthrosis generally formed between the corpus and the cornu majus. The fact that in the adult the lesser horn is connected directly to the cornu majus and not to the body is confirmed by the embryological investigations reported in this study.