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To cite this article: Mariano Rocabado R.P.T. (1983) Biomechanical Relationship of the
Cranial, Cervical, and Hyoid Regions, Journal of Craniomandibular Practice, 1:3, 61-66, DOI:
10.1080/07345410.1983.11677834
Download by: [University of Auckland Library] Date: 26 March 2017, At: 15:30
Biomechanical Relationship
of the Cranial, Cervical,
and Hyoid Regions
Abstract
The relationship between the cranial, cervical, and hyoid
regions can be modified by removable orthopedic appliances
installed by the dentist and by manual orthopedic techniques
applied to the cervical spine by the physical therapist.
However, each of these disciplines evaluates and treats
according to the patient's symptoms and various objective
criteria that are primarily limited to that field.
The author suggests that these two approaches to normalizing
those relationships must be coordinated. He presents an
objective method of evaluating x-rays to determine the impact
of both disciplines, and suggests that this can help determine
the normal biomechanical relationship of these structures.
He also discusses the importance of the following points as
they relate to this method:
1. The position of the hyoid bone in determining the
appropriate curvature of the cervical spine.
2. The distance between the occiput and the atlas and its
relevance to the headache syndrome.
3. The angular relationship of the cranium and the cervical
spme.
Biomechanical Relationship
of the Cranial, Cervical,
and Hyoid Regions
A Discussion By Mariano Rocabado, R.P.T.
he importance of the hyoid bone lies in its unique cervical spine, as well as how it fits into the cra-
T relationship to other structures. It provides
attachment for muscles, ligaments, and fascia of the
niomandibular system. However, precise measure-
ment of the hyoid position by cephalometric means
pharynx, mandible, cranium, and cervical spine. has been difficult. Different investigations suggest
When cervical, cranial, and mandibular biome- that slight variation in the posture of the cervical
chanics are studied, the hyoid bone tends to be over- spine, the state of function (su~h as during the pro-
looked or given very little attention. However, it is a cess of swallowing), the x-ray technique used, or the
unique structure that, unlike all other bones of the tension that the patient may feel when asked to main-
head and neck, has no bony articulations or joint tain the teeth in an occluded position may all affect
relationships anteriorly on the cervical spine. the position of the hyoid bone when an x-ray is being
However, it is well-attached to the cervical spine made. However, if these problems are considered
through the cervical fascia. There are two major while radiographic studies are being done, conclu-
groups of muscles that interact with the hyoid bone: sions can be made regarding the hyoid position as
the suprahyoids and the infrahyoids. These muscles related to the cranial, mandibular, or cervical spine
rely on the hyoid bone for their normal actions, and regions. It has been shown that the relationship be-
they have very important functions in determining tween the hyoid bone and the mandible is maintained
cervical spine curvature. For example, the anterior from the age of three years, which correlates with the
belly of the digastric muscle increases the anterior- spurt oflongitudinal growth in the cervical spine that
posterior dimension of the oral pharynx during swal- induces a vertical force to the mandible, through the
lowing. The posterior belly of the digastric muscle light elastic forces of the supra- and infrahyoid mus-
acts with the stylohyoid muscle to prevent regurgita- cles. The position of the hyoid bone tends to remain
tion of food after swallowing. And the suprahyoid constant between the inferior half of the body of the
muscle depresses the mandible by contracting C3 vertebra and the superior half of the C4 vertebra.
against the fixed hyoid platform. Thus absence or During puberty, the hyoid bone usually moves
abnormality of these structures may seriously impair slightly forward. In the adult, its position is related to
mandibular dynamics. the anterior inferior angle of C3, and the posterior
The functioning of the suprahyoid as it induces horns tend to remain constant at the level of the disc
tension to the mandible can be observed during nor- between C2 and C3.
