The Hyoid Bone in Robin Sequence: Morphology and Position in the Context of Mandibular Distraction Osteogenesis
In brief
Mandibular distraction does not shift the hyoid forward in Robin sequence
CT scans of 38 patients with Robin sequence found no evidence that mandibular distraction moves the hyoid forward, challenging a proposed explanation for how the surgery improves airway patency. Abnormal hyoid ossification was more common in patients than controls, affecting 36.8% before surgery versus 13.3% of controls. Changes in tongue shape and muscle tension are possible alternatives, but remain hypotheses.
- Journal
- Plastic and reconstructive surgery (Q1)
- Published
- 19 October 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Annie T Wang, Shelby L Nathan, Hannes Prescher, Callum F Ross, Russell R Reid, Peishu Li
- PMID
- 42896307
- DOI
- 10.1097/PRS.0000000000013560
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 25 October 2026): Hyoid bone morphology in Robin sequence and distraction osteogenesis
Abstract
BACKGROUND: Robin Sequence (RS) is a congenital condition marked by micrognathia, glossoptosis, and airway obstruction. Patients with RS exhibit anatomical differences in the hyoid bone, a key mediator of swallowing and respiration. Severe RS is treated with mandibular distraction osteogenesis (MDO) to lengthen the mandible and increase oropharyngeal space, the latter thought to be caused by changes in hyoid position. Here, we test this hypothesis by quantitatively evaluating 3D hyoid position and morphology in patients with RS and comparing them to pediatric controls. METHODS: Computed tomography (CT) scans were obtained for 38 patients with RS pre- and post-MDO and 15 control patients. Hyoid position relative to craniomandibular landmarks and hyoid morphology were compared between pre- and post-MDO RS patients and controls. RESULTS: Pre-MDO patients have shorter relative hyoid-menton distances than post-MDOs and controls (p<0.01). Relative hyoid-basion and hyoid-vertebral column distances are comparable between groups. Controls have smaller relative hyoid-temporomandibular joint distances than RS patients (p<0.05). RS patients have a higher prevalence of abnormal hyoid ossification (control: 13.3%; pre-MDO: 36.8%) and demonstrate dimensional differences in hyoid width and angle related to both RS and MDO. CONCLUSIONS: MDO does not enlarge the oropharyngeal space by moving the hyoid anteriorly. Instead, we hypothesize MDO improves airway patency by 1) changing tongue shape and the geometry of the anterior pharyngeal wall, and 2) increasing suprahyoid muscle passive tension. Our results provide new insights into the mechanisms of mandibular distraction and highlight importance of the hyoid and its attachments in the pathologic presentation of RS.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.