Radiologic Findings and Outcomes of Hyoid Compression Syndrome

Objective/Hypothesis: The goal of this study was to elucidate the radiologic findings of Hyoid Compression Syndrome (HCS) and how this uncommon condition is distinguished from related pain syndromes such as Eagle’s Syndrome or glossopharyngeal neuralgia. Additionally, this study set out to describe treatable symptoms from within the spectrum of HCSassociated symptoms. Study Design: Prospective open design. Methods: HCS patients were collected from a single tertiary academic center within a 12-month period. Surgical planning was done with the collaboration of surgical and radiologic teams. Patients completed the validated Neck Disability Index (NDI) survey as well as a subjective questionnaire preoperatively and 6-months postoperatively. Results: Two HCS patients were treated with surgical resection. Preoperative CT imaging revealed impingement of the carotid artery by the greater cornu of the hyoid bone and provocative imaging in the symptomatic position demonstrated carotid artery compression on the affected side. Postoperative imaging showed resolution of impingement. Patients reported overall NDI improvement of 10% and 4%. While many of the NDI domains failed to show improvement, the headache domain maintained substantial and consistent improvement. Substantial headache improvement was reinforced based on patient subjective data. Both patients displayed postoperative improvement in blurred vision. Conclusion: HCS is an uncommon, but significant, cause of head and neck pain. The syndrome typically presents hidden within a constellation of related symptoms which can further complicate the diagnosis. However, prompt radiologic diagnosis should lead to surgical intervention which should demonstrate reduction in headaches and patient-specific symptomatic improvement. CASE 1 A 55-year old female complained of bilateral neck pain and paresthesias of the face, neck, and pharynx for several years, exacerbated with head turning in either direction. Additionally, she experienced severe, migraine-like headaches as well as milder temporal headaches. Physical examination revealed numbness of her tongue, pharynx and oral cavity areas upon compression of the hyoid. Review of her computed tomography (CT) imaging (see Figure 1) revealed compression of the left and right common carotid arteries, especially upon head turning, as well as elongation of the right thyroid ala. She underwent bilateral resection of the greater cornu of the hyoid bone, as well as resection of the right superior thyroid cornu. Seven months postoperatively the patient questionnaires revealed substantial improvement specifically within her headaches and blurred vision. Her NDI showed 10% reduction in symptoms. INTRODUCTION Head and neck pain syndromes are often difficult to diagnose and may present with vague, common medical complaints such as headaches, earaches, or temporomandibular joint disorders. A frequently overlooked cause of head and neck pain is hyoid compression syndrome (HCS). This syndrome was first described in 1954 and thought to be caused by the irritation of the carotid arteries or carotid bulb by the hyoid bone.1 Patients with HCS generally experience facial and upper neck pain, often radiating to the face or accompanied by temporal headaches, and often exacerbated with swallowing or ipsilateral head turning.1-3 Because there is no consensus for diagnostic symptoms, diagnosis is therefore often dependent on both radiography and clinical suspicion. Although successful treatment of HCS by resection of the greater cornu of the hyoid bone has been previously described2,4-5, the confusion surrounding patient presentation and symptomatology, as well as the relative paucity of hyoid compression literature, has frequently left hyoid compression patients without recourse. We therefore share our experience with HCS. HCS patients were collected from a single tertiary academic center within a 12-month period. We encountered two patients who underwent surgical resection of the hyoid bone to alleviate symptoms consistent with hyoid bone compression syndrome. As HCS symptoms are poorly defined, patients completed the validated Neck Disability Index (NDI) survey as well as a subjective questionnaire preoperatively and 6months postoperatively as a measure of symptomatology improvement . Due to the small sample size, a statistical analysis of the questionnaires was not appropriate. METHODS AND MATERIALS Hyoid compression syndrome is an important condition which can be difficult to diagnose and easily confused with other head and neck pain syndromes, but should be considered in patients with atypical neck or facial pain. It is important to have a high index of suspicion and clinical knowledge of this pain syndrome, as well as radiologic evidence to aid in diagnosis. Once an accurate diagnosis is made, surgical resection of the hyoid should help to alleviate symptoms which can be ascribed to HCS, such as headache and neck pain. CONCLUSIONS 1. Brown LA. Hyoid Bone Syndrome*. Southern Medical Journal. 1954;47(11):1088-1091. 2. Kopstein E. Hyoid Syndrome. Arch Otolaryngol. August 1, 1975 1975;101(8):484-485. 3. Robinson PJ, Davis JP, Fraser JG. The hyoid syndrome: a pain in the neck. The Journal of Laryngology & Otology. 1994;108(10):855-858. 4. Lim RY. The hyoid bone syndrome. Otolaryngology - Head and Neck Surgery. 1982;90(2):198-200. 5. Lim RY. Carotodynia Exposed: Hyoid Bone Syndrome. Southern Medical Journal. 1987;80(4):444-446. REFERENCES Daniel Lattin, MS David Geffen School Medicine at UCLA Email: dlattin@mednet.ucla.edu Phone: 703-485-6300 CONTACT Figure 3. Patient 2 postoperative (L) 3-Deimensional reconstruction and (R) axial CT in neutral position, cut edge of the left lateral aspect of the hyoid bone (see arrows). Figure 2. Patient 2 preoperative (L) 3-Deimensional reconstruction and (R) axial CT in neutral position, showing abutment of the left greater cornu of the hyoid bone to the (see arrows). Figure 1. Patient 1 preoperative axial CT in neutral position showing abutment of the right internal carotid cartery by the right greater cornu of the hyoid bone (yellow arrow), as well as flattening of the left common carotid artery by the left greater cornu of the hyoid bone (blue arrow).