Chondrosarcoma of the hyoid bone: a case of mistaken identity in the submandibular region.

We describe a case of woman in her 60s who presented with a painless mass in her left submandibular region that biopsies and imaging suggested was a pleomorphic adenoma. Intraoperative findings showed a submandibular mass originating from the hyoid bone, and subsequent histopathological examination showed a grade 2 chondrosarcoma of the hyoid bone. Chondrosarcomas in the head and neck region are uncommon and presentations in the hyoid bone are very rare with only approximately 27 previously published cases. Presentations that pose as more benign pathology can cause diagnostic dilemmas for clinicians.

Chondrosarcoma of hyoid bone: a case report.

Chondrosarcoma of hyoid bone is a rare malignant tumour, with only a few cases reported in literature. We present the case of a 28-year-old male with grade I hyoid bone chondrosarcoma.

[Effect of the Hyoid Bone Suspension Technique on the Preservation of Swallowing Function after Total Glossectomy and Pectoralis Major Musculocutaneous Flap Reconstruction for Locally Advanced Tongue Cancer].

Dysphagia is a major postoperative complication in patients with locally advanced oral cancer. In this case report, we describe the effect of the hyoid bone suspension technique on the preservation of swallowing function after total glossectomy and pectoralis major musculocutaneous flap reconstruction for locally advanced tongue cancer. Case: A 72-year-old Japanese male was diagnosed with advanced squamous cell carcinoma on the left side of his tongue(cT4aN2cM0, cStage ⅣA). Under general anesthesia, the patient underwent a tracheotomy, bilateral modified radical neck dissection type Ⅲ, total glossectomy, and reconstruction with a left pectoralis major musculocutaneous flap(PMMC flap). Intraoperatively, the PMMC flap was designed to have a heart shape of 11×6 cm and was elevated. Subsequently, holes were made at the lower edge of the mandible, and the hyoid bone was suspended and fixed to the mandibular border using 2-0 nylon sutures. The postoperative course was uneventful; the flap was completely engrafted and was in good condition. The hyoid bone suspension technique can reproduce the pharyngeal phase of swallowing, and the palatal augmentation prosthesis helps to improve food mass feeding and preserve the swallowing function.

Giant cell tumor of hyoid bone: Diagnostic dilemma with a novel management.

Giant cell tumor of bone (GCTB) is locally aggressive tumor occurring in the epiphysis of long bones. GCTBs are uncommon tumors in the head-and-neck region and rarely involve hyoid bone. We report a case of GCTB of hyoid bone. The patient presented with swelling in left submandibular region. The tumor was surgically excised after initial denosumab therapy. Despite adequate resection and rehabilitation, he was tube dependent. Subsequently it was found that the patient had a coexisting myotonic dystrophy, unknown to exist with GCTB of hyoid. Eventually, the patient succumbed to respiratory failure secondary to myotonic dystrophy. GCTB hyoid is a rare presentation posing a diagnostic dilemma. Ours is the first case to report the use of denosumab for GCT in head-and-neck region. Myotonic dystrophy Type I and GCTB are both known to result from abnormality of closely situated foci on chromosome 19.

18F-FDG PET/CT in Osteoradionecrosis of the Hyoid.

Osteoradionecrosis (ORN) is a well-documented complication following radiation treatment for head and neck malignancy. Facial bones, mainly the mandible, laryngeal cartilage, and skull, are frequently involved sites for ORN. A rare site for ORN is the hyoid, with very limited cases described in the literature. Recognition of the imaging pattern of hyoid ORN is critical to avoid misdiagnosis of recurrent disease, prompting early treatment.

Hyoid Bone Metastasis in Patients With Lung Adenocarcinoma: A Case Report.

OBJECTIVE: Hyoid bone metastasis from lung adenocarcinoma is exceedingly rare. This study aims to provide an experience to clinicians in the differential diagnosis of hyoid tumors and discusses its possible source. METHODS AND RESULTS: We report a 68-year-old male patient having hyoid bone metastasis from lung adenocarcinoma. The initial symptom of the hyoid bone metastasis was neck pain exacerbated by swallowing. The hyoid bone mass was resected based on comprehensive analysis including whole-body bone imaging and pathologic analysis of the hyoid bone mass. The adenocarcinoma of hyoid was identified as a metastatic lesion of lung adenocarcinoma. The patient recovered well and the anterior cervical pain was significantly alleviated after surgery and the patient underwent corresponding chemotherapy. CONCLUSION: In patients with hyoid metastasis of lung adenocarcinoma, surgical resection may reduce the pain in anterior cervical after full consideration of physical condition.

