Hyoid Triangle Research Articles

Position and orientation of hyoid bone in mouth breathing children: a cephalometric study

Introduction: The importance of the hyoid bone is associated with its unique anatomical position. The hyoid bone is the only bone in the facial skeleton that attaches to other bones only with the help of muscles. Aim: The aim of this article is to make a cephalometric analysis of the craniofacial anatomy and position of the hyoid bone in children with mixed dentition who have difficult nasal breathing, habitual mouth breathing and a control group of nasal breathing children. Materials and methods: A total of 120 lateral cephalograms of children with mixed dentition were analyzed. The examined X-rays were divided into three groups: 50 lateral cephalograms of children with difficult nasal breathing; 18 lateral cephalograms of children with a habitual mouth breathing and 52 lateral cephalograms of nasal breathing children. To determine the position of the hyoid bone we used the method of Bibby and Preston.1 Results: When comparing the type of the hyoid triangle we found the presence of a statistically significant difference (χ2 = 24.97; p <0.001). In 84% of the children with nasal breathing difficulties there is a negative hyoid triangle and in only 16.00% a positive hyoid triangle. In the nasal breathing children, the positive triangle occurs in 84.60% of cases. In children with habitual mouth breathing the distribution is almost even. A significant difference was found when comparing the height of the negative triangle in children with nasal breathing difficulties and nasal breathing children (t = 6.06; p <0.001). Conclusion: In mouth breathing children there is a lower and posterior position of the hyoid bone compared to nasal breathing children. The negative triangle is characteristic for children, who have difficult nasal breathing, whereas the positive triangle is specific for nasal breathing children.

Effects of therapies for temporomandibular disorder on the craniocervical posture: A randomized clinical trial

Objective: The present study searched evaluate whether the occlusal splint, physiotherapy and counseling therapies used in the treatment of temporomandibular disorders (TMD) alter the craniocervical posture and pain. Methods: Controlled, randomized, blinded study that included individuals previously diagnosed with TMD through the RDC/TMD (Research criteria for temporomandibular disorders). The patients were randomly selected from four treatment groups: occlusal splint (OS, n = 17), physiotherapy (P, n = 19), counseling (C, n = 15) and occlusal splint associated with counseling (OSC = 14), totaling 65 individuals. For the postural analysis, a teleradiography was performed at the baseline and 1 month after the application of the therapy, in order to observe the occiput-atlas distance (OAD), the craniocervical angle (CCA) and the positioning of the hyoid triangle (HT). CorelDraw X6 software (2012 Corel Corporation, Canada) was used in the images. The data obtained was submitted to several paired T tests (α = 5%) and for the pain variable the SPANOVA test was applied. Results: Except for the OSC group in the CCA variable (p = 0.003), the results showed that there was no statistically significant difference for the analyzed variables regarding the different therapies over time. However, it can be observed that all the treatment groups allowed a reduction of the patients' pain (p = 0.013) over time. Conclusion: It is concluded that the therapies applied have little influence on craniocervical posture but are effective for the relief of painful symptoms.

Temporomandibular and odontological abnormalities in patients with rheumatoid arthritis

ObjectiveTo characterize the orofacial abnormalities in patients with rheumatoid arthritis (RA) and compare them with those in a reference population. MethodsThe study included 30 RA patients and 30 consecutive patients in an odontology clinic in whom RA was ruled out. Patients underwent a clinical dental examination which included: (1) clinical and radiographic abnormalities of the temporomandibular joint; (2) biomechanical craniocervical analysis; (3) state of dentition and treatment needs; (4) periodontal status; (5) oral hygiene status; and (6) facial pain, which was compared among study groups. In addition, the association between the variables studied was determined through correlation tests. ResultsPatients with RA showed a higher prevalence of temporomandibular abnormalities, both clinical (100.0% vs 60.0%, P<.001) and radiographic, including erosions (50.0% vs 16.0%, P=.010), compared with individuals in the control group. Likewise, patients with RA had a greater number of missing teeth (6.9±5.7 vs 3.0±2.0, P=.001), more caries (13.4±5.4 vs 4.9±6.5, P=.001), periodontitis (1.3±0.9 vs 0.8±0.8,P=.015), poorer oral hygiene (43.3% vs 13.3%, P=.005) and greater facial pain (66.7% vs 20.0%, P<.001). The cephalometric analysis of Rocabado showed differences in the craniocervical angle and hyoid triangle between RA and controls. Significant correlations were obtained between oral and temporomandibular abnormalities. ConclusionsPatients with RA showed a greater orofacial deterioration, which reflects the importance of multidisciplinary care, including periodic dental examination.

