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VOLUME 19 , ISSUE 5 ( 2018 ) > List of Articles


Cephalometric Evaluation of the Hyoid Bone Position in Lebanese Healthy Young Adults

Antoine Daraze

Keywords : Airway space, Anthropometry, Cephalometry, Crosssectional study, Hyoid bone position, Lebanon, Obstructive sleep apnea, Sex dimorphism, Tongue, Young adults

Citation Information : Daraze A. Cephalometric Evaluation of the Hyoid Bone Position in Lebanese Healthy Young Adults. J Contemp Dent Pract 2018; 19 (5):490-501.

DOI: 10.5005/jp-journals-10024-2289

License: CC BY-NC 3.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Introduction: The objectives of this study are to assess hyoid sagittal and vertical position, and potential correlations with gender, skeletal class, and anthropometrics. Materials and methods: Twenty-seven cephalometric linear, angular, and ratio measurements for the hyoid were recorded on lateral cephalograms obtained from 117 healthy young Lebanese adults. Anthropometric parameters including height, weight, body mass index (BMI), and neck circumference (NC) were measured. Results: Statistically significant gender differences were demonstrated for 21 out of 27 parameters considered. All linear and two out of three angular measurements defining the vertical hyoid position were larger in males compared with females. Five linear, one angular, and two ratio measurements showed differences in the sagittal dimension. Skeletal classes did not influence the sagittal and vertical hyoid position. Anthropometric variables as height were strongly correlated to the vertical hyoid position, while weight correlated more sagittally. Conclusion: Cephalometric norms for hyoid position were established, sexual dimorphism and ethnic differences were demonstrated. Skeletal patterns did not influence the sagittal and vertical hyoid bone position. Anthropometric parameters, such as BMI correlated the least to both vertical and sagittal hyoid position measurements, while the impact of height and weight as separate entities made a paradigm shift providing accurate and strong correlation of the vertical hyoid position to the height, and the sagittal hyoid position to the weight of individuals. Clinical significance: The cephalometric norms for the hyoid bone position in the Lebanese population established in the present study are of paramount clinical importance and should be considered in planning combined orthodontic and breathing disorders treatments.