BRAFV600E mutation: a potential predictor of more than a Sistrunk's procedure in patients with thyroglossal duct cyst carcinoma and a normal thyroid gland.

To assess the utility of mutational markers in determining the most appropriate initial surgery for patients with thyroglossal duct cyst carcinoma (TGDCCa) and a normal thyroid gland. Our sample comprised 15 patients with a diagnosis of TGDCCa and a thyroid gland histologically negative for any malignant involvement, who underwent surgery between the years 1994 and 2017. Clinical records were reviewed and tissue specimens were genetically tested for the presence of the most commonly encountered mutational markers in differentiated thyroid cancer: BRAF, N-RAS, and H-RAS. The primary outcome of interest was the correlation between mutational marker positivity and the T-stage of the primary tumor and its potential implication on therapeutic decision making. All 15 cases were papillary carcinomas with a mean tumor size of 17 mm (2-40 mm). According to the 7th edition of the American Joint Committee on Cancer TNM staging system, these represented: T1 (n = 3), T2 (n = 1), and T3 (n = 11). Cancerous invasion of the pericystic soft tissue and/or hyoid bone was considered T3. BRAFV600E was the only mutational marker identified (7 in 15 cases). All BRAFV600E-positive lesions were T3, necessitating radioactive iodine ablation (RIA) therapy, therefore, total thyroidectomy. The correlation between BRAFV600E positivity and extracystic cancerous extension was statistically significant [1.0 (7/7) vs. 0.5 (4/8); p value = 0.0035]. BRAFV600E positivity seems to be predictive of locally advanced disease mandating RIA therapy. Therefore, it could serve as a preoperative tool that predicts the need for total thyroidectomy, in addition to Sistrunk's procedure.

A patient with conventional and follicular variant papillary thyroid microcarcinoma and Eagle's syndrome, Langlais type III, with hyoid bone variation.

AIM: Presenting an extraordinary case of Eagle's syndrome (ES) with the classical and follicular variant of papillary thyroid microcarcinoma (PTmC) and an uncommon stylohyoid ligament calsification, aside from O'Carroll's System. CASE REPORT: A 52-year-old Turkish man with an histopathology of the follicular variant of PTmC (FVPTmC) of his right lobe and conventional PTmC of his left lobe of the thyroid with an adjuvant 100 mCi radioactive iodine (RAI) ablation was admitted. On the routine follow-up of the present case, a lineer structure at the 3rd compartment of neck in his ultrasonography, a styloid ligament calsification in his noncontrast computed tomography (CT), and a left styloid process of the temporal bone of 29 mm in size in his three-dimensional (3D) CT scanning had been revealed. Conclusively, an ES, Langlais Type III with The Calcification Pattern IV, was recognized. DISCUSSION: A noninvasive peroral medical management was administered as a first-line treatment for the neuropathic sequelae of ES and it has provided relief of signs and symptoms without any recurrence to date, for three years and three months. CONCLUSION: To our knowledge, it is an highly extreme and first case of ES in the English literature, recognized in the course of his programmed follow-up of his conventional PTmC and FVPTmC, simultaneously possessing an exceptional stylohyoid ligament calsification, apart from O'Carroll's System, even with an anatomic variation of the hyoid bone. KEY WORDS: Eagle's Syndrome Follicular variant of papillary thyroid microcarcinoma, Hyoid bone variation, Langlais classification, O'Carroll's System, Radioactive iodine, Papillary thyroid microcarcinoma.

Tongue-pressure resistance training improves tongue and suprahyoid muscle functions simultaneously.

