Hyoid Bone Displacement Research Articles

Relationships between Craniofacial Morphology, Sex, and Deglutitive Hyoid Bone Movement

Purpose : The purpose of this study was to examine the relationship between six craniofacial measures and superior and anterior hyoid bone movement during a liquid swallow. Method : Twelve White adults (6 males, 6 females) between 19-27 years of age participated. Video fluoroscopic recordings were obtained while participants swallowed 7 ml of liquid barium in the upright position. Six craniofacial measures (i.e. Frankfort-mandibular angle, nasion to menton, anterior tubercles C1 to C4, nasion to sella, sella to basion, and nasion-sella-basion angle) were obtained at rest on all participants and used to determine their association with hyoid bone displacement. Results : Males demonstrated larger craniofacial dimensions than females with the exception of nasion-sella-basion angle. Significant sex differences were noted for nasion to menton ( p = .05). There were no statistically significant correlations ( p < .05) or predictive relationships between maximum anterior and superior hyoid bone displacements and the six craniofacial measures. Conclusion : The present study demonstrated differences in craniofacial morphology related to sex, however, no correlation or predictive relationship between craniofacial measures and hyoid bone movement during swallowing of a 7 ml liquid bolus were observed. Limitations include a small sample size, lack of descriptive anthropometric features (e.g. height and weight), and limited number of swallows per subject. Future studies should include larger sample sizes and investigate the effects of bolus volume and abnormal craniofacial morphology on hyoid bone movement.

Spatiotemporal characteristics of swallowing in Parkinson's disease.

The aim of this study was to quantitatively investigate spatiotemporal movement abnormalities during the pharyngeal phase of swallowing in individuals with Parkinson's disease (PD) and to investigate relationships between disease and dysphagia severities. Retrospective study. We performed two-dimensional motion analysis of the hyoid bone, epiglottis, and vocal folds using videofluoroscopic images from 33 PD patients and 33 age-matched, healthy controls. The outcome measures were spatial and temporal movement variables during swallowing. Additionally, three subgroups of patients were compared based on the Hoehn and Yahr scale to identify the relationship between disease and dysphagia severities. Individuals with PD showed a reduced anterior hyoid bone displacement after normalization for each individual. The maximal angle of the epiglottic rotation was smaller in PD patients. The time to maximal displacement of the hyoid bone, epiglottis, and vocal folds were significantly delayed in PD patients (P = 0.001, 0.002, and < 0.001, respectively); the mean velocities of the hyoid bone and epiglottic movements were also reduced in PD patients (P < 0.001 and < 0.001, respectively). The velocity curves of the hyoid bone revealed more peaks in individuals with PD, representing incoordination during swallowing. Clinical disease severity was related to level of diet and supervision but not with dysphagia severity. This study shows that oropharyngeal bradykinesia, incoordination, reduced anterior hyoid bone movement, and decreased epiglottic rotation angle during swallowing are the most noticeable findings in individuals with PD. N/A.

Análise quantitativa da deglutição de parkinsonianos pré e pós-riboflavina

Objetivo verificar as mudanças quantitativas na dinâmica da deglutição em pacientes portadores da doença de Parkinson, submetidos à administração de riboflavina e restrição de carnes vermelhas e de aves, no período de um ano. Métodos participaram do estudo 16 pacientes com doença de Parkinson, com media de idade de 67,25 anos, media do nível de severidade da doença de II para III e com media de 3,5 anos de tempo de diagnóstico da doença. As avaliações videofluoroscópicas da deglutição foram realizadas antes e após um ano de administração de riboflavina e restrição de carne vermelha e de aves. Foram analisadas presença de queixas relacionadas à deglutição e análise quantitativa por meio de medidas computadorizadas do deslocamento do osso hióide e da cartilagem cricóidea, abertura da transição faringoesofágica (TFE) e da constrição da faringe. Resultados verificou-se redução no percentual de queixas relacionadas à deglutição no momento pós-administração de riboflavina. Com relação às medidas quantitativas, observou-se no momento pós um discreto aumento na abertura da TFE para todas as consistências oferecidas, aumento da constrição da faringe para a consistência líquido engrossado, discreta redução dos valores de deslocamento do osso hióide, e tanto discreta redução como discreto aumento dos valores de deslocamento da cartilagem cricóidea dependendo da consistência alimentar, sendo redução significante para o líquido. Conclusões as medidas quantitativas realizadas na movimentação dos órgãos relacionados à deglutição não demonstraram diferenças significantes entre os momentos pré e pós-riboflavina e a restrição de carne vermelha e de aves.