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  1. Romanes GJ. Cunningham's manual of practical anatomy, vol. 3. 14th edition. New York, NY: Oxford University Press; 1983.
  2. Drake RL, Vogl AW, Mitchell AWM. Head and neck: Gray's anatomy for students, 3rd edition. London, UK: Churchill Livingstone; 2014.
  3. Graber LW. Hyoid changes following orthopedic treatment of mandibular prognathism. Angle Orthod 1978 Jan;48(1):33-38.
  4. Sheng CM, Lin LH, Su Y, Tsai HH. Developmental changes in pharyngeal airway depth and hyoid bone position from childhood to young adulthood. Angle Orthod 2009 May;79(3):484-490.
  5. Liu SR, Yi HL, Yin SK, Guan J, Chen B, Meng LL, Zou JY, Zhang WT. Primary maxillomandibular advancement with concomitant revised uvulopalatopharyngoplasty with uvula preservation for severe obstructive sleep apnea-hypopnea syndrome. J Craniofac Surg 2012 Nov;23(6):1649-1653.
  6. Gustavsson U, Hansson G, Holmqvist A, Lundberg M. Hyoid bone position in relation to head posture. Svensk tandla kare tidskrift. Swed Dent J 1972 Aug;65(8):423-430.
  7. Valk JP, Zonnenberg AJ, van Maanen CJ, Onno GT. The biomechanical effects of a sagittal split ramus osteotomy on the relationship of the mandible, the hyoid bone, and the cervical spine. Am J Orthod Dentofac Orthop 1992 Aug;102(2): 99-108.
  8. Adamidis IP, Spyropoulos MN. Hyoid bone position and orientation in Class I and Class III malocclusions. Am J Orthod Dentofac Orthop 1992 Apr;101(4):308-312.
  9. Ucar FI, Ekizer A, Uysal T. Comparison of craniofacial morphology, head posture and hyoid bone position with different breathing patterns. Saudi Dent J 2012 Oct 31;24(3):135-141.
  10. Chen CM, Lai S, Chen KK, Lee HE. Correlation between the pharyngeal airway space and head posture after surgery for mandibular prognathism. BioMed Res Int 2015;(2015):Article ID 251021:8 pgs.
  11. Efendiyeva R, Aydemir H, Karasu H, Toygar-Memikolu U. Pharyngeal airway space, hyoid bone position, and head posture after bimaxillary orthognathic surgery in class III patients: long-term evaluation. Angle Orthod 2014 Mar;84(5): 773-781.
  12. Nagy A, Molfenter SM, Peladeau-Pigeon M, Stokely S, Steele CM. The effect of bolus volume on hyoid kinematics in healthy swallowing. BioMed Res Int 2014 Mar;738971.
  13. Yamaoka M, Furusawa K, Uematsu T, Okafuji N, Kayamoto D, Kurihara S. Relationship of the hyoid bone and posterior surface of the tongue in prognathism and micrognathia. J Oral Rehabil 2003 Sep;30(9):914-920.
  14. Ceylan I, Oktay H. A study on the pharyngeal size in different skeletal patterns. Am J Orthod Dentofac Orthop 1995 Jul;108(1):69-75.
  15. Kuroda T, Nunota E, Hanada K, Ito G, Shibasaki Y. A roentgeno- cephalometric study on the position of the hyoid bone. Bull Tokyo Med Dent Univ 1966 Jun;13(2):227-243.
  16. Chauhan A, Autar R, Pradhan KL, Yadav V. Comparison of pharyngeal airway dimension, tongue and hyoid bone position based on ANB angle. Natl J Maxillofac Surg 2015 Jan;6(1):42-51.
  17. Gunduz Arslan S, Dilde. N, Devecioglu Kama J. Cephalometric investigation of first cervical vertebrae morphology and hyoid position in young adults with different sagittal skeletal patterns. Sci World J 2014 Jul;159784.
  18. Jose NP, Shetty S, Mogra S, Shetty VS, Rangarajan S, Mary L. Evaluation of hyoid bone position and its correlation with pharyngeal airway space in different types of skeletal malocclusion. Contemp Clin Dent 2014 Apr;5(2):187-189.
  19. Li ZM, Wu J, Men HY, Li HF. Cone-beam CT study for the oropharyngeal airway volume and hyoid position of adults Class III skeletal malocclusion. Shanghai J Stomatol 2015 Jun;24(3):351-355.
  20. Bibby RE, Preston CB. The hyoid triangle. Am J Orthod 1981 Jul;80(1):92-97.
  21. Ferraz MJ, Nouer DF, Berzin F, Sousa MA, Romano F. Cephalometric appraisal of the hyoid triangle in Brazilian people of Piracicaba's region. Braz J Oral Sci 2006 Apr;5(17): 1001-1006.
  22. Trenouth MJ, Timms DJ. Relationship of the functional oropharynx to craniofacial morphology. Angle Orthod 1999 Oct;69(5):419-423.
  23. Chi L, Comyn FL, Keenan BT, Cater J, Maislin G, Pack AI, Schwab RJ. Heritability of craniofacial structures in normal subjects and patients with sleep apnea. Sleep 2014 Oct;37(10): 1689-1698.
