Head and Neck Pain
by Edwin A. Ernest III, DMD, and E. George Salter, PhD
 A condition
characterized by both dental and non-dental referral sites, this degenerative injury of
the middle pharyngeal constrictor muscle is confirmed by photomicroscopic evidence of
insertion tendinosis.
[Editor’s note: first published in the Journal of Prosthetic Dentistry1
in 1991, this report of hyoid bone syndrome has been updated by the authors to reflect the
latest information on the condition.]
 The hyoid bone has been identified with a specific, although not
well recognized, pain syndrome for over 40 years.2 The painful symptoms are
generally caused by trauma at the greater cornu of the hyoid bone with the pain radiating
to other sites.3
Treatment for the condition ranges from injections of local anesthetic or cortisone to
resection of the greater cornu. The pain usually radiates from the greater cornu of the
hyoid bone to the throat, mandible, mandibular molar teeth, zygomatic arch, condyle, face,
ear, and temple superiorly; anteriorly to the neck, clavicle, upper half of the breast,
shoulder, arm, and over the shoulder to the scapula of the back inferiorly on the same
side.4
The condition is not well known in medicine and dentistry for at least two reasons: (1)
the diffuse and seemingly unrelated radiation of symptoms and (2) the apparent absence of
histopathologic evidence of injury.
Hyoid bone syndrome was first described by Brown2 in 1954, and later by
Steinmann,5 Kopstein,6 Lim,3 and Ernest.4 The
syndrome represents a group of confounding head and neck symptoms that may suggest
carotodynia7 to the unsuspecting clinician. The primary site of pain is
associated with the region of the greater cornu tip of the hyoid bone. Steinmann,5
Kopstein,6 Lim,7 and Ernest have reported surgical removal of the
greater cornu with remarkable resolution of pain for the affected patient. However, some
clinicians deny the existence or the validity of hyoid bone syndrome because reports offer
no objective evidence other than the signs, symptoms, and results of surgery.
This article presents photomicroscopic evidence to validate the hyoid bone syndrome,
and reports a focal, degenerative injury of the middle pharyngeal constrictor muscle
(MPCM) as the site of a painful injury associated with hyoid bone syndrome. The site of
injury involving the MPCM is consistent on a clinical, anatomic, and histopathologic basis
with a description of the somatic tissue responsible for the painful constellation of
symptoms of hyoid bone syndrome.
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— Nov/Dec 2006
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