9211-830 Guyuron
Guyuron B.
Problem neck, hyoid bone, and submental myotomy.
Plast Reconstr Surg. 1992 Nov;90(5):830-7; discussion 838-40.
Division of Plastic Surgery, Mt. Sinai Medical Center, Cleveland, Ohio.
Despite significant attention to the cervical region over the last two decades,
the hyoid bone has not received deserved recognition. In this report, the
anatomy and role of the hyoid bone and suprahyoid muscles in cervicomental
morphology are reviewed. From an analysis of cephaloxerograms on 54 patients, it
was concluded that on a balanced neck, the most caudal border of the hyoid body
is located at or above a line parallel to the Frankfort horizontal line passing
through the most caudal border of the mandibular symphysis (menton). Of the
muscles that control the position of the hyoid bone, the anterior belly of the
diagastric, geniohyoid, and mylohyoid muscles pull the hyoid bone cephalad and
anteriorly. The stylohyoid muscles, on the other hand, pull this bone cephalad
and posteriorly, while the sternohyoid and omohyoid muscles pull it caudally.
Transection of the first three muscles at their attachment to the posterior
aspect of the mandible in patients with dysmorphic necks due to caudal and
anterior hyoid position will allow posterior and cephalad relocation of this
bone, which improves the neck contour. Sixteen patients, with an average
follow-up of 27 months, have undergone this procedure, with cervicomental
contour improvement in all cases. The degree of improvement ranged from 1 to 5
(5 being excellent): One patient was ranked 1, two patients were ranked 2, two
patients were ranked 3, and the rest were ranked 4 or 5. One patient had
overcorrection as a result of an aggressive concomitant submental lipectomy.
Another patient had central depression in the submental area. None of the
patients had difficulties with mandibular movement or swallowing.
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