hyoid bone problems

[shell k]

History of my problem: For as long as I can remember, I have had a problem with my hyoid bone popping out and causing excrutiating pain. It is always the same - the right side of my neck. At about the age of 8 I talked to my pediatrician about it and he promptly told me it was not possible. That I was having anything "pop out" in my neck. He contended that there wasn't anything there that could pop out. So I just continued to push it back into place whenever it popped out. Back then, it was very easy to push back and only lasted a few seconds until I got it back. About 3 years ago, I noticed that this was happening more and more frequently (used to be about 2-3 times per year) Now it was happening about every month and was much harder to push back. Sometimes taking 20 or more minutes. During that time, it was extremely painful to swallow or talk. After I would finally get it pushed back into place, the pain would go away, but my whole neck would be sore up to my ear and through my jaw. It felt bruised, but no visible bruising on the outside. Over the next couple of years, this problem continued to get worse, happening weekly with some minor "slippage" on a daily basis.  Throughout my life, I have talked to various family practice doctors about this problem. They all contended that it must just be a "lump in my throad" like when you get emotional. Or maybe it's just excess head conjestion. Or maybe it's just a muscle spasm. Or maybe I'm just imagining it. Whatever the case, no one had ever heard of anything like it and no one ever took me seriously. So, I started researching on my own. I could not find anything that sounded like what I had. I posted questions to "Ask and Expert" all over the web. I did get some respones. all of which started with "wow, that is interesting. Never heard of anything like that before." One physician directed me to find a good ENT. So, I did. He took me seriously. He ran tests - CT scans, swallowing x-rays, blood work, etc. I saw a speech pathologist and everything. The swallowing x-rays showed that my hyoid bone did not more in unison. It appeared that the hyoid, which I'm told forms in the womb from 3 point of origin and then fuses into a solid bone before birth, had never fused into the solid bone at all. The ENT that ran the tests did not feel qualified to handle this case, so he referred me to a colleague who does a lot of throat cancer surgery and work around the hyoid bone. He reviewed the tests and theorized that if we removed the portion of the hyoid that was not firmly attached to the rest of the bone, it should solve the problem. I ran this thought process past the head of Otolaryngology at the Mayo Clinic, who had also never heard of such a problem, and he concurred that this theory did make sense. However, there were no guarantees due to the fact that no one had ever seen or heard of anything like it before. So, I went ahead with the surgery on 10/26/06. It seemed to go well. For 3 months, I had no problems. Then on 1/23/07, it popped again, just like it had always done. I immediately went back to the surgeon who is completely at a loss of what to do. His only recommendation is to do more surgery and remove more of the hyoid bone. However, the more they take out the greater the risk of swallowing issues post-surgery. I'm not sure I'm ready to sign up for that again just yet. Since the 1/23 incident, it has happened 3 more times with the last time being only 2 weeks from the previous episode. I'm worried that this is going to continue to get worse again. If it were only going to happen a couple of times a year, I would just deal with it like I have my whole life. But if it gets back to being almost every day, I can't imagine having to continue to deal with that for the rest of my life. As long as the bone is in place, I have no problems. No swallowing problems, no pain, nothing. I just never know when it's going to pop. I do a lot of public speaking and presentations. My greatest fear is that it will happen in front of an audience. The pain is so sudden and intense that I immediatley burst into tears. This is the main reason I have been pursuing this issues to begin with. Any suggestions? I saw in your archives that a person with the nick name of "creyn" described a similar condition back on 11/22/2004 on this web site. Did anyone ever help her? Any feedback would be greatly appreciated. Thanks!

[wildblue98]

I personally don't think steroid injections would help, I think my tendons are simply streched and are not holding the hyoid bone at its right place therefore the bone needs to be excised. Of course I'm not a doctor and I could be talking out of my ***, but based on the fact that I've lived with this thing for the past 8 monts and based on all the research I've made that's what I think.

I totally agree on this one, my muscles and tendons feel stretched, I think that is what we all share in common is the strained muscles and tendons leading into the hyoid once the area becomes more lax and less taut following trauma the hyoid does not stay in its original place it starts shifting on other nearby structures and the local inflammation from these structures hitting and the actual muscle strain itself causes a constellation of symptoms known as the hyoid bone syndrome.