  24. Kollias I, Krogstad O. Adult craniocervical and pharyngeal changes-a longitudinal cephalometric study between 22 and 42 years of age. Part 1: morphological craniocervical and hyoid bone changes. Eur J Orthod 1999 Aug;21(4):333-344.
  25. Battagel JM, Johal A, L'Estrange PR, Croft CB, Kotecha B. Changes in airway and hyoid position in response to mandibular protrusion in subjects with obstructive sleep apnoea (OSA). Eur J Orthod 1999 Aug;21(4):363-376.
  26. Pae EK, Quas C, Quas J, Garrett N. Can facial type be used to predict changes in hyoid bone position with age? A perspective based on longitudinal data. Am J Orthod Dentofac Orthop 2008 Dec;134(6):792-797.
  27. Malhotra A, Huang Y, Fogel R, Lazic S, Pillar G, Jakab M, Kikinis R, White DP. Aging influences on pharyngeal anatomy and physiology: the predisposition to pharyngeal collapse. Am J Med 2006 Jan;119(1):72:e9-e14.
  28. Tourné LP. Growth of the pharynx and its physiologic implications. Am J Orthod Dentofac Orthop 1991 Feb;99(2):129-139.
  29. Eggensperger N, Smolka K, Johner A, Rahal A, Thüer U, Iizuka T. Long-term changes of hyoid bone and pharyngeal airway size following advancement of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005 Apr;99(4):404-410.
  30. Enacar A, Aksoy AU, Sencift Y, Haydar B, Aras K. Changes in hypopharyngeal airway space and in tongue and hyoid bone positions following the surgical correction of mandibular prognathism. Int J Adult Orthodont Orthognath Surg 1994;9(4):285-290.
  31. Kawamata A, Fujishita M, Ariji Y, Ariji E. Three-dimensional computed tomographic evaluation of morphologic airway changes after mandibular setback osteotomy for prognathism. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000 Mar;89(3):278-287.
  32. Greco JM, Frohberg U, Van Sickels JE. Long-term airway space changes after mandibular setback using bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 1990 Apr;19(2):103-105.
  33. Siersbæk-Nielsen S, Solow B. Intra- and inter-examiner variability in head posture recorded by dental auxiliaries. Am J Orthod 1982 Jul;82(1):50-57.
  34. Daraze A, Delatte M, Liistro G, Majzoub Z. Cephalometrics of pharyngeal airway space in Lebanese adults. Int J Dent 2017 Jan;2017 Article ID 3959456.
  35. Steiner CC. Cephalometrics for you and me. Am J Orthod 1953 Oct;39(10):729-755.
  36. Sakakibara H, Tong M, Matsushita K, Hirata M, Konishi Y, Suetsugu S. Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea. Eur Respir J 1999 Feb;13(2):403-410.
  37. Malkoc S, Usumez S, Nur M, Donaghy CE. Reproducibility of airway dimensions and tongue and hyoid positions on lateral cephalograms. Am J Orthod Dentofac Orthop 2005 Oct;128(4):513-516.
  38. Battagel JM, Johal A, Kotecha B. A cephalometric comparison of subjects with snoring and obstructive sleep apnoea. Eur J Orthod 2000 Aug;22(4):353-365.
  39. Yucel A, Unlu M, Haktanir A, Acar M, Fidan F. Evaluation of the upper airway cross-sectional area changes in different degrees of severity of obstructive sleep apnea syndrome: cephalometric and dynamic CT study. Am J Neuroradiol 2005 Nov;26(10):2624-2629.
  40. Lee SH, Choi JH, Shin C, Lee HM, Kwon SY, Lee SH. How does open-mouth breathing influence upper airway anatomy? Laryngoscope 2007 Jun;117(6):1102-1106.
  41. Johal AM, Patel SI, Battagel JM. The relationship between craniofacial anatomy and obstructive sleep apnoea: a casecontrolled study. J Sleep Res 2007 Sep;16(3):319-326.
  42. Akpinar ME, Celikoyar MM, Altundag A, Kocak I. The comparison of cephalometric characteristics in nonobese obstructive sleep apnea subjects and primary snorers cephalometric measures in nonobese OSA and primary snorers. Eur Arch Oto-Rhino-Laryngol 2011 Jul;268(7):1053-1059.
  43. Thapa A, Jayan B, Nehra K, Agarwal SS, Patrikar S, Bhattacharya D. Pharyngeal airway analysis in obese and non-obese patients with obstructive sleep apnea syndrome. Med J Armed Forces India 2015 Dec;71:S369-S375.
  44. Lee J, Ramirez S, Will M. Gender and racial variations in cephalometric analysis. Otolaryngol Head Neck Surg 1997;117(4):326-329.
  45. Julià-Serdà G, Pérez-Peñate G, Saavedra-Santana P, Ponce- González M, Valencia-Gallardo JM, Rodríguez-Delgado R, Cabrera-Navarro P. Usefulness of cephalometry in sparing polysomnography of patients with suspected obstructive sleep apnea. Sleep Breath 2006 Dec;10(4):181-187.