PURPOSE: Producing tongue pressure (TP) by pushing the tongue against the palate consists of lifting the tongue muscles and elevating the floor of the mouth via suprahyoid muscle contraction. Though studies have shown that tongue-pressure resistance training (TPRT) increases tongue function, none have focused on suprahyoid muscle function enhancements. Our study aimed to verify whether TPRT improves both tongue function and hyoid movement during swallowing. MATERIALS AND METHODS: Eighteen patients (mean age: 76.8±6.2 years) with presbyphagia presenting with symptoms such as coughing and choking were enrolled. All patients performed daily living activities independently. None of the participants had diseases causing dysphagia or previous oral or pharyngeal surgery. Participants were instructed to push their tongues against the palate as hard as possible with their mouths closed for 10 seconds, and then resting for 10 seconds. A set consisted of five consecutive exercise and resting periods; two sets per day were performed for a month. TP and the oral diadochokinetic rate (ODKR), measured by repetitions of the syllables /ta/ and /ka/, assessed tongue function. The extent of anterior and superior hyoid movement and parameters related to swallowing, including the penetration aspiration scale (PAS) and the normalized residue ratio scale (NRRS) in the valleculae (NRRSv) and piriform sinus (NRRSp), were evaluated based on videofluoroscopic data. RESULTS: The anterior (P=0.031) and superior hyoid movement (P=0.012), TP (P=0.002), ODKR/ta/ (P=0.034), ODKR/ka/ (P=0.009), and the width of the upper esophageal sphincter (P=0.001) were larger at follow-up than at baseline. NRRSp (P=0.022), PAS (P=0.016), and pharyngeal transit times (P=0.004) were smaller at follow-up than at baseline. CONCLUSION: TPRT improved tongue strength, dexterity, both anterior and superior hyoid elevation, and swallowing functions. Therefore, TPRT could improve tongue function and suprahyoid muscle function simultaneously and contribute to prevention of sarcopenic dysphagia.

Thyroglossal duct cyst masquerading as a laryngocele.

Thyroglossal duct cysts (TGDCs) are the most common congenital neck mass and often present in the paediatric population as a painless mass in the midline. A lateralised neck mass presenting for the first time in an adult may raise more concern for malignancy or a laryngocele. A 50-year-old man presented with an asymptomatic right level II neck mass adjacent to the thyroid cartilage. Preoperative CT revealed a cystic mass right of the midline with an intralaryngeal component. Intraoperatively, the lesion tracked towards the central hyoid bone; a Sistrunk procedure was performed. Postoperative pathology revealed a small foci of thyroid tissue within the mass. Careful consideration of the origin of this unusually presenting TGDC enabled appropriate operative management.

Osteoradionecrosis of the hyoid bone complicated by pharyngocutaneous fistula: A case report and literature review.

BACKGROUND: Osteoradionecrosis (ORN) is a well-known complication following irradiation of head and neck malignancies. ORN commonly occurs in the mandible but is rarely reported in the hyoid bone. CASE PRESENTATION: A 76-year-old female with a history of oropharyngeal squamous cell carcinoma presented with pharyngocutaneous fistula 14 years after primary chemoradiation. Imaging showed necrosis of the hyoid bone. She underwent excision of the hyoid to rule out malignancy. Pathology was negative for carcinoma, but did show extensive fragmentation and bony necrosis consistent with ORN. The patient's clinical course, surgical treatment, and management considerations are discussed here. CONCLUSIONS: Hyoid ORN should remain in the differential during diagnostic workup of previously irradiated head and neck cancer patients. The presentation of a pharyngocutaneous fistula should prompt workup to rule out malignancy before assigning a diagnosis of ORN.

Changes in airway dimensions after robot assisted surgeries in steep Trendelenburg position.

Robotic surgeries in the extreme Trendelenburg position can lead to changes in the airway dimensions. We conducted a prospective, observational trial to explore the use of ultrasound to quantify these changes in the airway dimensions and identify the factors associated with it. Fifty-two American society of Anaesthesiologists physical status I-II patients between 18 and 70 years of age of either sex scheduled to undergo robot assisted urological procedures in steep Trendelenburg position were enrolled. Anterior soft tissue thickness at the level of hyoid bone and vocal cords, tongue thickness, Malampatti grading and neck circumference were measured at predefined postoperative intervals in the immediate postoperative period, at 2-, 6- and 12-h period postoperatively. Linear stepwise regression analysis was done to explore the factors associated with change in anterior tissue thickness immediately after surgery. The mean difference (95%; CI) in the anterior soft tissue thickness in the immediate postoperative period at the level of hyoid was 0.023 (0.029-0.016) cm, p < 0.001 and at level of vocal cords was - 0.012 (- 0.017 to - 0.008) cm, p < 0.001 from the baseline. There was a significant increase in tongue thickness (0.002), Mallampati score (p = 0.002) and neck circumference (p < 0.001) in immediate postoperative period. The change in anterior tissue thickness at the level of hyoid was affected by total intraoperative fluids used (r = 0.602, p < 0.001), airway trauma (r = 0.275, p = 0.002) and duration of surgery (r = 0.243, p = 0.025). Significant changes in airway dimensions after robotic surgeries in Trendelenburg position persist till 2 h in the postoperative period which warrant vigilant monitoring for any airway compromise during this period.