Correlation Between Hyoid Bone and Pharyngeal Airway Space in Differing Vertical Skeletal Dysplasia

The hyoid and the tongue are intimately associated structures. The hyoid bone forms the anterior limit of the pharyngeal airway space. Thus, the position of hyoid bone and position of tongue can be considered determinants of pharyngeal airway space. Sixty samples, divided in three groups based on their growth pattern were studied and McNamara’s airway analysis and hyoid triangle analysis were used to evaluate the pharyngeal airway space and hyoid bone position respectively. A negative correlation was found in hyperdivergent group between the upper and lower airway space and the FMA. A positive correlation was seen in hyperdivergent group between the upper and lower airway space and the anteroposterior position of the hyoid bone.

Change of hyoid bone position in patients treated for and resolved of myofascial pain

ABSTRACTObjective: The purpose of this study was to investigate change in hyoid bone position for patients suffering from myofascial pain and to evaluate the modified hyoid triangle as a three-dimensional cephalometric modality for measuring hyoid position.Methods: Pre- and post-treatment CBCT scans for 30 female patients resolved of myofascial pain were reviewed by a blinded investigator using the modified hyoid triangle. Changes in dimensions of the hyoid triangle were analyzed with the t-test for paired comparisons.Results: Statistical analysis showed a drawing nearer of the chin to the third cervical vertebra (–2.0 mm, p = 0.026) and a release of the hyoid bone away from the floor of the mouth (1.5 mm, p = 0.011).Discussion: These findings suggest resolution of myofascial pain may correlate with decreased forward head posture and relaxation of suprahyoid musculature. The potential for change in oropharyngeal dimension and airway is evident.

Correlation between the position of hyoid bone and subregions of the pharyngeal airway space in lateral cephalometry and cone beam computed tomography.

To correlate the pharyngeal airway subregions with the positioning of the hyoid bone. The study examined 107 lateral cephalometric (LC) and cone beam computed tomography (CBCT) images. Linear and volumetric measurements of the pharyngeal subregions were made and correlated to linear measurements using hyoid triangle analysis on images of LC and multiplanar (MPR) and three-dimensional (3D) reconstructions of CBCT. There was significant correlation between linear measurements of the pharyngeal subregions and hyoid bone position in LC images and in MPR and 3D reconstructions of the CBCT. Correlations were more frequent in the oropharynx and hypopharynx, especially for LC images. No correlations were observed between LC images or CBCT reconstructions and the volumetric measurements of the pharyngeal subregions and the position of the hyoid bone. The hyoid bone position showed more correlations with oropharynx and hypopharynx airway measurements. The hyoid triangle method was not applicable to 3D images, since it showed a smaller number of measures correlated to the hyoid bone position.

Analysis of the cranio-cervical curvatures in subjects with migraine with and without neck pain

ObjectiveTo investigate the differences in head and cervical spine alignment between subjects with migraine and healthy people. DesignA cross-sectional, observational study. ParticipantsFifty subjects with migraine and 50 matched healthy controls. Main outcomes measuresThe presence of neck pain and neck pain-related disability was assessed. Four angles (high cervical angle, low cervical angle, atlas plane angle and cervical lordosis Cobb angle) as well as four distances (anterior translation distance, C0 to C1 distance, C2 to C7 posterior translation and hyoid triangle) were calculated using digitalised radiographs and analysed using K-Pacs® software. ResultsSubjects with migraine reported a longer history of neck pain symptoms, and higher pain intensity and neck-pain-related disability than controls (P<0.01). Patients exhibited a smaller anterior translation distance (mean difference: 4.9mm, 95% confidence interval 1.8 to 8.8; P<0.001) and hyoid triangle (difference: 3.0mm, 95% confidence interval 1.0 to 5.0; P=0.02) than healthy controls. When the presence or the absence of neck pain was included in the analysis, the differences did not change. Differences in anterior translation and hyoid triangle distances were considered clinically relevant for subjects with migraine suffering from neck pain. ConclusionSubjects with migraine exhibited straightening of cervical lordosis curvature. The presence of neck pain did not influence head posture in subjects with and without migraine.

