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Has anyone heard of a dislocated hyoid bone?????
885099_tn?1243550605
by lulin4, Apr 26, 2009
Please, please give me some direction to head in with this!!!  My 17 yr. old son complained of pain in his neck a couple of months after he flipped over a car.  he had knee injuries as well.  the orthopedic took an xray of his neck and said he was ok.
About 10 months later my son complained that while at his bus stop something popped in his throat and he couldn't breath for a minute and was forced to place pressure on it to pop it back in.  I found it very odd and kind of brushed it off and said you're ok now so.  Then a couple of months later it happened again.  His pediatrician sent us to an Endoconologist.  He had no answer and told us to see an ENT.  We saw the ENT, he stuck a scope up through his nose and down to the throat and said he saw nothing.  He sent him for a cat scan, which came back negative, so he brushed it off.  We went to another ENT who also saw nothing and brushed it off as well.  
This past week my son had his 3rd popping incident and this time the condition became cronic.  Every time he turns his head this thing pops in his throat and it is very painful and scarry.  I rushed him in to the 2nd ENT.  This time the Dr, witnessed the popping for himself.  He believes the hyoid bone is dislocating and rubbing into the cartilige of the thyroid.  
We are waiting on an auth. for an MRI.  THE PROBLEM IS AND QUESTION:

THE ENT SAID HE NEVER SAW THIS BEFORE AND SAID HE DOES NOT KNOW WHAT TO DO ABOUT IT????
IN THE MEANTIME HE INSTRUCTED MY SON TO WEAR A NECKBRACE TO STOP HIM FROM TURNING HIS NECK!!!  
DOES ANYONE HAVE EXPERIENCE IN THIS AREA???
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Member Comments (69)
Avatar_dr_m_tn
by Dr VinodBlank, Apr 27, 2009
This is a very rare incident.
Hyoid bone as such does not dislocate and it may happen in accidents to jaw bone.The Hyoid bone is the only bone in the body that does not attach directly . When a bone is dislocated, its ligaments are often torn or overstretched and this may be the reason it is giving him that popping sound and pain.
The only way is not to make the bone stretch or dislocate so he was given a neck brace.
Here by doing this the clinician is preventing the hyoid bone to pop out.
Management of injuries to the larynx is based on the mechanisms and extent of the injury found during the initial assessment. The first priority is always to establish the airway. If the patient is breathing well and the injury does not require surgical care, the patient may be observed for some months or else surgery is the only option.
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by lulin4, Apr 27, 2009
Thank you for educating me a bit.  I can understand that keeping his ligaments from moving may heal this problem or help it to some degree.

Do you think he should have this MRI?  He already had a catscan which showed nothing.
The Dr. suggested an MRI with contrast.  He has had so many MRI's on his knees already plus catscans and xrays over the past year. So much radiation can't be good for a kid his age.  I don't see how the MRI will show much more than the catscan, do you?

And also this Dr. said he has never seen this before and does not know how to treat it.
Avatar_n_tn
by Wildmountainchild, Apr 29, 2009
MRI's show an incredible amount of detail...more than is possible w/ a CT. Also, MRI's function differently and are not actually considered to impart radiation like CT's do. It's certainly woth it for your son to get one. The Dr. will be able to see if ligaments are torn. If it's possible for your son to initiate the dislocation it would be very beneficial to have images in the MRI taken while his hyoid is dislocated, however he will likely need to remain in that position for at least 30 minutes. If he can breathe OK maybe pain meds can be administered to make getting those images possible.
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by wildblue98, May 01, 2009
What your son has may have something to do with the elongation of his superior cornu of the thyroid cartilage. This is one of the weakest structures in the neck so if he did sustain a neck injury this area could easily become bent or stretched and rub against his hyoid bone because it is elongated. That clicking noise may be the elongated cartilage coming into contact with his hyoid bone or cervical transverse process. 3D AXIAL CT SCAN is the best imaging study to check for this make sure you have an ENT who reads the below article and understands this condition. Also, visit the section on this site on hyoid bone problems, or read under my posts and their is a lot more information on thyroid cartilage abnormality. Your son may have something different though but I would check for this  since it is a possibility this could be causing the clicking.

