Hyoid Bone Fracture?

I was wondering how many people here has a fracture on the Hyoid bone and what the implications of it may be? Is an ENT the best kind of doctor to consult with on that or perhaps other kind of doctors?

Fractured hyoid bone is quite rare I think- I've only read about it happening when someone's strangled! I would think there'd be problems with the airway if it was fractured? I know that people on here have had hyoid bone issues, but it's usually from elongated bones. either the lesser of greater cornu of the hyoid, the processes sticking out either side of it. If they're long, they could be close to the neck vertebrae processes, so could compress blood vessels.

I'm presuming that an ENT would be the one to talk to about that- have you had something shown up on a scan?

Yeah I read up about it online and it seems to be rare outside of blunt trauma to the neck or things like strangulation indeed. I was kinda scared after reading it... not sure if mine is pretty much healed or if it hasn't caused much issues now that it likely wouldn't in the future. But knowing that it's been fractured that area may be more vulnerable to injury should I ever get into another auto accident or other type of trauma (and my auto accident wasn't really a direct front impact to the neck either; rather, my head hit and broke the right side window).

It was my upper cervical chiropractor who alerted me to the fracture. He consulted with a radiologist for this. I've attached the 3D image. He said it's a non-union fracture. However, looking at the image now, I wonder if that really is a fracture, or just the way the body part of the bone join the horn would look like?

somehow having trouble uploading the image file.

Testing upload again... sorry for the redundant posts.

64-Screenshot2015122918.55.37.jpg (2.74 MB)

It's different to the other side, so it does look like it could've been fractured (not that I'm an expert at all!), and your chiropractor and the radiologist would know... there's a lot of calcification in the area on the ligaments too. I'm surprised if it happened when you had the accident they didn't see anything on a scan at the time?

I think heidemt's suggestion of sending your scan to Dr Samjii is a good idea- that scan pic is pretty convincing! Hopefully he might have an idea about the hyoid bone too.

Trouble is I didn't think to request this kind of scan and no doctor suggested it, in the weeks/months immediately following the accident. I had a cervical xray and a cervical MRI done back then, but they both came back with non-remarkable findings. It's only after a first TMJ splint appliance stopped giving me relief from pain (possibly aggravated it) and I realize things are still wrong that I sought help from another TMJ Specialist, who then took the CBCT scan to look at my jaw joints, and then finally I got those scans to the upper cervical chiropractor to take a look at my neck area.

I will call Dr. Samji's office to see if he can take a look at these. I don't think my local ENT would be very knowledgeable in this... I am still orienting myself with this new finding too... when you said there's a lot of calcification in the area, could you expand on how one could tell (how should it look rather?)

I thought maybe they did the CT's more routinely in the US than in the UK following an accident. I just had an x-ray after mine, then had problems ever since, over 20 years ago. I had some 'experimental' treatment of traction and manipulation when it didn't improve after a few months- boy was that painful, just made everything worse!

On your scan you can see going up from the hyoid bone the stylohyoid ligaments each side going up towards the jaw- if they weren't calcified you wouldn't be able to see them. I hope that Dr Samji can help you, let us know how you get on with his office.

Oh I didn't read your previous message carefully, I thought you said calcification on the hyoid bone. I wonder how long it takes for the ligament to become calcified like that... over periods of weeks, months, or years?

Yeah in the US, at least from my experience, I think if you don't complain and demand... they will just go through standard protocols. At the ER after the auto accident they only took a xray of my lungs. I guess because I wasn't complaining strong enough about the head and neck pain for them to be concerned, as they were looking for serious life threatening issues. I was in quite a bit of shock and terror then that I actually didn't feel much of anything (I knew my body felt really stiff, but probably I was too tensed from the adrenaline to feel the pain). Of course after leaving the ER I started to really feel everything. Do they do the CTs on the head or/and neck routinely in the UK following an accident?

I was thinking if I keep asking for more images done on other areas I may find yet more fractures/issues. I kept hearing and feeling something shifting (popping/clicking/grating sound) in the middle-to-lower-back area of my head... and behind my nose. Similar to the TMJ joint popping/clicking sound, but originating from a different place that I can't quite pinpoint.

Also curious...if you don't mind me asking, what happened with your auto accident 20 years ago? Were you able to link your symptoms to the accident and get auto insurance claim to help with treatments?

Jules said:

I thought maybe they did the CT's more routinely in the US than in the UK following an accident. I just had an x-ray after mine, then had problems ever since, over 20 years ago. I had some 'experimental' treatment of traction and manipulation when it didn't improve after a few months- boy was that painful, just made everything worse!

On your scan you can see going up from the hyoid bone the stylohyoid ligaments each side going up towards the jaw- if they weren't calcified you wouldn't be able to see them. I hope that Dr Samji can help you, let us know how you get on with his office.

No, they don't do CTs routinely here either, just x-rays. I don't know for sure if the accident was the cause of ES with me, as it was such a long time ago, but my neck has always given me problems since, plus the earaches and low-level jaw pain- I'd always put it down to wisdom teeth and was too scared to do anything. Trauma is considered to be a cause of ES though, and a lot of people on here have mentioned whiplash. I was thrown forwards, and side to side, in a 65mph crash. Treatment in the UK is free, paid for in taxes, so I haven't had to worry about cost for treatment, thankfully. I did get some compensation, which at the time seemed generous, but nowadays I think I'm really paying for it! I didn't like to make too much fuss at the time about the pain I was in as a colleague was driving when we were at work, so I didn't want to get him into trouble. Silly really, as I struggled with the heavy lifting at work, I think that made it worse, and I had to give up the job eventually, which was when I got the compensation.