Craniocervical Posture in Children with Class I, II and III Skeletal Relationships

Objective: To describe the characteristics of craniocervical posture of children aged between 6 and 11 years and its relationship to their sagittal skeletal classification. Material and Methods: This descriptive cross-sectional study involved 107 children (55 girls - 52 boys), aged between 6 and 11 years. The sample included no previous orthodontically/orthopedic treated and systemically healthy children. After proper calibration, lateral skull radiographs, taken for diagnosis purpose for maxillary orthopedic treatment, were obtained by the same operator in natural head position. A radiographic analysis was made using a NEMOTEC software: 13 variables were registered: age, gender, ANB angle (to classify sagittal skeletal relationships) and 10 variables related to craniocervical posture: cervical lordosis, hyoid triangle, craniocervical angle, intervertebral spaces: C0-C1, C1-C2 and distances NSL-Ver, NL-Ver, ML-Ver, OPT-Hor, CVT-Hor. To evaluate the reliability of measures, 15 randomly selected radiographs were re-measured by the same investigator two weeks after the initial analysis. Results: Intra-class correlation coefficients were in a range of 0.945-0.996. Lordosis, CCA, C1-C2, OPT-Hor y CVT-Hor, values were higher in male than in female children (p<0.05). No statistically significant differences were found among groups of sagittal skeletal relationships, but class III children had a tendency to higher craniocervical flexion; 66.3% of the studied group presented rectified lordotic curvature and class II subjects presented increased values of NSL-Ver, NL-Ver and ML-Ver. Class I children had the lowest values for OPT-Hor and CVT-Hor. Conclusion: All craniocervical postural variables were higher in boys than in girls. No differences were found in this study between cervical postural variables with different malocclusion.

Analysis of the morphometric characteristics of the cervical spine and its association with the development of temporomandibular disorders

Objectives: Temporomandibular disorders (TMD) are frequently observed in various populations. They affect both the temporomandibular joints and several associated structures such as the cervical spine. In this observational, descriptive, cross-sectional study, the authors assessed possible relationships between various cranio-cervical parameters and TMD.Method: The study group consisted of 102 patients who were diagnosed with TMD and were treated at the Faculty of Dentistry of the University of Concepción, Chile. The control group was composed of 99 subjects without TMD, treated at other clinics of the University of Concepción.Results: The following relationships between TMD and cranio-cervical parameters were found to be statistically significant: TMD and inversion of the hyoid triangle (p = 0.0060); TMD and depth of cervical curvature (p = 0.0302); TMD and deformity of the cervical vertebrae (p = 0.0001).Discussion: The findings suggest a significant relationship between TMD findings and both cephalometric and morphometric parameters of the cervical spine.

Variation of hyoid bone position in different sexes and different types of skeletal malocclusions

Objective: This study was carried out to ascertain if the position of the hyoid bone demonstrates sexual dimorphism. Materials and Methods: This was a retrospective cross-sectional study conducted using patient records from the institution. Institutional Ethical Committee approval was obtained prior to the study. A total of 60 subjects were divided into three groups and studied. Hyoid triangle analysis by Bibby and Preston was carried out to determine the position of the hyoid bone. All radiographs were traced by a single operator and they were retraced to check for measurement error. Results: Student's t -tests and Mann-Whitney U-test were used to find out whether any sexual dimorphism exists. The horizontal distance from the hyoid bone to the retrognathion was found to be significantly larger in males than in females. The hyoid bone is positioned at a lower level in class I and II in males than in females. Also, it was observed that the hyoid angle was significantly greater in males than in females in class II group. Conclusion: Sexual dimorphism was observed in the sample studied.

Evaluation of hyoid bone position and its correlation with pharyngeal airway space in different types of skeletal malocclusion.

