The Influence of Rest Position of the Hyoid Bone upon ... · tiie influence of rest position of the hyoid bone upon neuromusculature adaptation to forced posterior displacement of
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Loyola University ChicagoLoyola eCommons
Master's Theses Theses and Dissertations
1976
The Influence of Rest Position of the Hyoid Boneupon Neuromusculature Adaptation to ForcedPosterior Displacement of the TongueKent B. AugustsonLoyola University Chicago
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Recommended CitationAugustson, Kent B., "The Influence of Rest Position of the Hyoid Bone upon Neuromusculature Adaptation to Forced PosteriorDisplacement of the Tongue" (1976). Master's Theses. Paper 2874.http://ecommons.luc.edu/luc_theses/2874
hibited what were appraised as being adaptive anterior tongue force
levels coinciding with their adaptive hyoid repositioning. Three more
subjects (J.E., C.B., and D.T.) exhibited increased force values com-
mensurate with their lack of hyoid adaptation.
Conversely, three subjects (D.P., C.M., and D.G.) had adaptive
hyoid changes but adaptation was not shown myometrically. And, six sub-
jects (J.S., H.Z., C.E., A.H., A.C., and S.G.) did not exhibit adaptive
hyoid repositioning, yet myometrically anterior tongue force levels in-
dicated adaptation.
Finally, three subjects (K.A., C.H., and B.M.) showed anterior
tongue force levels that made adaptation judgment in terms of myometrics
difficult.
SUBJECT
Group 1
J.S. K.A. J.E. H. Z. C.B. C,E. C,H.
Group 3
D.G. M.S. M.P. S.G. M.E. O.M. D.T. B.M. S.N.
TABLE II
SUBJECTS EXHIBITING EXTREMES IN MANDIBULAR PLANE-TO-HYOID DISTANCE
Hyoid to GoGn in nun.
32 29 28 26 25 25 24
17 17 17 17 16 15 15 14 14
Hyoid to Mid-Mand Corpus in nnn.
19 4 10 10 34 2 11
10 14 19 25. 13 8 23 12 11
Vert. Change in nun.
+5 -11 +4 -4 +2 +1 +3
-7 -5 -8 +1 -11 -5 -1 +2 -6
Horiz. Change in nun.
+2 -2 +2 +10 +3 -1
0
+1 -2 -3 -1 +1 +4 +1 -6 -4
34
35 Figure 7a
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BM
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r DISCUSSION
As mentioned, the relative vertical position of the hyoid bone, re-
lated to the mandibular plane, varied considerably from the lateral
cephalometric x-ray to the control cinefluorographic sequence. The
lateral cephalometric x-ray provides a static reading on hyoid position.
This poses a problem. The hyoid is a "floating bone", completely sup-
ported by muscle and ligamentous attachments. Cinefluorographic data
however, is dynamic. It allows the viewer to visualize physiologic
functional patterns. As a result, hyoid rest position can, in the au-
thor's opinion, be more accurately determined from cinefluorographic
sequences. Ingervall (1970) pointed out significant variations in hyoid
position between intercuspal and postural positions of the mandible. He
further found lateral cephalometric x-rays taken with the mandible in
postural position allowed reproducable hyoid positioning. The cephalo-
grams taken in this study for original screening purposes were shot in
the traditional intercuspal position. This could explain the variance
between the cephalometric and cinefluorographic hyoid rest position
noted. For the clinician to utilize lateral cephalometric x-rays to
monitor hyoid rest position, they should be taken with the mandible in
postural position.
For purposes of this study, repositioning of the hyoid bone in an
inferior-posterior direction was deemed adaptation. Two of the three
main sets of extrinsic tongue muscles, the hyoglossi and the genioglossi,
46
I ,li
r have attachments on the hyoid bone. Any repositioning of the hyoid bone
in an inferior-posterior direction accommodates posterior displacement
of the tongue.
47
The lack of adaptive repositioning of the hyoid bone in group 1 was
judged to be a result of the initial hyoid position. These subjects pre
sented with hyoid positions relatively distant from the mandibular plane.
Hyoid repositioning in an inferior-posterior direction could have en
croached on air-way space. Cuozzo (1975) mentioned this possibility in
explaining similar results. Brodie (1961) noted specifically the an
terior suprahyoids (mylohyoids and geniohyoids) as holding the larynx
forward to insure patency of the air-\vay.
One subject in group 1 (K.A.) did show adaptive hyoid repositioning
despite the initial mandibular plane-to-hyoid distance of 29 mm. The
initial horizontal position of the hyoid bone provided a possible ex
planation. The hyoid was positioned near the middle of the corpus. Only
one other subject in this group (C.E.) exhibited similar anterior hyoid
rest position. This forward carriage of the hyoid bone could account for
K.A.'s ability to show hyoid accommodation without embarrassing the air
way. C.E. exhibited myometric adaptation. Possibly the adaptive poten
tial of her intrinsic tongue musculature made hyoid repositioning un
necessary.
Group 2 subjects had mandibular plane-to-hyoid distances ranging
from 19-24 mm. K.H., with a distance of 24 mm., was placed in this group
even though C.H. was placed in group 1. It was determined that while a
r mandibular plane-to-hyoid distance of 24 mm. is relatively long, it was
judged to be in the average or medium range for someone of K.H. 's stat
ure. It should be noted that K.H. showed adaptive hyoid repositioning,
which supports this judgement.