Peripharyngeal tissue deformation and stress distributions in response to caudal tracheal displacement: pivotal influence of the hyoid bone?

Caudal tracheal displacement (TD) leads to improvements in upper airway (UA) function and decreased collapsibility. To better understand the mechanisms underlying these changes, we examined effects of TD on peripharyngeal tissue stress distributions [i.e., extraluminal tissue pressure (ETP)], deformation of its topographical surface (UA lumen geometry), and hyoid bone position. We studied 13 supine, anesthetized, tracheostomized, spontaneously breathing, adult male New Zealand white rabbits. Graded TD was applied to the cranial tracheal segment from 0 to ∼ 10 mm. ETP was measured at six locations distributed around/along the length of the UA, covering three regions: tongue, hyoid, and epiglottis. Axial images of the UA (nasal choanae to glottis) were acquired with computed tomography and used to measure lumen geometry (UA length; regional cross-sectional area) and hyoid bone displacement. TD resulted in nonuniform decreases in ETP (generally greatest at tongue region), ranging from -0.07 (-0.11 to -0.03) [linear mixed-effects model slope (95% confidence interval)] to -0.27 (-0.31 to -0.23) cmH2O/mm TD, across all sites. UA length increased by 1.6 (1.5-1.8)%/mm, accompanied by nonuniform increases in cross-sectional area (greatest at hyoid region) ranging from 2.8 (1.7-3.9) to 4.9 (3.8-6.0)%/mm. The hyoid bone was displaced caudally by 0.22 (0.18-0.25) mm/mm TD. In summary, TD imposes a load on the UA that results in heterogeneous changes in peripharyngeal tissue stress distributions and resultant lumen geometry. The hyoid bone may play a pivotal role in redistributing applied caudal tracheal loads, thus modifying tissue deformation distributions and determining resultant UA geometry outcomes.

Measurement of objective parameters associated with pharyngeal swallowing function in Chinese adults

To obtain a series of objective criteria associated with pharyngeal swallowing function using dynamic swallow study in Chinese adults. Dynamic videofluoroscopic swallow studies were performed on 80 normal adult volunteers. There were 40 males and 40 females aged from 20 to 60 years old. Measurement software Avidemux 2.5 and Image J were used to measure the objective parameters which were closely related to the pharyngeal swallowing function in the swallowing process, such as maximum displacement of the hyoid bone (HmaxD), pharyngeal transit time (PTT), pharyngeal constriction ratio(PCR), and maximum opening of the esophageal entrance (EEmax). In the 80 adults, the HmaxD, PTT, PCR, and EEmax were (1.91 ± 0.48) cm (x(-) ± s), (0.82 ± 0.15) s, 94.9% ± 3.41%, and (0.91 ± 0.05) cm respectively. The HmaxD of the male (2.04 ± 0.46) cm was significantly larger than that of the female (1.78 ± 0.47) cm (t = 2.44, P = 0.017), but the PTT, PCR, and EEmax had no significant difference between different gender and age groups (P > 0.05). Objective parameters of the HmaxD, PTT, PCR, and EEmax during swallowing are obtained in Chinese adults. These data are important for assessment of the swallow function and these data provide a foundation for further research on assessment of swallowing function in Chinese.

Prolonged Swallowing Time in Dysphagic Parkinsonism Patients With Aspiration Pneumonia