The complaint of a clicking in the throat when swallowing or (turning the neck) is uncommon but very discomforting and painful for those who experience it. It is such an unusual complaint that symptoms may be dismissed as psychogenic because a cause for the problem may not be readily apparent. We present a series of 11 cases in which all patients had an audible clicking or popping noise in the throat associated with neck and throat pain when swallowing or turning the neck. The most helpful diagnostic procedure was careful examination and palpation of the neck while the patient swallowed to localize the side and source of the clicking. Laryngeal computed tomographic (CT) scans helped in some cases to demonstrate thyroid-cartilage and/or vertebral body asymmetry. Each case was treated with surgery of the neck and larynx to trim the portion of the thyroid cartilage causing the clicking. In most cases the superior cornu of the thyroid cartilage projected posteriorly and medially. Surgery was successful in all cases to eliminate the symptoms. Though an uncommon complaint, our experience suggests that the clicking throat is a surgically treatable problem.



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by lulin4, May 04, 2009
Thank you for your information.  I did send my son for the MRI, which showed nothing because the hyoid was not dislocating at the time, of course once we got into the car heading home it popped out 3 times.  The imaging center told us to come back when it dislocates and they will do more testing.  The problem is that before it would pop and he would push it back in, now it just constantly pops and he feels sore and as if there is a golf ball in his throat.

I live on Long Island and every ENT I have taken him to or spoken with cannot even help him with this condition.  They say it is very rare. One ENT gave us a perscription to have a Barium Swallow test done (do you think this will be helpful with a diagnosis?)

I have an appointment next week with an ENT in NYC who says he has experience with this and can help, but I have to pay out of pocket.  I can afford the initial $250 visit, but I do not know what to do afterwards???  Do you have any suggesgtions?
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by wildblue98, May 09, 2009


The complaint of a clicking in the throat when swallowing is uncommon but very discomfortingand painful for those who experience it. It is such an unusual complaint
that symptoms may be dismissed as psychogenic because a cause for the problem may
not be readily apparent. We present a series of 11 cases in which all patients had an
audible clicking or popping noise in the throat associated with neck and throat pain when swallowing or turning the neck. The most helpful diagnostic procedure was careful examination and palpation of the neck while the patient swallowed to localize the side and source of the clicking.
Laryngeal computed tomographic (CT) scans helped in some cases to demonstrate thyroid cartilage
and/or vertebral body asymmetry. Each case was treated with surgery of the neck and
larynx to trim the portion of the thyroid cartilage causing the clicking. In most cases the superior
cornu of the thyroid cartilage projected posteriorly and medially. Surgery was successful in all cases
to eliminate the symptoms. Though an uncommon complaint, our experience suggests that the
clicking throat is a surgically treatable problem.
Arch Otolaryngol Head Neck Surg. 2001;127:1129-1131

Sex/Age, y Type of Symptoms (Duration, mo)
Location
of Symptoms
Prior Neck
Trauma Procedure Outcome
1/F/37 Clicking when swallowing, throat pain (5) R neck No R SCE Complete resolution
2/F/27 Clicking when swallowing, neck pain (9) Mid neck Yes Trim superior edge of the thyroid lamina Complete resolution
3/M/18 Clicking when swallowing, neck pain (24) L neck Yes L SCE Complete resolution
4/F/39 Clicking when swallowing, neck pain (12) Bilateral neck,
R.L
No Bilateral SCE, posterior edge thyroid
ala excision (staged)
Complete resolution
5/M/25 Clicking when swallowing, neck pain (12) Bilateral neck No Bilateral SCE Complete resolution
6/M/29 Throat pain when playing trumpet (12) R neck No R SCE Complete resolution
7/M/36 Odynophagia (6) L neck Yes L SCE Complete resolution
8/F/54 Throat pain, aphonia, odynophonia (8) R neck Yes R SCE Complete resolution
9/F/27 Throat, neck, facial pain (9) R neck Yes R SCE Complete resolution
10/F/51 Throat pain, clicking when swallowing (4) R neck Yes R SCE Complete resolution
11/F/15 Throat pain, clicking when swallowing (24) L neck Yes L SCE, L hyoid trim (staged) Complete resolution

Results of imaging studies (CT
scans) were initially reported as “normal.”
After several such studies, a different
techniquewasperformedat the
University of Utah. If the clicking occurred
when turning the head, a spiral
CT scan was performed with the
patient in the neutral position. It was
then repeated with the patient’s head
turned and during a swallow. This
demonstratedtheunderlyingdynamic
cause of the sound (Figure2). Interpretation
of the CT images requires
knowledge of the abnormalities that
may cause the clicking sound. The 3
abnormalities that were identifiedon
CTscanninginourseriesincluded(1)
posteriorelongationofthethyroidcartilage
ala, (2) superior elongation of
the superior cornu of the thyroid cartilage,
and(3)anasymmetrically large
cervical vertebra transverse process


