Anterior Neck Pain Due to Hyoid Malformation

Abstract

A nterior neck pain often presents a challenging problem for the otolaryngologist because of the various causes. We report an unusual case of an asymmetric hyoid bone impinging on the carotid sheath with resulting pain on head rotation. Although rare, awareness of this condition is vital in successful treatment as surgical intervention provides immediate and long-term resolution of the symptoms. REPORT OF A CASEA 21-year-old man with a several-year history of intermittent, severe right anterior level II neck pain and swelling reported that his symptoms worsened when he turned his head to the right but slowly resolved over hours to days. The pain was always on the right side and often caused the patient to become nonfunctional for days at a time. The patient became dependent on narcotic medication to control this pain. Symptoms also included right torticollis and dysphagia. On physical examination, point tenderness was located in proximity to the superior portion of the right lateral hyoid bone.Computed tomography showed a significantly asymmetric hyoid bone. The right greater cornu of the hyoid extended laterally and was immediately adjacent to the carotid sheath at the bifurcation of the carotid artery. In the Figure, the right lateral portion of the hyoid bone is almost seen wrapping around the carotid sheath at this level with definite asymmetry compared with the left side. The left greater cornu of the hyoid was shorter and not closely associated with the carotid sheath. The patient was brought to the operating room for excision of the right greater cornu of his hyoid bone.The right lateral portion of the hyoid bone was excised without complication. After surgery, the patient had almost immediate relief of the pain. There was no need for further narcotic pain medication use. On follow-up examination, full neck range of motion was restored and his symptoms had completely resolved, with no return of pain. He is 7 years without incident.COMMENT

Carotidynia Versus Transient Perivascular Inflammation of the Carotid Artery (TIPIC) Syndrome: Finding Common Ground

“…Non-vascular causes are typically the direct result of inflammatory, infectious or neoplastic processes of the head and neck [ 4 , 11 ]. Amongst this later group are aphthous ulcers, dental disease, temporomandibular joint disease, migraine, superior laryngeal nerve neuralgia [ 12 ], elongated styloid process or ossification of the stylohyoid ligament (Eagle Syndrome) [ 13 ] and hyoid bone malformations [ 14 ].…”