Lin C-W, Chang Y-C, Chen W-S, Chang K, Chang H-Y, Wang T-G. Prolonged swallowing time in dysphagic Parkinsonism patients with aspiration pneumonia. ObjectiveTo quantitatively measure which dysphagic features, including swallowing time and hyoid bone displacement, would be associated with increased risk of aspiration pneumonia in dysphagic Parkinsonism patients. DesignClinical survey. SettingTertiary care center. ParticipantsPatients with Parkinsonism and dysphagia (N=25), referred for videofluoroscopic swallowing study, were recruited by retrospective review of medical records. They were divided into 2 groups according to the history of aspiration pneumonia. InterventionsNot applicable. Main Outcome MeasureSwallowing time including onset of pharyngeal swallowing, oral transit time and pharyngeal transit time, and maximum hyoid bone displacement including total, horizontal, and vertical displacement during swallowing in thin and thick bariums were recorded. ResultsPatients with history of aspiration pneumonia had significantly longer pharyngeal transit time (4.14 vs 2.31s, P=.038) and onset of pharyngeal swallowing (2.16 vs 1.04s, P=.031) than those without, when swallowing thin barium. Patients with aspiration pneumonia also had significantly longer swallowing time when swallowing thick barium (oral transit time: 7.14 vs 2.33s, P=.018; pharyngeal transit time: 6.39 vs 1.23s, P=.004; onset of pharyngeal swallowing: 5.11 vs .31s, P=.006). There was no significant difference in hyoid bone displacement between the 2 groups. ConclusionsPatients with Parkinsonism dysphagia and aspiration pneumonia had longer swallowing time than those without, but there was no difference in displacement of hyoid bone.

Application of Ultrasonography in Assessing Oropharyngeal Dysphagia in Stroke Patients

This study applied submental ultrasonography (SUS) to measure changes in dysphagic stroke patients' tongue thickness and hyoid bone displacement when swallowing 5 mL of water and correlated the results with the severity of clinical dysphagia. We included 60 stroke patients (30 tube-feeding-dependent and 30 on regular oral intake) and 30 healthy controls. An additional 10 healthy people were recruited to assess the reliability of SUS. Measurements of hyoid bone displacement using videofluoroscopic swallowing study (VFSS) and SUS were compared for 12 stroke patients to assess the correlation between the two methods. Changes in tongue thickness and hyoid bone displacement were significantly less in the tube-feeding group. Those with a tongue thickness change of less than 1.0 cm and hyoid bone displacement of less than 1.5 cm were likely to be tube-feeding. SUS showed good intra-rater/inter-rater reliability and correlated well with VFSS measurement. SUS can be an adjunct assessment tool of swallowing.

Relationship between Class III malocclusion and hyoid bone displacement during swallowing: a cine-magnetic resonance imaging study

ObjectiveThe displacement of the hyoid bone (HB) is a critical biomechanical component of the swallowing function. The aim of this study was to evaluate the swallowing-induced vertical and horizontal displacements of the HB in subjects with 2 different magnitudes of skeletal Class III malocclusion, by means of real-time, balanced turbo-field-echo (B-TFE) cine-magnetic resonance imaging.MethodsThe study population comprised 19 patients with mild skeletal Class III malocclusion, 16 with severe skeletal Class III malocclusion, and 20 with a skeletal Class I relationship. Before the commencement of the study, all subjects underwent cephalometric analysis to identify the nature of skeletal malformations. B-TFE images were obtained for the 4 consecutive stages of deglutition as each patient swallowed 10 mL of water, and the vertical and horizontal displacements of the HB were measured at each stage.ResultsAt all stages of swallowing, the vertical position of the HB in the severe Class III malocclusion group was significantly lower than those in the mild Class III and Class I malocclusion groups. Similarly, the horizontal displacement of the HB was found to be significantly associated with the severity of malocclusion, i.e., the degree of Class III malocclusion, while the amount of anterior displacement of the HB decreased with an increase in the severity of the Class III deformity.ConclusionsOur findings indicate the existence of a relationship between the magnitude of Class III malocclusion and HB displacement during swallowing.

Position and Orientation of Hyoid Bone in Class II Division 1 Subjects: A Cephalometric Study

Objective: The present study was undertaken to compare the pharyngeal dimensions in Angle’s Class I normal and Angle’s Class II division 1 samples, and to correlate it with the dentoskeletal parameters in both the groups. Materials and methods: The sample consists of 92 pretreatment lateral cephalogram, which were categorized into two groups, Group A and Group B, that they should present Angle’s Class I and Angle’s Class II molar relationship. Each group consists of 25 males and 21 females. Descriptive statistics for 14 variables were calculated. Results obtained from this study imply that Angle’s Class II Division 1 samples with retrognathic mandible showed an inferoposterior displacement of hyoid bone. Results: The positional alteration of hyoid was prevalent in skeletal malrelationship rather than dentoalveolar malocclusion. The anteroposterior dimension of pharynx at hyoid level was more in males than in females, and it was relatively less in Angle’s Class II Division 1 samples to Class I samples. No significant sexual dimorphism exists in angular measurements of hyoid positioning.