I don't know how long the calcification takes- you would've thought it would take quite a while, but we have had a few members with ES post-tonsillectomies, I think symptoms have started a year after their op.

Interesting. I see a lot of parallels. I do have pre-existing chronic pain conditions though, which indeed could give me neck pain some times; however, now I have this additional, new level and quality of neck pain ever since the auto accident. Initially after the accident I felt a lot of neck pain, some vague headache, and ear-infection-like pain (and eventually the jaw pain, eye pain, etc. became evident and later on almost constant). The driver was a friend of mine, so just like you, I didn't want to make too much fuss or go get a lawyer because I didn't want to get him into more trouble than he was already facing. I guess I was naively optimistic (or didn't want to believe I would have to deal with more chronic issues). I just tried to endure and hope the symptoms would resolve on its own with time and acupuncture and massages. I get what you mean about how in retrospect, that "some amount of compensation" pale in comparison to what you are paying now and in the future, with physical and emotional pain, and difficulty performing jobs, consequential financial loss, etc.

You were so brave too, to go through those "'experimental' treatment of traction and manipulation." I was so afraid to have anyone work on my neck area, especially regular chiropractors that adjust/snap the cervical spine. Fortunately my instinct served me well. The upper cervical chiro (he doesn't do manipulations like regular chiro) said my conditions may have been made much worse had I went for any typical adjustments on the neck.

Thank you for sharing so kindly with me. I find much solace in talking to everyone in this group, knowing that I'm not alone and people here believe and understand the pain and frustration.

Btw, I was never told how long my ossified stylohyoid ligaments measure. I am assuming that since they look pretty much ossified all the way down to the the attachment of the hyoid bone, that they must be over the 3 or 4 cm mark diagnosis criteria (indicated by some literatures online)?

The ligaments don't often get measured- quite often they'll say in the report partially calcified etc., it's usually the styloid processes which get measured. Did they comment at all about the processes with you? ES can be caused by elongated or angular SP's, or by calcified stylohyoid ligaments.

I don't think I was brave with the neck treatment at all- more misguided, you trust doctors, don't you?! Sadly that many years ago there wasn't the info available like we have with the internet now to look into things ourselves. Your chiropractor sounds great, I definitely wouldn't allow anyone to do too much to me now! I'm thinking about seeing a physio again though, as I have a disc problem C5-C6, plus trigeminal neuralgia on the side I had the styloidectomy on, which hasn't resolved, and I think the neck issues aggravate the TN... if you're interested there's some research about neck problems and the effect on nerves, here's a link from the Ben's Friends TN site: http://www.livingwithtn.org/page/cervogenic-model

I haven't read it myself yet, as it looks quite daunting, but will get round to it soon!!

Ah I see again I wasn't paying enough attention to detail was was confusing things... thanks for the clarification.

Was the trigeminal neuralgia a result from your styloidectomy? Would you rather not have done the styloidecomy in retrospect? or it did give you a lot of symptoms relief?

And thanks for that link! I have bookmarked it for now for later reading.

I have non idea if the imaging I have show the condition/shape of the processess well or could give an idea how elongated (or not) it is. Not too sure if I have an image that shows that area well.

The TMJ doc who helped me took the CBCT didn't comment on the styloid processes (just the ossified stylohyoid ligaments), but on his report he mentioned mild pain was elicited upon palpation of my left styloid process, and moderate pain on the right styloid process.

Another TMJ doctor who I sent my scans for professional opinion on the likelihood of my auto accident causing the disc placement said "one interesting finding is the elongated styloid processes. This is not the result of the accident but can result from long-term stress and/or bite problems. This can cause pain on the side of the neck, especially under the ears, difficulty swallowing, and can also mimic a TMJ problem." He also thinks I may have SCM syndrome (since it was indicated on the report from the previous TMJ doctor that severe pain was elicited upon palpation of the sternocleidomastoid bilaterally. And that SCM syndrome could also mimic a TMJ.

I am very eager to hear what Dr. Samji would say.

I had the TN before surgery- it was one of the early symptoms I had, toothache in one particular tooth where there was nothing wrong! It gradually worsened though, so no, the styloidectomy didn't cause it, and hasn't made it any worse. Because the styloids are/ were compressing the jugular veins both sides, I was having a lot of dizziness, pressure in my ears and head, plus other symptoms, which have hugely improved post-surgery, so that's been fantastic for me. As for the TN, maybe that's caused by something else, I don't know, but it seems it's here to stay!!

A lot of other members have been diagnosed with TMJD too, whether that's a genuine diagnosis or whether it's caused by the ES too, don't know, but Maxence posted and interesting link he found recently- that a French dentist had put forward a theory that ES can be caused by disturbance with bites/ bruxism, which tallies with what your specialist said too.

I hope that you get some help from Dr Samji, keep us posted! Hopefully he'll either see your scans or order new ones to check the styloid process length and the calcified ligaments which will clarify that for you.