Introduction:The hyoid bone and its relation with the pharyngeal space in health and disease has been an intriguing subject for years.Aim:This study attempts to evaluate the hyoid bone position and to ascertain any correlations with pharyngeal airway space in skeletal class I, II, and III malocclusions.Materials and Methods:McNamara's airway analysis was carried out to assess the upper and lower airway widths and Hyoid triangle analysis by Bibby and Preston was carried out to determine the position of the hyoid bone.Conclusion:A positive correlation was found between the lower airway and horizontal distance from the hyoid bone to the retrognathion in class I skeletal pattern with average growth pattern.

Relation Between the Craniocervical Cephalometric Analysis and Class I, II and III Skeletic Patterns in Young Subjects

The skull posture on the spine is an important factor for the diagnosis of craniomandibulars functional disorders in children, as well as in adults. Alterations in biomechanics may be evidenced in common x-rays. The aim of this study was to relate findings of craniocervical analysis with skeletal pattern Class I, II, III in individuals from 7 to 12 years old. X-rays of 92 individuals were taken by NHP method and digitalized for computerized analysis of skeletic patterns and craniocervical analysis. Descriptive analysis was used to relate craniocervical analysis values with the type of skeletal pattern presented by individuals. For skeletal pattern Class I, II and III, nasopharyngeal soft tissue percentage and oropharyngeal soft tissue linear quantity were above normality value; nasopharyngeal cervical plot was normal and hyoid triangle was positive for the majority of the individuals. The angular relationship between skull and cervical spine show values lower than those considered normal for skeletal pattern class I and II. It was concluded that in the majority of the individuals with skeletal pattern Class I, II and III had high values of airway blockage, head posterior rotation, nasopharyngeal cervical plot with normal values and positive hyoid triangle.

Comparative analysis of assessment of the craniocervical equilibrium through two methods: cephalomotry of Rocabado and cervical range of Motion

There are several instruments of evaluation of the craniocervical equilibrium; the most reliable are the radiographies. This study used the cephalometric analysis of Rocabado to measure the sensibility and specificity of the Cervical Range of Motion (CROM), a goniometer designed to assess cervical movements in degrees, and measure the forward head position in centimeters. This instrument frequently used, has been tested as a reliable instrument to evaluate the cervical movements but not the forward head. The sample consisted of 30 volunteers, 18 females, 12 males, mean age of 24.63 years. All participants were evaluated with CROM and radiographies in the resting head position and in erect head position. The values considered by the cephalometry consisted in the angle made between the McGregor plane and the vertical line formed by the base of the odontoid process to its apex; the posterior space between C0-C1 and C1-C2 and the hyoid triangle. 30% of the subjects had forward head posture, according to de cephalometry of Rocabado (decreased space between C0-C1, C1-C2) and 43,3% according to CROM. 16,6% had decreased posterior-inferior angle, and 13% had the hyoid triangle facing up. ROC curve of identifying forward head posture yielded area under the curve of 0,778 (95% confidence interval 0,596-0,960). The sensibility of CROM was: 77%. The specificity 71%. This study suggests that CROM has a moderate sensibility and specificity, useful for clinic use, but not for research.

Craniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing

Introduction The objective of the present study was to assess the craniocervical posture and the positioning of the hyoid bone in children with asthma who are mouth breathers compared to non-asthma controls. Methods The study was conducted on 56 children, 28 of them with mild ( n = 15) and moderate ( n = 13) asthma (14 girls aged 10.79 ± 1.31 years and 14 boys aged 9.79 ± 1.12 years), matched for sex, height, weight and age with 28 non-asthma children who are not mouth breathers. The sample size was calculated considering a confidence interval of 95% and a prevalence of 4% of asthma in Latin America. Eighteen variables were analyzed in two radiographs (latero-lateral teleradiography and lateral cervical spine radiography), both obtained with the head in a natural position. The independent t-test was used to compare means values and the chi-square test to compare percentage values ( p < 0.05). Intraclass correlation coefficient (ICC) was used to verify reliability. Results The Craniovertebral Angle (CVA) was found to be significantly smaller in asthma than in control children (106.38 ± 7.66 vs. 111.21 ± 7.40, p = 0.02) and the frequency of asthma children with an absent or inverted hyoid triangle was found to be significantly higher compared to non-asthma children (36% vs. 7%, p = 0.0001). The values of the inclination angles of the superior cervical spine in relation to the horizontal plane were significantly higher in moderate than in mild asthma children (CVT/Hor: 85.10 ± 7.25 vs. 90.92 ± 6.69, p = 0.04 and C1/Hor: 80.93 ± 5.56 vs. 85.00 ± 4.20, p = 0.04). Conclusions These findings revealed that asthma children presented higher head extension and a higher frequency of changes in hyoid bone position compared to non-asthma children and that greater the asthma severity greater the extension of the upper cervical spine.