Biomechanical Analysis of Hyoid Bone Displacement in Videofluoroscopy: A Systematic Review of Intervention Effects

This systematic review explores studies using biomechanical analysis of hyoid bone displacement in videofluoroscopy of swallowing as a spatial outcome parameter to evaluate intervention effects. Two authors independently carried out the literature search using the electronic databases Embase, PubMed, and Cochrane Library. Differences in their search findings were settled by discussion. The search was limited to publications in the English, German, French, Spanish, or Dutch language. MeSH terms were used, supplemented by free-text words to identify the most recent publications. In addition, reference lists were searched by hand. Only studies using videofluoroscopy to evaluate the biomechanical effects of swallowing interventions in dysphagic subjects were included in the review. While the body of literature on measuring hyoid bone displacement in videofluoroscopy has grown, only 12 studies met the inclusion criteria. Several of the 12 studies had methodological shortcomings. In general, the conclusions could not be compared across the studies because of their heterogeneous designs and outcome measures. Overall, several intervention effect studies reported significant results. In particular, bolus modification and swallowing maneuvers showed a greater range of hyoid bone displacement. In light of this review, further research on hyoid bone displacement as a spatial variable in well-defined patient populations using well-defined videofluoroscopic protocols to measure intervention effects is recommended.

Sonographically measured hyoid bone displacement during swallow in preschool children: A preliminary study

This study explored normative parameters regarding maximum displacement of hyoid bone movement during spontaneous swallows using ultrasound (US) in a sample of healthy preschool children. We hypothesized that consistency and bolus size would influence hyoid movement, but gender would not be a factor. Parental questionnaire responses and sensorimotor examinations were utilized to determine subject eligibility. Subjects were presented randomized bolus volumes of thin liquids/puree via a spoon while the US probe was placed submentally in the midsagittal plane. Maximum hyoid bone displacement was determined following a frame-by-frame analysis of the US recording during spontaneous swallowing of discrete bolus sizes. Twenty-nine subjects produced 346 swallows that were subsequently analyzed. Significant findings (p < 0.05) included a gender effect with the smallest bolus of liquids presented. Bootstrap estimates based on our sample revealed that 99% of preschool children would present with hyoid bone displacement within 0.3 cm of our sample. Based on our early experience, we were able to observe and measure changes in hyoid bone position during swallowing in preschoolers, which may be gender related. More studies are needed to corroborate our findings. In addition, comparisons of maximum hyoid displacement are warranted in subjects that present with feeding delays.

Reduction in Hyoid Bone Forward Movement in Irradiated Nasopharyngeal Carcinoma Patients With Dysphagia

Wang T-G, Chang Y-C, Chen W-S, Lin P-H, Hsiao T-Y. Reduction in hyoid bone forward movement in irradiated nasopharyngeal carcinoma patients with dysphagia. Objective To quantitatively assess the movement of the hyoid bone and pyriform sinus stasis in irradiated nasopharyngeal carcinoma (NPC) patients suffering from dysphagia. Design Retrospective data analysis. Setting A tertiary teaching hospital. Participants NPC subjects (n=33, 25 men and 8 women) and healthy subjects (n=10, 7 men and 3 women) participated in the study. Intervention Videofluoroscopic swallowing study (VFSS) of all subjects. Main Outcome Measures The displacement and velocity of hyoid bone movement, the amount of pyriform sinus stasis, and the widest opening distance of the cricopharyngeal muscle during swallowing. Results The displacement of the hyoid bone in the NPC patients was significantly less than that of the healthy subjects (1.58±0.59 vs 2.23±0.49cm, P=.0033). The displacement of the hyoid bone was divided into forward and vertical directions, and the forward displacement in the NPC patients was found to be less than that of the healthy subjects (0.85±0.50 vs 1.65±0.51cm), achieving statistic significance ( P<.0001). The pyriform sinus stasis of the NPC subjects was significantly more than that of the healthy subjects (2.24±0.98 vs 0.30±0.17cm 2, P<.0001). The movement velocity of the NPC subjects was less than that of the healthy subjects (2.49±1.41 vs 5.10±0.85cm/s, P=.0086). Furthermore, the NPC subjects with aspiration experienced less displacement of the hyoid bone than those without aspiration (1.23±0.45 vs 1.76±0.58cm, P=.029). Conclusion The irradiated NPC subjects with dysphagia experienced a reduction in hyoid bone displacement, occurring in a forward direction. The displacement of the hyoid bone was less in the aspiration subjects than in those without aspiration.

