Hyoid Syndrome




Abstract


Hyoid syndrome is caused by calcification and inflammation of the attachment of the stylohyoid ligament to the hyoid bone. Hyoid syndrome is caused by calcification and inflammation of the attachment of the stylohyoid ligament to the hyoid bone. The pain of hyoid syndrome is sharp and stabbing; it occurs with movement of the mandible, turning of the neck, or swallowing. The pain starts below the angle of the mandible and radiates into the anterolateral neck. Some patients complain of a foreign body sensation in the pharynx. Injection of local anesthetic and steroid into the attachment of the stylohyoid ligament to the greater cornu of the hyoid bone is both a diagnostic and a therapeutic maneuver.




Keywords

hyoid syndrome, neck pain, dysphagia, stylohyoid ligament, osteomyelitis, glossopharyngeal neuralgia

 


ICD-10 CODE M65.20




The Clinical Syndrome


Hyoid syndrome is caused by calcification and inflammation of the attachment of the stylohyoid ligament to the hyoid bone. The styloid process extends in a caudal and ventral direction from the temporal bone from its origin just below the auditory meatus. The stylohyoid ligament’s cephalad attachment is to the styloid process, and its caudad attachment is to the hyoid bone. In hyoid syndrome, the stylohyoid ligament becomes calcified at its caudad attachment to the hyoid bone ( Fig. 13.1 ). Tendinitis of the other muscular attachments to the hyoid bone may contribute to this painful condition. Hyoid syndrome also may be seen in conjunction with Eagle’s syndrome. Patients suffering from diffuse idiopathic skeletal hyperostosis are thought to be susceptible to the development of hyoid syndrome because of the propensity for calcification of the stylohyoid ligament in this disease ( Fig. 13.2 ).




FIG 13.1


In hyoid syndrome, the stylohyoid ligament becomes calcified at its caudad attachment to the hyoid bone.



FIG 13.2


Cervical spine abnormalities in diffuse idiopathic skeletal hyperostosis (DISH). A and B, Radiographic abnormalities in this patient with DISH include extensive anterior bone formation, ossification of the posterior longitudinal ligament (arrows), and ossification of both stylohyoid ligaments (arrowheads). C, In another patient, note the extensive ossification of the stylohyoid ligament (arrowheads) and the changes caused by spinal DISH.

(From Resnick D. Diagnosis of bone and joint disorders . 4th ed. Philadelphia: Saunders; 2002:1483.)




Signs and Symptoms


The pain of hyoid syndrome is sharp and stabbing; it occurs with movement of the mandible, turning of the neck, or swallowing. The pain starts below the angle of the mandible and radiates into the anterolateral neck ( Fig. 13.3 ); it is often referred to the ipsilateral ear. Some patients complain of a foreign body sensation in the pharynx. Injection of local anesthetic and steroid into the attachment of the stylohyoid ligament to the greater cornu of the hyoid bone is both a diagnostic and a therapeutic maneuver.




FIG 13.3


The pain of hyoid syndrome is sharp and stabbing and occurs with movement of the mandible, turning of the neck, or swallowing. The pain starts below the angle of the mandible and radiates to the anterolateral neck.




Testing


No specific test exists for hyoid syndrome. Plain radiography, computed tomography, or magnetic resonance imaging of the neck may reveal calcification of the caudad attachment of the stylohyoid ligament at the hyoid bone. This calcification is highly suggestive of hyoid syndrome in patients suffering from the previously described constellation of symptoms. A complete blood count, erythrocyte sedimentation rate, and antinuclear antibody testing are indicated if inflammatory arthritis or temporal arteritis is suspected. As noted earlier, injection of small amounts of anesthetic into the attachment of the stylohyoid ligament to the hyoid bone can help determine whether this is the source of the patient’s pain. If difficulty swallowing is a prominent feature of the clinical presentation, endoscopy of the esophagus, with special attention to the gastroesophageal junction, is mandatory to identify esophageal tumors or strictures resulting from gastric reflux.

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Sep 9, 2019 | Posted by in PAIN MEDICINE | Comments Off on Hyoid Syndrome

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