Hyo-Mental Angle and Distance: An Important Adjunct in Airway Assessment of Adult Mucopolysaccharidosis

Mucopolysaccharidosis (MPS) is a rare congenital lysosomal storage disorder with complex airways. High anterior larynx is assessed by thyromental distance (TMD) nasendoscopy. A simpler method to assess this hyoid bone is described. The distance between the central-hyoid and symphysis of the mandible (hyo-mental distance; HMD) and inclination of this line to the horizontal axis (hyo-mental angle; HMA) in neutrally positioned patients is investigated.

HMA, HMD in MPS, and non-MPS were compared, and their correlation with height and weight were assessed.

50 adult MPS patients (M = 32, F = 18, age range = 19-66 years; mean BMI = 26.8 kg/m²) of MPS I, II, III, IV, and VI were compared with 50 non-MPS (M = 25, F = 25; age range = 22-84 years; mean BMI = 26.5 kg/m²). Mean HMA in MPS was 25.72° (-10 to +50) versus 2.42° (-35 to +28) in non-MPS. Mean HMD was 46.5 (25.7-66) millimeters in MPS versus 41.8 (27-60.3) in non-MPS. HMA versus height and weight showed a moderate correlation (r = -0.4, p < 0.05) in MPS and no significant correlation (r < 0.4, p > 0.05) in non-MPS. HMD versus height and weight showed no correlation (r < 0.4, p > 0.05) in both groups.

HMA seems more acute in MPS despite nearly the same HMD as non-MPS, signifying a high larynx, which may be missed by TMD.