HYOID SYNDROME - A CASE REPORT

Abdul Majid, Assistant ProfessorNazir Ahmad, RegistrarNaim Manhas, PG StudentDepartment of Otorhinolaryngology,Govt. Medical College, SrinagarTahmina Ruhi, ResidentJ.V. Medical College, Srinagar.

A symptom complex consisting of referred pain along the branches of external carotidartery and unilateral pricking sensation in the pharynx without any organic lesion isknown as hyoid syndrome. A rare case of hyoid syndrome due to chondroma of hyoidbone is presented.

Introduction for a group of symptoms namely cervical and facialpains with or without styloid elongation. There is

Cervical and facial pains of long duration and relief after excision of the greater cornu of the hyoid.'obscure nature are baffling. Cases of elongatedstyloid processes are well known but Harma (1967)has reported that 50% of them are symptomless,

Fig. 2 Op'rarivp 9pecimcii (2 to 2 - )

Showing p - . ton of the o : old bone (arrowed)

Fig. 1 : Pre-operative photograpt ) ' .,,t s .:J Profifir.

while Steinmann (1968) reported a case of styloidsyndrome in the absence of an elongated styloidprocess.

Kopstein (1975) coined the term "Hyoid Syndrome"

Case Repc1

A 40 year old male reported to the ENTDepartment oo' S.M.H., Hospital Srinagar with ahistory of swelliri, Left side of neck since last 4years and pain radiating to ipsilateral ear. He hadpricking sensation in throat and occasional left

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shoulder pain. He did not get any relief with theanalgesics and local injections of steroids. Therewas no associated symptoms or sign related to

Fig. 3 : Histopathological (micro) photo-graph (3 to 3-) Chondroma H & E x 400

any upper aero-digestive lesion. General physicalexamination revealed nothing significant. Onexamination routine Ear, Nose, examination wasnormal and so was the indirect laryngoscopicexamination.

Fig. 4 : Post-operative photograph (4 to 4 )Front and Profile Showing the linear healthy scar

Neck Examination : Revealed a single swelling inrelation to the greater cornu of hyoid bone of leftside. The swelling measured about 6 cms x 4 cmsin size and was nontender, firm, lobulated andmoved with deglutation.

X-ray soft tissue neck and spine showed a roundsoft tissue shadow in relation to the greater cornuof hyoid bone. Barium swallow X-ray ofoesophagus was normal.

Fine needle aspiration cytological examination wascarried out. It was however reported as cysticdegeneration in pleomorphic adenoma. Patientwas prepared for surgical extraction.

Operative Procedure

Under general anaesthesia, crease incision wasmade over the swelling. Dissection revealed that afirm and solid tumour was arising from the greatercornu of hyoid bone, lying embeded in the tumourmass. Excision of the tumor was done alongwiththe greater cornu of hyoid bone and part of thebody of the hyoid. The specimen was sent forhistopathology. Patient was discharged on 8th postoperative day.

Histopathology Report

Microscopic examination shows cartilage tumor ofbenign morphology (Chondroma).

Discussion

Excision of the styloid process has been thetime honoured surgical treatment for styloidsyndrome.

Excision of the hyoid have been most gratifying'in hyoid syndrome.

The exact pathology of the hyoid syndrome is notclear. According to Chandler (1977) anatomicalvariations and variable degree of calcification ofthe styloid process and its ligaments may beresponsible for these syndromes. Eagle (1962)believes that formation of a stilly bony clasp, whichhampers the elastic movement of stylohyoid andthyro-hyoid ligament during the contraction of thepharyngeal muscles, is responsible for thedysphagia and for the stabbling or dull pain in thethroat. Though the exact genesis of the symptomsis not known fully, it appears that the symptomcomplex of hyoid syndrome are due to irritation ofthe sympathetic plexus around the carotid artery orthe sinus branch of the glossopharyngeal nerve,by the greater cornu of hyoid. Leriche andFontaine (1959) believed that the pain was due tostimulation of the vasomotor fibres in the area ofthe pain, rather than to direct stimulation of thesympathetic trunk.

Investigations : Routine haemogram, urine test In our case there was no other apparentwere within normal limits, cause of the hyoid syndrome except the

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Hyoid Syndrome—A Case Report—Abdul Majid eta!.

chondroma of the hyoid bone because after 1. To report the rare benign cartilagenous tumorsurgery there was marked improvement in the of the hyoid (Chondroma), andpatients complaints. 2. To support the views of the other authors in

Conclusions recommending the excision of the greatercornu of hyoid in cases of proven hyoid

The purpose of this case report is : syndrome.

References

1. Bhide, A. R. and Dehadray, A. Y. (1980) : Excision of the greater cornu of the hyoid in hyoidsyndrome. A Uris, Nasus, Larynx (Tokyo) 7, 1-6.

2. Bhide, A. (1985) : Hyoid syndrome – A review. IJLO, Vol. 37, No : 4.3. Chandler, J. R. (1977) : Anatomical variations of the stylohyoid complex and their clinical

significance, Laryngoscope : 87.4. Eagle, W.W. (1962) : The symptoms, diagnosis and treatment of elongated styloid process. Anals

of Surgery, 28 : 15.5. Harma, R (1967) : Stylalgia clinical experience of 52 cases. Acta : Otolaryngologica, 224 : 149-

155.6. Kopstein E. (1975) : Hyoid syndrome. Archives of the Otolaryngology, 101 : 484-485.7. Leriche, R. and Fontaine R. (1959) : Pain, neurophysiology Vol. 1, American Physiological Society,

Washington P. 483.8. Steinmann, E.P. (1968) : Styloid syndrome in absence of an elongated process. Acta

Otol a ryngological 66 : 347-356.

ENT Department, L.T.M. Medical College & L.T.M.G. Hospital, Sion, Mumbaiannounces the following courses:

Name Date Fees

Vth Functional 21.12.96 Rs.800/-Endoscopic Sinus and Hostel ChargesSurgery 22.12.96 Rs.200/-

llnd Basic Audiology 24.2.97 Rs.400/-& Speech Therapy Hostel Charges

Rs.100/-

Thirteenth From 25.2.97 Rs.1250/-Microsurgery of Ear & 1.3.97 Hospitals chargesLarynx Course & Temporal Rs.400/-Bone Dissection

Additional details for individual courses may be obtained by correspondence withthe following address : Prof. Dr. R.V. Juvekar Plot No. 2, Sai Nagar Colony, St.Anthony's Road, Chembur, Mumbai-400 071

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