Thyroglossal duct cysts: sonographic appearances in adults.
BACKGROUND AND PURPOSE: Previous reports have suggested that thyroglossal duct cysts (TDCs) appear on sonograms as well-defined cystic masses with thin walls and posterior enhancement. In our experience, however, TDCs have a variable sonographic appearance. We report our findings in 40 patients with TDCs and document the variability of sonographic patterns. METHODS: All patients in whom the diagnosis of TDC was made clinically (by at least two head and neck surgeons) and sonography detected a cystic mass related to the hyoid bone were included in this study. Sonograms of 40 patients with TDCs were reviewed. The features evaluated were the location, internal echogenicity, posterior enhancement, presence of septa, solid component, and fistulous tract. The echo pattern was not compared with the biopsy results. RESULTS: Four patterns of TDCs were identified: anechoic (28%), homogeneously hypoechoic with internal debris (18%), pseudosolid (28%), and heterogeneous (28%). The majority showed posterior enhancement (88%), were midline (63%), and infrahyoid in location (83%). Only half of all TDCs showed a typical thin wall. CONCLUSION: On sonograms, TDCs in adults are not simple cysts, as previously suggested, but have a complex pattern ranging from a typical anechoic to a pseudosolid appearance. (+info)
Adult craniocervical and pharyngeal changes--a longitudinal cephalometric study between 22 and 42 years of age. Part I: Morphological craniocervical and hyoid bone changes.
The purpose of this study was to investigate longitudinally, by cephalometric means, alterations in craniocervical morphology and hyoid bone position in adult males and females, in three different age groups at 10-year intervals, and to compare the changes between the two genders. The material consisted of three series of cephalograms of 26 males and 24 females with approximately a 10-year interval between each series. Alterations with increasing age in males and females included: 1 An increase in anterior and posterior facial height in both genders, a reduction in mandibular prognathism, and an increase in the mandibular plane angle in females only. 2 The hyoid bone assumed a more inferior position in relation to different skeletal structures for both sexes. 3 Head posture alterations were similar for the male and female group over time. The overall significant inter-sex changes over a 20-year period were a reduction in mandibular prognathism, an increase in the mandibular plane angle in females, and a more inferior position of the hyoid bone in males. (+info)
Changes in airway and hyoid position in response to mandibular protrusion in subjects with obstructive sleep apnoea (OSA).
This prospective clinical study examined the alterations in airway and hyoid position in response to mandibular advancement in subjects with mild and moderate obstructive sleep apnoea (OSA). Pairs of supine lateral skull radiographs were obtained for 13 female and 45 male, dentate Caucasians. In the first film, the teeth were in maximal intercuspation, while in the second the mandible was postured forwards into a position of maximum comfortable protrusion. Radiographs were traced and digitized, and the alterations in the pharyngeal airway and position of the hyoid were examined. Males and females were analysed separately. In males only, correlations were sought between the changes in hyoid and airway parameters, and the initial and differential radiographic measurements. In males, mean mandibular protrusion at the tip of the lower incisor was 5.3 mm, increasing its distance from the posterior pharyngeal wall by 6.9 mm (or 9 per cent). Movement of the hyoid showed extreme inter-subject variability, both in the amount and direction. In relation to the protruded lower jaw, the hyoid became closer to the gonion by 6.9 mm and to the mandibular plane by 4.3 mm. With respect to the upper face, a 1.3-mm upward and 1.1-mm forward repositioning was seen. The percentage alterations in airway dimensions matched or bettered the mandibular advancement. The minimum distances behind the soft palate and tongue improved by 1.0 and 0.8 mm, respectively. Despite their smaller faces, females frequently showed greater responses to mandibular protrusion than males. No cephalometric features could be identified which might indicate a favourable response of the airway to mandibular protrusion. Larger increments of hyoid movement were associated with an improved airway response, but the strength of the correlations was generally low. (+info)
A cephalometric comparison of subjects with snoring and obstructive sleep apnoea.
This prospective study analysed the upright lateral cephalometric radiographs of 115 dentate, Caucasian males. Forty-five subjects exhibited proven obstructive sleep apnoea (OSA), 46 were simple snorers, and the remaining 24 subjects, who had no history of respiratory disease and did not snore, acted as controls. Radiographs were traced and digitized, and comparisons were made of the dento-skeletal, soft tissue, and oropharyngeal features of the three groups. Differences were also sought between the snoring and OSA subjects. Of the hard tissue measurements, only the cranial base angle and mandibular body length showed significant inter-group differences (P < 0.001 and P < 0.05, respectively). When the airway and associated structures were examined, both snorers and OSA subjects exhibited narrower airways, reduced oropharyngeal areas, shorter and thicker soft palates, and larger tongues than their control counterparts. Comparison of the two sleep disordered breathing groups showed no differences in any of the skeletal or dental variables examined. However in OSA subjects, the soft palate was larger and thicker (P < 0.05), both lingual and oropharyngeal areas were increased (P < 0.01 and P < 0.05, respectively) and the hyoid was further from the mandibular plane (P < 0.05). Thus, whilst the dento-skeletal patterns of snorers resembled those of subjects with OSA, some differences in soft tissue and hyoid orientation were apparent. There was not, however, a recognizable gradation in size of the airway and its associated structures from control through snoring to OSA subjects. This suggests that there may be a cephalometrically recognizable predisposition towards the development of sleep disordered breathing, but that this is only one facet of the condition. (+info)
Surgical mandibular advancement and changes in uvuloglossopharyngeal morphology and head posture: a short- and long-term cephalometric study in males.