[wildblue98]

Also Daniel I was wondering if you could get an update on Luca I know he just had the Left SCE and left hyoid greater cornu excision a couple months ago. It would be good to hear his results.

[wildblue98]

MAJOR CORRECTION: There are two major nerves that run near the hyoid bone these are the hypoglossal nerves and removing the whole hyoid bone at once is NOT THE BEST approach according to the medical literature for hyoid syndrome (not one surgeon approached the issue this way in studies), rather the sides of the greater cornua are transected up to the body of the bone,leaving the center portion intact.

[wildblue98]

Daniel those are great images which exact test did you use? (with or without contrast) that is great visualization of the area. You may very well have hyoid syndrome if this is that doctor's assessment I would not be surprised as I have similar symptoms, as I remember though your clicks are coming from the center of the hyoid region arent they? I have read for hyoid syndrome steriod injections and other conservative treatments like NSAIDS usually only work if the problem is mild and has been prevalent for a short time. Based on my experience with steriod shots in other regions of my body I can tell you they are by no means a cure all rather a temporary fix, its like a massive does of local anti-inflammatories to the area it may very well be worth a try before an invasive surgery, but in my case after having this 2 years, and based on my past injuries I can tell an injection of some steriod really isnt going to cure the problem. The normal course of action for the hyoid syndrome based on the studies I read is that if it does not respond to conservative treatment like anti-inflammatories and NSAIDS within 1 or 2 months than excision of the greater cornu of the hyoid is a very rational procedure with effective results. There are two major nerves that run near the hyoid bone these are the hypoglossal nerves and removing the whole hyoid bone at once is definitely the best approach according to the medical literature for hyoid syndrome, rather the sides of the greater cornua are transected up to the body of the bone,  but Daniel if your clicking is coming from the center region of your throat and a doctor has agreed upon this, this could be your thyroid lamina clicking against the center portion of your hyoid, then cutting out the sides would do you no good, and a cartilage excision based on the literature would be a more rational option. Depends on what is causing that click and where it anatomically is you need to find this information out to put togethor a treatment plan.

[Daniel85]

Hi, guys!

Let me remind you my case: click in the throat due to trauma. From what I can feel the hyoid bone rubs against the cartilage during swallowing. The click migrates from the left to the right side, from the back to the thryroid lamina. There's a  swollen tendon/muscle on the right side.

I did a 3d CT scan and I uploaded some of my my images in my profile. If anyone is interested, you can check them out.

Dr. Berke's team asked me to send them the CD with the images since all images are like 400 MB (around 150-200 images). So the cd is currently traveling and after they receive it they'll say what they think.


I contacted another doctor from the UK, Dr. Simon Browning. He has described a similar condition. The article is called "A new and clinically symptomatic variant of thyroid cartilage anatomy" if anyone wants to check it out, type it in google since it won't let me post links here.

He evaluted my CT scan images and said everything looks normal. He thinks I have "HYOID SYNDROME". Article on the net: "The hyoid syndrome: a pain in the neck". It basically is an inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon. And the suggested treatmen is steroid injections. He said he typically has like 2 cases an year and he treats them with injections and everything goes back to normal. He said if unjections don't work, the second option is surgery in which 2/3 of the hyoid bone gets removed.

I know Adam who posted on this site had his whole bone removed without any problems, but Dr. Browning said that it's not advised because there are two important nerves right next to the hyoid bone and it's better for a certain part to be left.

What do you guys thuink about all that?

I personally don't think steroid injections would help, I think my tendons are simply streched and are not holding the hyoid bone at its right place therefore the bone needs to be excised. Of course I'm not a doctor and I could be talking out of my ***, but based on the fact that I've lived with this thing for the past 8 monts and based on all the research I've made that's what I think.

Any advise would be much apprecaited.

[miskatonic]

Good luck, man -- certainly keep us posted. Wishing you a click-free christmas and a pain-free new year.