The effect of maxillary molar distalization on cervical posture

PURPOSE: The objectives of this study were to determine whether maxillary molar distalization with a Pendulum appliance affects the cervical posture, and whether lateral cephalometry can measure these changes. METHODS: Twenty Dental Class II subjects, aged 11.5–15.5, were selected for maxillary molar distalization with a Pendulum appliance. Before treatment, a lateral cephalogram was recorded in natural head position. The lateral cephalogram was repeated after molar correction to dental Class I and appliance removal. The differences between pre-treatment and post-treatment data were determined and analyzed with paired t-tests. RESULTS: The craniocervical angle (CCA) decreased 2.3°, Cobb angle increased 0.4°, Hyoid triangle height increased 0.13 mm, the distance between C0 and C1 increased 0.28 mm, and the distance between C1 and C2 increased 0.23 mm. None of the differences in these measurements were significant. CONCLUSIONS: Measured changes in cervical posture ?following maxillary molar distalization with a Pendulum appliance were not significant when measured by lateral cephalometry. It could not be determined whether the pre- and post-treatment natural head position was reproducible so as to not affect the measurement of appliance-induced changes.

Avaliação cefalométrica da posição do osso hióide em crianças respiradoras bucais

MATERIAL E MÉTODOS: em função das relações anatomofuncionais do osso hióide com o complexo craniofacial, realizou-se avaliação cefalométrica da posição do osso hióide em relação ao padrão respiratório. A amostra consistiu de 53 crianças, gênero feminino, com idades médias de 10 anos, sendo 28 respiradoras nasais e 25, bucais. As medidas cefalométricas horizontais, verticais e angulares foram utilizadas com a finalidade de determinar a posição do osso hióide. Estabeleceu-se uma comparação entre os grupos por meio do teste "t" de student, bem como correlação de Pearson entre as variáveis. RESULTADOS: Observou-se que não ocorreram diferenças estatísticas significativas para a posição mandibular e posição do osso hióide e o tipo do padrão respiratório. No Triângulo Hióideo, o coeficiente de correlação de 0,40 foi significativo entre AA-ENP (distância entre vértebra atlas e espinha nasal posterior) e C3-H (distância entre a terceira vértebra cervical e osso hióide) demonstrando uma relação positiva entre os limites ósseos do espaço aéreo superior e inferior. Para as medidas cranianas sugeriu-se uma relação entre a posição do osso hióide com a morfologia mandibular. CONCLUSÃO: Os resultados permitiram concluir que o osso hióide mantém uma posição estável, provavelmente, para garantir as proporções corretas das vias aéreas e não depende do padrão respiratório predominante.

Cephalometric assessment of the hyoid bone position in Oral Breathing Children

SummaryMaterial and Methods: because of its anatomical and functional relationship with the craniofacial complex, we assessed the cephalometry of the hyoid bone position in relation to the respiratory pattern of these 53 female children, with average age of 10 years; 28 of them are nasal breathers and 25 are oral breathers. Horizontal, vertical and angular cephalometric measures were used in order to determine the hyoid bone location. The Student “t” and the Pearson correlation tests were used in order to compare the groups and the variables.ResultsWe did not see statistically significant differences in mandible and hyoid bone positions and the respiratory pattern. In the hyoid triangle, the 0.40 correlation coeficient was significant between AA-ENP (distance between the Atlas vertebrae and the posterior nasal spine) and C3-H (distance between the third cervical vertebrae and the hyoid bone) showing a positive relation between the bony limits of the upper and lower air spaces. For cranial measures we have suggested a relationship between the hyoid bone position and the mandible morphology.ConclusionThe results led us o conclude that the hyoid bone keeps a stable position, probably in order to secure correct ratios in the airways, and it does not depend on the respiratory pattern.