Hyoid Bone and Laryngeal Movement Dependent Upon Presence of a Tracheotomy Tube

The aim of this prospective, consecutive study was to investigate the biomechanical effects, if any, of the presence of a tracheotomy tube and tube cuff status, tube capping status, and aspiration status on movement of the hyoid bone and larynx during normal swallowing. Seven adult patients (5 male, 2 female) with an age range of 46-82 years (mean = 63 years) participated. Criteria for inclusion were no history of cancer of or surgery to the head and neck (except tracheotomy), normal cognition, normal swallowing, and ability to tolerate decannulation. Digital videofluoroscopic swallowing studies were performed at 30 frames/s and with each patient seated upright in the lateral plane. Variables evaluated included maximum hyoid bone displacement and larynx-to-hyoid bone approximation under three randomized conditions: tracheotomy tube in and open with a 5-cc air-inflated cuff; tracheotomy tube in and capped with deflated cuff; and tracheotomy tube out (decannulated). Differences between maximum hyoid bone displacement and larynx-to-hyoid approximation (cm) based on presence/absence of a tracheotomy tube, tube cuff status, and tube capping status were analyzed with the Student's t test. Reliability testing with a Pearson product moment correlation was performed on 21% of the data. No significant differences (p > 0.05) were found for both maximum hyoid bone displacement and larynx-to-hyoid bone approximation during normal swallowing based on tracheotomy tube presence, tube cuff status, or tube capping status. Intraobserver reliability for combined measurements of maximum hyoid displacement and larynx-to-hyoid approximation was r = 0.97 and interobserver reliability for the absence of aspiration was 100%. For the first time with objective data it was shown that the presence of a tracheotomy tube did not significantly alter two important components of normal pharyngeal swallow biomechanics, i.e., hyoid bone movement and laryngeal excursion. The hypothesis that a tracheotomy tube tethers the larynx thereby preventing hyoid bone and laryngeal movement during normal swallowing is not supported.

Structural Displacements in Normal Swallowing: A Videofluoroscopic Study

Dynamic videofluoroscopic swallow studies were performed on 60 normal adult volunteers to establish normative data for displacement of upper aerodigestive tract structures during deglutition. Variables evaluated included hyoid bone displacement, larynx-to-hyoid bone approximation, pharyngeal constriction, and the extent of pharyngoesophageal sphincter (PES) opening during liquid swallows of 1, 3, and 20 cc. Results showed direct relationships between bolus size and hyoid displacement, between bolus size and PES opening, and between bolus size and pharyngeal constriction. Only hyoid-to-larynx approximation remained unchanged across bolus sizes. Sex differences were noted for all variables except PES opening. Reliability for most measurement variables was excellent. To our knowledge, normative data for pharyngeal constriction and larynx-to-hyoid approximation have not previously been described.

Three-dimensional computed tomographic evaluation of morphologic airway changes after mandibular setback osteotomy for prognathism