Clicking in the throat can be treated
surgically.Physicalexaminationisfundamentaltoidentifytheclickingsource
so that a treatment procedure can be
confidently recommended. Patients
canbereassuredthattheseuncommon
symptoms are not products of their
imagination or something seen only
inmovies;theyare realandcanbesuccessfully
treated. In our series, laryngeal
clicking when swallowing was a
bona fide symptom with an identifiable
cause. It often had associated
throat pain and dysphagia and was
frequently, but not necessarily, associated
with prior trauma to the neck
orintubation.Themostcommoncause
was an elongated or posteriorly orientedsuperiorcornuofthethyroidcartilage.
Based on our experience, we
conclude the following: (1) Physical
examination is needed, with careful
palpation of theneckduring swallowing
and reproduction ofsymptomsto
localize the source of the click. Attention
shouldbedirectedtowardthe superior
cornu of the thyroid cartilage
when symptoms are to the side of the
neck and toward overlapping structures
in the thyrohyoid space when
symptoms are in the anterior of the
neck. (2) Laryngoplasty isaneffective
treatment under local or general anesthesia
to trim the offending region
(s) of the thyroid cartilage and/or hyoid
bone responsible for the clicking.
Accepted for publicationMay17, 2001.
Supported by grant K08-
DC00132 from the National Institutes
of Health, National Institute on
Deafness and Other Communication
Disorders, Bethesda, Md.
Corresponding author: Marshall
E. Smith, MD, Division of Otolaryngology–
Head and Neck Surgery,
3C-120, University of Utah
School of Medicine, 50 N Medical Dr,
Salt Lake City, UT 84132 (e-mail:
marshall.***@****).
REFERENCES
1. Counter RT. A clicking larynx. J Laryngol Otol.
1978;92:629-31.
2. Makura ZGG, Nigam A. The clunking neck.J Laryngol
Otol. 1995;109:1217-1218.
3. Hilali AS, Saleh HA, Hickey SA. Clicking hyoid.
J R Soc Med. 1997;90:689-690.
(REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/VOL 127, SEP 2001 WWW.ARCHOTO.COM
1131
©2001
885099_tn?1243550605
by lulin4, May 16, 2009
Update on my son.  We saw a highly recommended ENT he did a scope video of Kurt's hyoid bone and it is definitely dislocated from the ligaments on the left side.  He seemed stumped on how to proceed with this injury.
He took his video and my copies of the CT and MRI (which were both negative according to the radiologist) and is bringing them to meet with his board at Cornell University this upcoming Thursday.
We are sitting impatiently awaiting his direction on what they can do to fix this.  It is extremely rare.
Avatar_dr_m_tn
by Dr VinodBlank, May 17, 2009
Good and great going and they will have to work out in giving a support to his hyoid bone so that it does not dislocate.
Every human being is special and different and the knowledge of anatomy will work here and a neat research procedure is what should be planned now.
Take care and support Kurt!
Avatar_n_tn
by jl16, Jun 04, 2009
Hello,

I am a 25 year-old male and have been suffering for about a year with what seems to be an identical problem. I will swallow, but it often feels as though the cartilage in my neck is dislodged and it becomes very uncomfortable and painful to the point that I get headaches if I leave it for any amount of time...so I am constantly "repositioning" the cartilage. The problem, though, is that as time has gone on I have become used to just "repositioning" it to the point that it just seems to be "floating" in my neck...repositioning it gives me comfort for one swallow, then it is dislocated again. And now whenever I walk and step with my left foot I hear and feel the clicking in my neck, almost like something is "broken" and shifting around. I have seen an ENT, and my doctor, and my chiropractor has also examined it...I've had a CT scan, an MRI, blood work, and an ultrasound, and all have come back unfounded. The chiropractor said it might be broken "strap" muscles; the ENT figured it was inflamed, and the MD isn't much help at all. This condition is extremely annoying and uncomfortable (not to mention scary), and I'm glad I found this thread so I know I'm not the only one and maybe there is a fix out there!! Thanks for any additional advice, and lulin4 good luck to your son.

Jason