The aim of the present study was to investigate, by means of an extensive cephalometric examination, the alterations which took place in hyoid bone position, head posture, position and morphology of the soft palate, and tongue and sagittal dimensions of the pharyngeal airway after mandibular advancement osteotomy for the correction of mandibular retrognathism. The sample consisted only of adult males who underwent mandibular advancement by bilateral sagittal ramus split osteotomy (BSRO) with rigid fixation. Profile cephalograms were obtained 1-3 days before surgery (20 subjects), and 6 months (20 subjects) and 3 years (19 subjects) after the surgery. Statistical evaluation was performed by paired Student's t-test and Pearson product moment correlation analysis. At the short-term follow-up, hyoid bone and vallecula assumed a more superior (AH perpendicular FH, AH perpendicular ML, AH perpendicular S, V perpendicular FH) and anterior position (AH-C3 Hor, V-C3), which was maintained at the long-term follow-up. The soft palate (NL/PM-U) became more upright at the short-term follow-up. The tongue demonstrated a transient increase in height (H perpendicular VT) and a less upright position (VT/FH) at the long-term observation. In addition, a more upright cervical spine (OPT/HOR, CVT/HOR) was recorded at the long-term follow-up. The pharyngeal airway space at the level of the oropharynx (U-MPW) and the retroglossal space at the base of the tongue (PASmin) showed an increase in the sagittal dimension at the short-term follow-up. Significant widening at the PASmin level was sustained at the long-term follow-up, indicating that mandibular advancement osteotomy could increase airway patency and be a treatment approach for sleep apnoea in selected patients. (+info)
Surgical mandibular setback and changes in uvuloglossopharyngeal morphology and head posture: a short- and long-term cephalometric study in males.
A detailed cephalometric analysis was conducted on a sample of 31 adult males who underwent correction of mandibular prognathism by mandibular setback osteotomy (BSRO) with rigid fixation to evaluate the changes in uvuloglossopharyngeal morphology, hyoid bone position and head posture. Lateral cephalograms were obtained 1-3 days prior to the operation and at standardized 6 months and 3 years post-operative follow-up. Statistical evaluation was performed by paired Student's t-test and Pearson product moment correlation analysis. Inferior position of the hyoid bone (AH perpendicular FH, AH perpendicular ML, AH perpendicular S) and valeculla (V perpendicular FH) was recorded at the 6-month follow-up, a transient finding as at 3 years almost complete recovery to their pre-surgical position was noted. No posterior displacement of the above structures (AH-C3 Hor, V-C3) was recorded. Soft palate length (pm-U) was increased and maintained at the long-term follow-up while its posture (NL/pm-U) became less upright. The tongue showed increased length (V-T) and sagittal area (TA) and a more upright posture (VT/FH) at the late follow-up. Increased contact length between tongue and the soft palate (CL) and less residual oropharyngeal area [area not occupied by soft tissues, (TA + SPA)/OPA] was found at the long-term follow-up. Craniocervical agulation (NSL/OPT, NSL/CVT) was increased indicating cervical hyperflexion at the 3-year follow-up. Reduction of the sagittal dimension of the oropharyngeal airway space (U-MPW) appeared at the first follow-up and was sustained at the longest follow-up which, in conjunction with the decrease in residual oropharyngeal area, could raise questions regarding airway patency after mandibular setback osteotomy. (+info)
CT findings associated with Eagle syndrome.
Eagle syndrome is an aggregate of symptoms caused by an elongated ossified styloid process, the cause of which remains unclear. This is a rare finding that often goes undetected in the absence of radiographic studies. In this case, we present the diagnostic CT and lateral view plain film radiography findings of a 39-year-old woman with clinical evidence of Eagle syndrome. Eagle syndrome can occur unilaterally or bilaterally and most frequently results in symptoms of dysphagia, headache, pain on rotation of the neck, pain on extension of the tongue, change in voice, and a sensation of hypersalivation (1, 2). We present rare and diagnostic radiographic evidence of this on both plain film radiographs and CT scans. Although well documented in otolaryngology literature and dentistry literature, this syndrome has not been reported in the radiology literature. (+info)
Space-time pressure structure of pharyngo-esophageal segment during swallowing.
We applied high-resolution manometry with spatiotemporal data interpolation and simultaneous videofluoroscopy to normal pharyngeal swallows to correlate specific features in the space-time intraluminal pressure structure with physiological events and normal deglutitive transsphincteric bolus flow to define normal biomechanical properties of the pharyngo-esophageal (PE) segment. Pressures were recorded by microperfused catheter, and the two-dimensional space-time data sets were plotted as isocontours. On these were superimposed bolus trajectories, anatomic segment movements, and hyo-laryngeal trajectories from concurrent videofluoroscopy. Correlation of the highly reproducible space-time-pressure structure with radiographic images confirmed that primary deglutitive PE segment functions (pressure profile, laryngeal elevation, axial sphincter motion, timing of relaxation, contraction) are accurately discernible from single isocontour pressure visualization. Pressure during bolus flow was highly dependent on axial location within PE segment and time instant. The intrabolus pressure domain, corresponding to the space-time region between bolus head and tail trajectories, demonstrated significant bolus volume dependence. High-resolution manometry accurately, comprehensively, and highly reproducibly depicts the PE segment space-time-pressure structure and specific physiological events related to upper esophageal sphincter opening and transsphincteric flow during normal swallowing. Intrabolus pressure variations are highly dependent on position within the PE segment and time. (+info)