Potential Anatomic Markers of Obstructive Sleep Apnea in Prepubertal Children.

STUDY OBJECTIVES: Adenotonsillar hypertrophy is the major cause of obstructive sleep apnea (OSA) in prepubertal children, but children without enlarged lymphoid tissues may still suffer from OSA. This study aimed to identify other potential anatomic features associated with childhood OSA. METHODS: This prospective study took place between January 2010 and April 2014. Prepubertal children suspected to have OSA, aged 6 to 11 years, were recruited. They underwent anthropometric measurements, nocturnal polysomnography, tonsil size evaluation, x-ray cephalometry, and sonographic measurement of lateral parapharyngeal wall (LPW) thickness. Linear regression analyses were used to test for the association between anatomic measurements and OSA severity. Logistic regression analyses were used to identify potential anatomic markers for different cutoffs (obstructive apneahypopnea index (OAHI) ≥ 1 and ≥ 5 events/h) for OSA. RESULTS: Forty-seven children with OSA (20 with moderate to severe disease) and 43 children for the control group were recruited. Sonographic measurement of LPW thickness and position of hyoid bone taken from x-ray cephalometry were risk factors associated with OSA. Linear regression analyses found that these two phenotypes were associated with OAHI. Multivariate models adjusted for age, sex, body mass index, z score, and tonsil size revealed that lower position of hyoid bone was independently associated with higher risk for OSA, whereas both lower position of hyoid bone and greater LPW thickness were associated with higher OAHI and also a higher risk for moderate to severe OSA. CONCLUSIONS: Position of hyoid bone and LPW thickness are anatomical markers of childhood OSA independent of obesity and tonsil size. Screening tools may include cephalometry and sonographic measurement of LPW to allow better delineation of OSA risk.

[A Case of Carotid Artery Stenosis Associated with Repetitive Stimulation of the Hyoid Bone].

A 40-year-old man presented with left-arm weakness, facial palsy, and dysarthria. Magnetic resonance imaging(MRI)revealed acute-stage cerebral infarction in the internal watershed area of the right hemicerebrum and MR angiography(MRA)demonstrated 56% stenosis of the right common and internal carotid arteries. Computed tomography(CT)scan showed no calcification and a stenotic lesion of the right common carotid artery, adjacent to the prolonged greater horn of the right hyoid bone. Because no other causes were found for the cerebral infarction, the compression of the stenosis of the right carotid artery was suspected as the cause of the cerebral infarction. Carotid arterectomy was performed five months after onset. Intraoperative finding showed tight adhesion between the carotid sheath and the adventitia of the carotid artery. Pathological findings showed a proliferation of fibroblast cells in the resected plaque. Common or internal carotid artery stenosis related to compression from the hyoid bone is rare. These cases hold a potential for tight adhesion around tissues. Therefore, in cases of prolonged hyoid bone, increased attention should be given to the operative procedure.

Laryngeal anatomical variants and their impact on the diagnosis of mechanical asphyxias by neck pressure.

The aims of this investigation were to determine the characteristics and prevalence of anatomical variants of the larynx apparatus and to evaluate the impact of these variants on the accurate diagnosis of laryngeal fractures. A population-based study was carried out, analyzing a series of 207 consecutive autopsied cases in the Institute of Legal Medicine of Galicia (Northwestern Spain). The prevalence of triticeal cartilage was 52.7% and that of agenesis of thyroid horns 10%. Calcification of the stylo-hyoid ligament accounted for 1.4%. We identified three new anatomical variants: the terminal segmentation of the thyroid horns (11.6%), ectopic superior thyroid horns (8%) and lateral thyrohyoid ossification (5.3%). These three names, based on anatomical criteria, are the author's proposal to solve the lack of uniformity in the designation of these variants. Agenesis of thyroid horns were related to the presence of ectopic superior thyroid horns in 93% of cases, either uni or bilateral. The combination of variants was present in 6.8% of the cases, being the terminal segmentation of the thyroid horns in association with triticeal cartilage the most frequent (3.8%). The probability of misdiagnosis due to the presence of anatomical variations in deaths by pressure on the neck was high in this population (71.5%). The prevalence of triticeal cartilage in more than half of the sample, determined an important rate of potential errors (46.4%), followed by the mistaken diagnoses induced by terminal segmentation of thyroid horns (7.3%) and by ectopic superior thyroid horns (6.3%). The likelihood of a misdiagnosed laryngeal fracture was greater if the thyroid cartilage was affected, with a higher proportion of false positives comparing to the hyoid bone (p<0.001). The higher frequency of thyroid fractures in neck pressure together with the prevalence and location of triticeal cartilage on the lower third of the lateral thyrohyoid ligament are the main reasons for these results. Further studies should be done with larger samples to expand epidemiological data and consolidate these results and their influence on the diagnosis of mechanical asphyxias.

