Korean J Orthod.  2012 Aug;42(4):190-200. 10.4041/kjod.2012.42.4.190.

Relationship between Class III malocclusion and hyoid bone displacement during swallowing: a cine-magnetic resonance imaging study

• Gokce SM
• Gokce HS
• Gorgulu S
• Karacay S
• Akca E
• Olmez H

• KMID: 1435413
• DOI: http://doi.org/10.4041/kjod.2012.42.4.190

Abstract

OBJECTIVE
The displacement of the hyoid bone (HB) is a critical biomechanical component of the swallowing function. The aim of this study was to evaluate the swallowing-induced vertical and horizontal displacements of the HB in subjects with 2 different magnitudes of skeletal Class III malocclusion, by means of real-time, balanced turbo-field-echo (B-TFE) cine-magnetic resonance imaging.
METHODS
The study population comprised 19 patients with mild skeletal Class III malocclusion, 16 with severe skeletal Class III malocclusion, and 20 with a skeletal Class I relationship. Before the commencement of the study, all subjects underwent cephalometric analysis to identify the nature of skeletal malformations. B-TFE images were obtained for the 4 consecutive stages of deglutition as each patient swallowed 10 mL of water, and the vertical and horizontal displacements of the HB were measured at each stage.
RESULTS
At all stages of swallowing, the vertical position of the HB in the severe Class III malocclusion group was significantly lower than those in the mild Class III and Class I malocclusion groups. Similarly, the horizontal displacement of the HB was found to be significantly associated with the severity of malocclusion, i.e., the degree of Class III malocclusion, while the amount of anterior displacement of the HB decreased with an increase in the severity of the Class III deformity.
CONCLUSIONS
Our findings indicate the existence of a relationship between the magnitude of Class III malocclusion and HB displacement during swallowing.

Keyword

Swallowing; Hyoid bone; Class III malocclusion; Magnetic resonance imaging; Deglutition

MeSH Terms

Deglutition
Displacement (Psychology)
Humans
Hyoid Bone
Magnetic Resonance Imaging
Malocclusion
Water
Water

Figure

• 

  Figure 1 Definition of cephalometric points traced on the MR images. H, hyoidale, the most anterosuperior point of the hyoid bone; S, sella, the point representing the midpoint of the pituitary fossa (sella turcica); RGN, retrognathion, the most prominent point of the posterior border of the mandibular symphysis; C3, the most inferoanterior point on the body of the third cervical vertebra; ANS, anterior nasal spine, the tip of the bony anterior nasal spine, in the median plane; PNS, posterior nasal spine, the tip of the bony posterior nasal spine, in the median plane; NL, nasal line, a horizontal line running through ANS and PNS.

• 

  Figure 2 Definition of the linear measurements of the hyoid bone traced on the magnetic resonance images. H-S (mm), the vertical distance between point H and point S; H-NL (mm), the vertical distance between point H and point NL; H-C3RGN (mm), the vertical distance between point H and the line connecting points C3 and RGN; H-C3 (mm), the horizontal distance between point H and C3; H-RGN (mm), the horizontal distance between point H and RGN.

• 

  Figure 3 Four contiguous dynamic cine-magnetic resonance images obtained during swallowing for patients with mild skeletal Class III malocclusion. A, Stage 1, contact of the tongue tip with the maxillary incisors and/or the palatal mucosa (oral preparatory stage). B, Stage 2, loss of contact of the dorsum of the tongue with the soft palate (oral stage). C, Stage 3, passage of the bolus head across the posterior/inferior margin of the ramus of the mandible (pharyngeal stage). D, Stage 4, passage of the bolus head through the opening of the esophagus (esophageal stage).

• 

  Figure 4 Four contiguous dynamic cine-magnetic resonance images obtained during swallowing for patients with severe skeletal Class III malocclusion. A, Oral preparatory stage. B, Oral stage. C, Pharyngeal stage. D, Esophageal stage.

• 

  Figure 5 Four contiguous dynamic cine-magnetic resonance images obtained during swallowing for patients with normal skeletal Class I occlusion (control group). A, Oral preparatory stage. B, Oral stage. C, Pharyngeal stage. D, Esophageal stage.

• 

  Figure 6 Intragroup comparison of the hyoid bone positions at different stages.

• 

  Figure 7 Intergroup comparison of the hyoid bone positions.

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