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[Internal Carotid Artery Stenosis Associated with Hyoid Bone:Can Hyoid Bone be a Risk Factor for Acute

Ichiro Kawahara¹, Keisuke Ozono, Takashi Fujimoto

¹Department of Neurosurgery, Nagasaki Rosai Hospital.

No Shinkei Geka. Neurological Surgery

|October 13, 2016

Insights

Eagle syndrome, linked to styloid process issues, can also involve the hyoid bone. Abnormal hyoid bone positioning can impact the internal carotid artery, potentially causing acute cerebrovascular syndrome.

Area of Science:

Anatomy
Neurology
Vascular Surgery

Background:

Eagle syndrome is typically associated with styloid process elongation or stylohyoid ligament calcification.
The role of the hyoid bone, part of the stylohyoid complex, in acute cerebrovascular syndrome (ACVS) is less understood.
Investigating the hyoid bone's anatomical relationship with the internal carotid artery (ICA) is crucial for understanding ACVS etiology.

Purpose of the Study:

To investigate the anatomical relationship between the hyoid bone and the internal carotid artery (ICA).
To determine if variations in hyoid bone anatomy are associated with acute cerebrovascular syndrome (ACVS).

Main Methods:

Three-dimensional computed tomographic angiography (3D-CTA) of the neck was performed on 218 patients between January 2014 and December 2015.
Analysis focused on the spatial relationship between the hyoid bone and the internal carotid artery (ICA).

Main Results:

An abnormal anatomical relationship between the hyoid bone and ICA was observed in 10 (4.6%) patients.
ICA entrapment by the hyoid bone occurred in 5 cases, contact/adjustment in 3, and compression in 2, leading to ACVS.
Inward displacement of the ICA was noted in 7 cases, with hyoid bone repositioning in 4 cases and ICA repositioning in 1 case.

Conclusions:

The anatomical position of the hyoid bone can vary significantly and represents a potential risk factor for ACVS.
In patients presenting with ACVS and an inward-coursing ICA, a proactive examination of the hyoid bone-ICA relationship is recommended.
This study highlights the hyoid bone as a potential, underrecognized factor in ACVS pathogenesis.

Read full analysis

Abstract:

Eagle syndrome is a well-known disease caused by elongation of the styloid process and/or calcification of the stylohyoid ligament, which interferes with adjacent anatomical structures, giving rise to acute cerebrovascular syndrome(ACVS)and/or pain. Although hyoid bone is also a stylohyoid complex, its association with ACVS is not well known. Thus, we investigated the anatomical relationship between the internal carotid artery(ICA)and the hyoid bone. Between January 2014 and December 2015, three-dimensional computed tomographic angiography(3D-CTA)of the neck was performed for 218 patients. Of the patients, an abnormal anatomical relationship was noted in 10(4.6%)cases. In 5 cases, the ICA was entrapped by the hyoid bone. In 3 cases, the ICA was in contact with or adjusted to the hyoid bone. In 2 cases, the ICA was compressed by the hyoid bone, causing ACVS. In 7 cases, the position and course of the ICA were inward. In 4 of these cases, the hyoid bone was repositioned back to its normal location. Moreover, in 1 case, the course of the ICA was repositioned back to its normal location beside the hyoid bone. The anatomical position of the hyoid bone may vary more than expected and can be a risk factor for ACVS. In particular, in cases of ACVS where the ICA has an inward course, the relationship between the ICA and the hyoid bone should be proactively examined.

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