mal orthostatic posture, when the head relies on
equal anterior and posterior muscle tension. The Analysis of the Craniovertebral Relationship, the
craniovertebral joints will maintain their normal Position of the Hyoid Bone, and the Curvatures of
position, and the temporomandibular joints will re- the Cervical Spine
main equally balanced towards the cranium through
tensile forces produced by normal function of the The hyoid bone position is a reflection of the ten-
supra- and infrahyoid muscles. sions of the muscles, ligaments, and fascia attached
Many studies have attempted to determine the to it (Figure 1). We have studied the relationship of
actual position of the hyoid bone in relation to the the hyoid bone to the cervical spine using a technique
developed by Dr. Bibby 1 from South Mrica and with the plane of C3-RGN.
adapted to these cephalometric examinations by the AA: The most anterior point of the body of the atlas
author. It uses the hyoid triangle, which allows the (Cl vertebra) seen in the lateral cephalometric
assessment of hyoid bone posture. This may be used radiograph.
as one of the components necessary to determine: PNS (Posterior Nasal Spine): The tip of the posterior
1. The craniovertebral relationship. nasal spine seen in the lateral cephalometric radio-
2. The relationship of the hyoid bone to the graph.
curvatures of tile cervical spine. MGP (McGregor's Plane): A line that connects the
3. Normal physiological positions and func- basi-occiput with the posterior nasal spine.
tions. OP (Odontoid Plane): A line that crosses from the
The study of these biomechanical relationships is anterior inferior angle of the odontoid to the apex
important to the dental field. For this reason, we of the odontoid.
have presented here a detailed procedure for com- OA: The distance from the basi-occiput to the pos-
pleting cephalometric studies of the craniovertebral terior arch of the atlas (Cl vertebra).
relationships, the relation to the hyoid triangle, and
the determination of normal or abnormal curvatures
of the cervical spine. General Considerations for Cephalometric Tracings
of the Head, Neck, and Hyoid Regions
Cephalometric Points and Defmitions
1. The hyoid tracing employs planes between the
cervical spine and the mandibular symphysis.
C3: The most inferior anterior angle of the body of 2. A triangle is formed by joining the cephalometric
the third cervical vertebra. points of the retrognathion (RGN), the hyoidale
RGN (Retrognathion): The most inferior posterior (H), and C3.
point of the mandibular symphysis. 3. The anterior posterior position of the hyoid bone
H (Hyoidale): The most superior anterior point of the is determined by measurements from the plane of
body of the hyoid bone. H-RGN and H-C3 in anterior and posterior direc-
Hyoid Plane: The plane from H along the long axis of tions.
the greater horns of the hyoid bone. 4. The vertical position of the hyoid bone is deter-
Hyoid Plane Angle: The most superior posterior mined by dropping a perpendicular from the plane
angle made by the intersection of the hyoid plane ofC3-RGN to a point labeled H-1 on the hyoidale
(H).
5. The angular position of the hyoid bone is consi-
dered.
6. The analysis of the hyoid triangle gives the posi-
tion of the hyoid bone fixed in space in three
directions without the use of cranial reference
planes. Slight variations of cranial position will
induce in those planes large discrepancies which
can cause errors in the measurement of the hyoid
position; this is avoided by using the triangle
method.
G? l;j~::·. . 7. Craniovertebral positions are evaluated by using
c::::J
e7 ;9:~:~·~:·······
.
~-·
the posterior angle produced by the intersection
of the MGP plane and the OP plane. This angle is
an average of 101 degrees and can vary 5 degrees
N.. \.
.... "' ,'~ ... into either extension or tlexion.
... ...---''--, 8. The normal OA averages between 4 and 9 mm .
--
.-I5-C-AP..:..U-LA'I I STERNUM I
When it is less than 4 mm, mechanical suboccipit-
Fig. I al compression may be induced; this is a source of
Tensile forces of the head, neck, mandible, and hyoid regions. posterior headaches.
Fig. 4 Fig. 5
Normal cervical lordosis with a normal cmniovertebrdl Normal cmniovertebml relationship. Stmight cervical spine.
relationship.
Fig. 6 Fig. 7
Normal cmniovertebral relationship. Inverted cervical curvature. Extension of craniovertebral joints. Reversed cervical curvature.