Tuesday, May 31, 2011

A Pain in the neck!

Hyoid Bone Syndrome

The hyoid bone has been identified with a specific, although not well recognized, 
pain syndrome for over 40 years.  The painful symptoms are generally caused by 
trauma at the greater cornu of the hyoid bone with the pain radiating to other sites.

Treatment for the condition ranges from injections of local anesthetic or cortisone 
to resection of the greater cornu. The pain usually radiates from the greater cornu 
of the hyoid bone to the throat, mandible, mandibular molar teeth, zygomatic arch, 
condyle, face, ear, and temple superiorly; anteriorly to the neck, clavicle, upper half 
of the breast, shoulder, arm, and over the shoulder to the scapula of the back 
inferiorly on the same side.

The condition is not well known in medicine and dentistry for at least two reasons: (1) the diffuse and seemingly unrelated radiation of symptoms and (2) the apparent absence of histopathologic evidence of injury.

In my wanderings across the internet, I came across a paper called "Hyoid Syndrome:
A Pain In The Neck", which describes the symptoms as such:
* Lower facial / neck pain radiating to a variety of areas
* all patients, when asked to point to the area of most discomfort, indicated an area 
  overlaying the hyoid bone
* most patients described the pain as worse when swallowing
* many patients described a sensation of a foreign body
* all cases were unilateral, with a nearly 50/50 split between the left and right 

  side of the neck
* symptoms present for 3 months to 4 years in the sample group in the study (13 patients)
* all of these patients had had extensive diagnostics which showed nothing remarkable; 

  a couple had had teeth removed or sinus surgery to no avail
* in all cases, examination revealed tenderness upon palpitation of the neck in the region 

  of the greater cornu of the hyoid on the affected side
* palpitation of this area recreated/exacerbated symptoms

Bottom line: diagnosis is achieved by the exclusion of any physical abnormalities or infections with  various imaging techniques, combined with the specific finding of tenderness over the hyoid bone.

Did you know?

Hyoid bone

The hyoid bone (lingual bone) (Latin os hyoideum) is a horseshoe-shaped bone situated in the anterior midline of the neck between the chin and the thyroid cartilage. At rest, it lies at the level of the base of the mandible in the front and the third cervical vertebra behind.
Unlike other bones, the hyoid is only distantly articulated to other bones by muscles or ligaments. The hyoid is anchored by muscles from the anterior, posterior, and inferior directions and aids in tongue movement and swallowing. The hyoid bone provides attachment to the muscles of the floor of the mouth and the tongue above, the larynx below, and the epiglottis and pharynx behind.
Its name is derived from the Greek word hyoeides meaning "shaped like the letter upsilon" 

hyoid bone