48
The remaining subjects in group 2 showed varied hyoid response. As
alluded to above, to accurately predict hyoid adaptive potential overall
anatomic considerations, i.e. body size and structure, must be evaluated.
These factors become increasingly important when dealing with the middle
range of mandibular plane-to-hyoid distances. In such cases secondary
factors (if in fact they are only secondary) such as size of subject,
hyoid position in the horizontal dimension, and intrinsic tongue muscula
ture adaptation become increasingly important determinants in adaption
patterns.
Group 3, with hyoids positioned relatively near the mandibular
plane, generally showed adaptive hyoid repositioning in the inferior
posterior direction. It can be theorized that this hyoid stature allows
adaptation because the air-way space is not encroached upon by such ac
commodation. It should be noted that the two exceptions in this group
(S.G. and D.T.) exhibited hyoid rest positions quite posterior relative
to the mandibular corpus. It is hypothesized that despite the relatively
high carriage of the hyoid, adaptation in an inferior-posterior direction
was limited due to the relative posterior position of the bone. From
this posterior position it is theorized that adaptive positional changes
might embarrass the air-way. The hyoid behavior of K.A. in group 1 and
r S.G. and D.T. mentioned here suggests the horizontal hyoid position may
be a significant determinant of hyoid adaptive potential.
49
In interpreting the statistical results, it should be stressed that
groups 1 and 3 were comprised of the sample extremes in terms of mandib
ular plane-to-hyoid distance. The groups were compared to determine if
the vertical hyoid position had any statistical effect on the hyoid bone's
adaptive potential in the inferior-posterior direction. The T test run
on the changes in vertical dimension revealed that the two groups indeed
differed in their ability to move the hyoid inferiorly. This offers
statistical support for the theory first proposed by Cuozzo (1975). It
appears hyoid adaptive potential is influenced by its spatial relation
ship to· the mandibular plane.
The horizontal adaptive changes were not significantly different
(.20>P>.lO), when the two groups were compared. When interpreting this
it must be kept in mind, however, that the subjects studied were grouped
on the basis of vertical hyoid position. Thus, only initial vertical
position's effect on horizontal repositioning was tested. This is not
to say that horizontal position is not a factor in hyoid adaptation.
It has been mentioned that myometric results were varied when re
lated to adaptive changes in hyoid positioning. It must, however, be
remembered that hyoid repositioning is only one way in which the tongue
might adapt to forced posterior displacement. The intrinsic tongue mus
culature plays a role. It was not monitered in this study. Nevertheless,
it is reasonable to assume that the intrinsic tongue musculature's own
adaptive potential accounts for some of the apparent discrepancy between
myometric and cinefluorographic results.
Also, there are inherrent difficulties in any myometric recording.
50
These must be realized. First, there is always the possibility of alter
ing physiologic activity with the instrumentation used. Proffit (1975)
refers to this as "physiologic reactance". Secondly, it has been well
documented that there is a great deal of variability in the "normal"
swallowing pattern. The accuracy of myometric recordings as performed
in this study depended on the tongue tip placement against the recording
plate. There is the possibility that because of normal variation in
tongue position some subjects' anterior tongue force was only partially
captured at one or both recording sessions.
SUMMARY AND CONCLUSIONS
The purpose of this study was to determine whether the position of
the human hyoid bone, in its spatial relationship to the mandibular
plane, limits of influences the ability of the tongue musculature to
adapt to forced posterior displacement.
Twenty-two adult female subjects were included in the study. My
ometric recordings and cinefluorographic sequences of deglutition were
taken. Tongue crib appliances were placed in each subject. After 24
hours wear, and prior to removal of the appliances, the myometric re
cordings and cinefluorographic sequences were repeated.
Conclusions:
(1) The mandibular plane-to-hyoid distance does seem to
influence the ability of the tongue neuromusculature
to adapt to forced posterior displacement.
(2) Hyoid bones positioned relatively distant from the
mandibular plane seemed unable to reposition in an
inferior··posterior direction in response to forced
posterior tongue displacement.
(3) Hyoid bones positioned relatively near the mandibular
plane seemed to possess the potential for inferior
posterior adaptive repositioning in response to forced
posterior tongue displacement.
(4) The horizontal position of the hyoid bone seemed also
to influence its physiologic adaptive capacity.
51
(5) Lateral cephalometric x-rays taken in the traditional
intercuspal position were found to be unreliable
monitors of hyoid rest position.
(6) From the lack of correlation between myometric and
cinefluorographic data, it was hypothesized that the
intrinsic tongue musculature plays a significant role
in adaptive behavior of the tongue.
52
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57
APPROVAL SHEET
The thesis submitted by Kent B. Augustson has been read and approved by the following committee:
Dr. Douglas C. Bowman, Director Associate Professor, Physiology and Pharmacology, Loyola
Dr. Bernard M. Pawlowski Clinical Associate Professor, Orthodontics, Loyola
Dr. Joseph M. Gowgiel Associate Professor and Chairman of Anatomy Loyola
The final copies have been examined by the director of the thesis and the signature which appears below verifies the fact that any necessary changes have been incorporated and that the thesis is now given final approval by the Committee with reference to content and form.
The thesis is therefore accepted in partial fulfillment of the requirements for the degree of Master of Science.