  46. Chang ET, Shiao GM. Craniofacial abnormalities in Chinese patients with obstructive and positional sleep apnea. Sleep Med 2008 May;9(4):403-410.
  47. Kurt G, Sisman C, Akin E, Akcam T. Cephalometric comparison of pharyngeal airway in snoring and non-snoring patients. Eur J Dent 2011 Jan;5(1):84-88.
  48. Banhiran W, Wanichakorntrakul P, Metheetrairut C, Chiewvit P, Planuphap W. Lateral cephalometric analysis and the risks of moderate to severe obstructive sleep-disordered breathing in Thai patients. Sleep Breath 2013 Dec;17(4):1249-1255.
  49. Gungor AY, Turkkahraman H, Yilmaz HH, Yariktas M. Cephalometric comparison of obstructive sleep apnea patients and healthy controls. Eur J Dent 2013 Jan;7(1):48-54.
  50. Piccin CF, Pozzebon D, Scapini F, Corrêa EC. Craniocervical posture in patients with obstructive sleep apnea. Int Arch Otorhinolaryngol 2016 Jul;20(03):189-195.
  51. Seto BH, Gotsopoulos H, Sims MR, Cistulli PA. Maxillary morphology in obstructive sleep apnoea syndrome. Eur J Orthod 2001 Dec;23(6):703-714.
  52. Adisen MZ, Misirlioglu M, Yorubulut S, Nalcaci R. Correlation of upper airway radiographic measurements with risk status for obstructive sleep apnea syndrome in young dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2017 Jan;123(1):129-136.
  53. Smith AM, Battagel JM. Non-apneic snoring and the orthodontist: radiographic pharyngeal dimension changes with supine posture and mandibular protrusion. J Orthod 2004 Jun;31(2):124-131.
  54. Vidovic N, Mestrovic S, Djogas Z, Bukovic D, Brakus I, Boric Brakus R, Kovacic I. Craniofacial morphology of Croatian patients with obstructive sleep apnea. Coll Antropol 2013 Apr;37(1):271-279.
  55. Genta PR, Schorr F, Eckert DJ, Gebrim E, Kayamori F, Moriya HT, Malhotra A, Lorenzi-Filho G. Upper airway collapsibility is associated with obesity and hyoid position. Sleep 2014 Oct;37(10):1673-1678.
  56. Schorr F, Kayamori F, Hirata RP, Danzi-Soares NJ, Gebrim EM, Moriya HT, Malhotra A, Lorenzi-Filho G, Genta PR. Different craniofacial characteristics predict upper airway collapsibility in Japanese-Brazilian and white men. Chest J 2016 Mar;149(3):737-746.
  57. Miyao E, Miyao M, Ohta T, Okawa M, Inafuku S, Nakayama M, Goto S. Differential diagnosis of obstructive sleep apnea syndrome patients and snorers using cephalograms. Psychiatry Clin Neurosci 2000 Dec;54(6):659-664.
  58. Takai Y, Yamashiro Y, Satoh D, Isobe K, Sakamoto S, Homma S. Cephalometric assessment of craniofacial morphology in Japanese male patients with obstructive sleep apnea–hypopnea syndrome. Sleep Biol Rhythms 2012 Jul;10(3):162-168.
  59. Galväo CA. Hyoid bone's cephalometric positional study in normal occlusion and in malocclusion patients. Rev Odontol UNESP 1983 Dec;12(1/2):143-152.
  60. Shen GF, Samman N, Qiu WL, Tang YS, Xia J, Huang YL. Cephalometric studies on the upper airway space in normal Chinese. Int J Oral Maxillofac Surg 1994 Aug;23(4):243-247.
  61. Samman N, Mohammadi H, Xia J. Cephalometric norms for the upper airway in a healthy Hong Kong Chinese population. Hong Kong Med J 2003 Feb;9(1):25-30.
  62. Shastri D, Tandon P, Nagar A, Singh A. Cephalometric norms for the upper airway in a healthy North Indian population. Contemp Clin Dent 2015 Apr;6(2):183-188.
  63. Abu Allhaija ES, Al-Khateeb SN. Uvulo-glosso-pharyngeal dimensions in different anteroposterior skeletal patterns. Angle Orthod 2005 Nov;75(6):1012-1018.
  64. Saðlam AM, Uydas NE. Relationship between head posture and hyoid position in adult females and males. J Cranio- Maxillofac Surg 2006 Mar;34(2):85-92.
  65. Marþan G. Head posture and hyoid bone position in adult Turkish Class III females and males. World J Orthod 2008 Dec;9(4):391-398.
  66. Haralabakis NB, Toutountzakis NM, Yiagtzis SC. The hyoid bone position in adult individuals with open bite and normal occlusion. Eur J Orthod 1993 Aug;15(4):265-271.
  67. Taylor M, Hans MG, Strohl KP, Nelson S, Holly Broadbent B. Soft tissue growth of the oropharynx. Angle Orthod 1996 Oct;66(5):393-400.
  68. Muto T, Kanazawa M. Positional change of the hyoid bone at maximal mouth opening. Oral Surg Oral Med Oral Pathol 1994 May;77(5):451-455.
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