Cephalometric appraisal of the hyoid triangle in brazilian people of Piracicaba’s region

The Triangle Hyoid was measured by cephalometric measures in Brazilian individuals from Piracicaba’s region by establishing comparisons with the values existing in the literature objectiving to establish values of normality for the position of the hyoid bone. The sample consisted of 31 cephalometric radiographs of Brazilian individuals with Angle’s Class I malocclusion, mix dentition,16 boys and 15 girls with ages raging from 8 to 15 years. The gotten data had submitted it test “t” of Student that showed the occurrence of sexual dimorfism for the ântero-posterior position of the hyoid bone(H) to the retrognation (RGn). The antero-posterior hyoid position (H) in relation to the third cervical vertebra (C3) was constant, with values of 34.03 mm and standard deviation of 3.85. The distances between antero-posterior position of C3 and symphysis (RGn) were similar to those found in the literature. The vertical position of the hyoid bone was higher and less inclined. The correlation coefficient between the atlas vertebrae to posterior nasal espine (AA-PNS) and C3-H was significant (0.56), which is suggesting that the hyoid bone represents the previous limit of the upper airspace in a level more inferior than the PNS in accordance with the literature. It concluded itself that there is a related sexual differences and face standard with the position of the hyoid bone indicates the necessity of a refined evaluation of this bone, therefore represents an important element for the orthodontic and functional orthopedic and speech therapist and physitherapist.

Does Head Posture Have a Significant Effect on the Hyoid Bone Position and Sternocleidomastoid Electromyographic Activity in Young Adults?

The aim of this study was to evaluate the associations between head posture (head extension, normal head posture, and head flexion) and anteroposterior head position, hyoid bone position, and the sternocleidomastoid integrated electromyographic (IEMG) activity in a sample of young adults. The study included 50 individuals with natural dentition and bilateral molar support. A lateral craniocervical radiograph was taken for each subject and a cephalometric analysis was performed. Head posture was measured by means of the craniovertebral angle formed by the MacGregor plane and the odontoid plane. According to the value of this angle, the sample was divided into the following three groups: head extension (less than 95°); normal head posture (between 95° and 106°); and head flexion (more than 106°). The following cephalometric measurements were taken to compare the three groups: anteroposterior head position (true vertical plane/pterygoid distance), anteroposterior hyoid bone position (true vertical plane-Ha distance), vertical hyoid bone position (H-H’ distance in the hyoid triangle), and C0-C2 distance. In the three groups, IEMG recordings at rest and during swallowing of saliva and maximal voluntary clenching were performed by placing bipolar surface electrodes on the right and left sternocleidomastoid muscles. In addition, the condition with/without craniomandibular dysfunction (CMD) in each group was also assessed. Head posture showed no significant association with anteroposterior head position, anteroposterior hyoid bone position, vertical hyoid bone position, or sternocleidomastoid IEMG activity. There was no association to head posture with/without the condition of CMD. Clinical relevance of the results is discussed.

The hyoid bone position in mouth breathers and tongue-thrusters

In 1981 Bibby and Preston commented on the uniqueness of the anatomic relationships of the hyoid bone, notably that it was not fixed in space by bony articulations. This fact alone makes it a potential indicator of certain individual features of importance in orthodontic diagnosis and treatment. This study investigates the effect of mouth breathing and tongue-thrusting on the hyoid bone position by means of the hyoid triangle analysis. Three groups of eighteen subjects formed the sample, one group of mouth breathers, one group of tongue-thrusters, and a control group of subjects who exhibited neither of these. Preorthodontic lateral cephalometric radiographs were taken, and the position of the hyoid bone was analyzed from these. The groups were compared statistically by means of t tests and showed no statistically significant difference. These results show that the hyoid bone has a stable position and is independent of any posture alterations due to tongue-thrusting or mouth breathing.