Osteochondroma of the Hyoid: First Pediatric Case and Literature Review.

Osteochondromas, the most common benign bone tumors, are cartilaginous neoplasms of unknown origin with rare malignant potential. Osteochondromas rarely occur in the head and neck, and diagnosis relies on a combination of clinical, radiological, and histological criteria. Excision is often curative. We describe the first reported case of hyoid osteochondroma in an adolescent male with multiple osteochondroma, discuss its surgical management, and perform a review of the salient literature. Osteochondroma represents a rare diagnosis to include in the differential of any midline neck mass.

Osteoma of the hyoid: an unusual cause of a neck lump.

A 65-year-old man with a 2-month history of left-sided neck swelling presented through the cancer pathway. There was no associated 'red flag' symptoms, and clinical examination revealed a left anterior triangle, non-pulsatile firm swelling atypical of a lymph node. Ultrasound scan imaging confirmed a complex structure with an echogenic centre and hypoechoic periphery, which was confirmed on CT as an osteoma of the hyoid.This is an extremely unusual cause of a neck lump, and an extensive literature review revealed only two previously documented cases.

Osteoradionecrosis of the hyoid bone after intra-arterial chemoradiotherapy for oropharyngeal cancer: MR imaging findings.

BACKGROUND: Osteoradionecrosis (ORN) of the hyoid bone sometimes induces severe front neck infection and can cause laryngeal stenosis and carotid rupture. Although ORN of the hyoid bone is known to be a complication of chemoradiotherapy for head and neck cancer, there has been no basis for its evaluation. Our purpose is to present the clinical and MR imaging features of ORN of the hyoid bone. METHODS: The study group comprised patients with advanced oropharyngeal cancer treated with targeted intra-arterial cisplatin infusion with concomitant radiotherapy. ORN of the hyoid bone was identified on the basis of decreased signal intensity of the bone marrow on T1WI images. Signal intensity on T2WI images was used to distinguish between inflammation and fibrosis. RESULTS: A total of 39 pre-treatment MR images and follow-up MR images were reviewed. ORN of the hyoid bone were detected in 30% of patients after treatment, with 23% of them showing inflammation and 7.7% fibrosis. Two patients developed severe neck infection and received antibiotics and underwent surgical intervention by tracheostomy and resection of the hyoid bone. CONCLUSION: Our MR imaging study showed that ORN of the hyoid bone is not particularly rare in patients with oropharyngeal cancer treated with chemoradiotherapy. Clinicians should evaluate images carefully to prevent the development of severe complication due to infection associated with ORN of the hyoid bone.

Hyoid Bone and Thyroid Cartilage Metastases from Sigmoid Colon Adenocarcinoma: A Case Report.

BACKGROUND: Secondary tumours of the hyoid bone and thyroid cartilage are extremely rare. In this paper, we present a case of the hyoid bone and thyroid cartilage metastases in a patient treated for sigmoid colon adenocarcinoma. CASE REPORT: Four years after sigmoid colon adenocarcinoma was diagnosed and treated with surgery and chemotherapy, the patient developed bone metastases in the left sacroiliac joint and right proximal humerus. Although the patient did not complain of any related symptoms, in a bone scintigraphy the accumulation of Technetium-99m was incidentally detected in the two sites of the anterior neck. On ultrasound examination there were two hyperechoic and heterogeneous masses with calcifications placed in front of the hyoid bone and thyroid cartilage. Computerized tomography demonstrated massive hyoid bone and thyroid cartilage destruction. CONCLUSION: In patients with progressive sigmoid colon adenocarcinoma, destruction of the hyoid bone and thyroid cartilage could be suspected for metastases.