Objective. To observe changes in the pharyngeal airway and the hyoid bone position after mandibular setback osteotomy in 30 patients with mandibular prognathism by means of 3-dimensional computed tomography (3DCT). Study design. Preoperative and postoperative computed tomography (CT) examinations were performed on 17 patients treated by sagittal split ramus osteotomy with rigid osteosynthesis and on 13 patients treated by intraoral vertical ramus osteotomy without osteosynthesis. The amount of mandibular setback was measured by the preoperative to postoperative difference of the mandibular position in axial CT images. The sizes of the preoperative and postoperative pharyngeal airway were evaluated from semitransparent and crosscut 3DCT images. Postoperative displacement of the hyoid bone was evaluated by a technique to superimpose a postoperative hard tissue 3DCT image on the preoperative image. The helical scan technique was used in the CT examination. The volume rendering technique was used to create 3DCT images. Results. The mean mandibular setback was 7.8 ± 2.1 mm with a range of 5 to 11 mm. Three months after surgery, the lateral and frontal widths of the pharyngeal airway had decreased significantly in comparison with the preoperative width. The mean reduction rates of the lateral and frontal width were 23.6% and 11.4%, respectively. The diminished airway did not recover by either 6 months or 1 year after surgery in most cases. Downward and posterior displacement of the hyoid bone was seen postoperatively. There were positive correlations between the amount of mandibular setback and reduction of the lateral width of the pharyngeal airway ( r = 0.54) and the amount of hyoid bone displacement ( r = 0.42). There were no significant differences between the two surgical techniques. Conclusion. Three-dimensional computed tomography was a practical imaging technique to evaluate the morphologic airway changes. The pharyngeal airway may have irreversible narrowing after mandibular setback surgery. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:278-87)

Ventilatory and upper airway muscle responses to upper airway CO2 in anaesthetized neonatal guinea-pigs.

In adult animals, CO2 confined to the isolated upper airway (UA) lumen reflexly inhibits breathing and excites genioglossus muscle activity (Nolan et al, 1990) by affecting the activity of CO2-sensitive receptors in the superior laryngeal nerves (Bradford et al, 1993). These effects may be important in the regulation of breathing and UA patency since the genioglossus is a major UA dilator muscle. There is some evidence that superior laryngeal nerve (SLN) reflexes are more potent in neonates than in adults (Al-Shway & Mortola, 1982; Boggs & Bartlett Jr, 1982). Therefore, the present investigation examines the effects of UA CO2 on ventilation and geniohyoid (GH) muscle activity in neonatal Guinea-pigs. We chose to study the GH muscle because of its ease of access and because, like the genioglossus, it exerts an important influence on UA patency. Contraction of the GH causes anterior displacement of the hyoid bone and stiffening of the hypopharynx (Brouillette & Thach, 1979), a site which is vulnerable to collapse (Shepard Jr et al, 1991).

Quantitative Assessment of Hyoid Bone Displacement From Video Images During Swallowing

Given the relationship between hyoid displacement and aspiration, a simple, accurate, clinically useful method for identification of reduced hyoid displacement is needed. The purpose of this investigation was to validate a quantitative method for clinically assessing hyoid bone movement during swallowing. Videofluoroscopic evaluations of 20 male subjects--10 who had been subjectively assessed as demonstrating normal hyoid displacement during swallowing, and 10 who had been subjectively assessed as demonstrating reduced displacement during swallowing--were analyzed. A video measuring gauge was used, and a software spreadsheet was developed to perform trigonometric calculations for determination of anterior/superior hyoid trajectories. Statistically significant differences were found between groups in both the anterior and superior directions of hyoid movement. No significant differences were found between liquid and paste swallows within groups. This method is simple in that it is necessary to identify only three to five points on two video images. Those values are then input onto a preprogrammed spreadsheet that automatically performs the necessary calculations. Although the present investigation focused on the movements of the hyoid bone during swallowing, this method of tracking displacement can be used for virtually any task or structure whose movements can be captured on videotape.

Vertical hyoid bone displacement and fundamental frequency of phonation.

Vertical displacement of the hyoid bone as well as its effects on F0 were studied using five excised human larynges. Cranial force introduced to the hyoid bone caused a widening of the vestibule of the larynx, enlargement of the laryngeal ventricles, abduction of the ventricular folds, heightening of the epiglottis and slight abduction of the vocal folds. The displacement (X +/- SD) of the anterior part (corpus) of the bone was 8.0 +/- 5.2 mm and of the posterior part, 22.2 +/- 6.1 mm with a 10 N force. The difference was statistically significant and was found to depend mainly on the tight middle hyothyroid ligament. The cranial force displacing the hyoid bone invariably showed a positive relationship with F0. The F0 changes were statistically significant but relatively small (X +/- SD): 8 +/- 8.4 Hz (about 10%) with an intact hyothyroid ligament. When the subglottal pressure was low, a change in the vibratory pattern of the vocal folds was found in several specimens. The F0 changes found in the present study are too small to explain alone the differences in the so-called intrinsic F0 of vowels. However, they are believed to contribute to this phenomenon.