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A case of abnormal findings in the course of the vertebral artery associated with an ossified hyoid apparatus . a contraindication for manipulation of the cervical spine?

Author
Organization
Abstract
Objective: To describe a case of a simultaneous occurrence of an ossified stylohyoid ligament in a 56-year-old male cadaver and anomalies of the vertebral artery, and to consider the clinical implications for manipulative therapists. Intervention and Outcome: Dissection showed a simultaneous occurrence of complete developmental ossification of the left hyoid apparatus, variants of the vertebral artery, and a left superior vena cava in a 56-year-old male cadaver. Discussion: Developmental variants, posttraumatic and degenerative changes of the hyoid apparatus may result in variable degrees of ossification or calcification. Conclusion: This unusual disorder should be considered in the differential diagnosis of facial and neck pain especially within the scope of manipulation of the upper cervical spine. Cervical spine manipulation may exacerbate existing pathological conditions of the stylohyoid apparatus, thereby irritating neurovascular structures, and induce a fracture. Developmental ossification of this apparatus might be associated with anomalies in the atlantic section of the vertebral artery which make the patient more susceptible to vertebrobasilar insufficiency. We conclude that extreme care should be taken in the presence of such an ossification to avoid trauma to the stylohyoid apparatus and maybe even because of increased vertebrobasilar risk.
Keywords
hyoid bone, neck muscles, vertebral artery, vena cava, superior, cervical vertebrae, manipulation, spinal, STYLOHYOID CHAIN OSSIFICATION, EAGLES-SYNDROME, STYLOID PROCESS, CAROTID-ARTERY, LIGAMENT, MORPHOLOGY, ETIOLOGY, FRACTURE

Citation

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MLA
Cagnie, Barbara, Erik Barbaix, Elke Vinck, et al. “A Case of Abnormal Findings in the Course of the Vertebral Artery Associated with an Ossified Hyoid Apparatus . a Contraindication for Manipulation of the Cervical Spine?” JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS 28.5 (2005): 346–351. Print.
APA
Cagnie, Barbara, Barbaix, E., Vinck, E., D’Herde, K., & Cambier, D. (2005). A case of abnormal findings in the course of the vertebral artery associated with an ossified hyoid apparatus . a contraindication for manipulation of the cervical spine? JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS, 28(5), 346–351.
Chicago author-date
Cagnie, Barbara, Erik Barbaix, Elke Vinck, Katharina D’Herde, and Dirk Cambier. 2005. “A Case of Abnormal Findings in the Course of the Vertebral Artery Associated with an Ossified Hyoid Apparatus . a Contraindication for Manipulation of the Cervical Spine?” Journal of Manipulative and Physiological Therapeutics 28 (5): 346–351.
Chicago author-date (all authors)
Cagnie, Barbara, Erik Barbaix, Elke Vinck, Katharina D’Herde, and Dirk Cambier. 2005. “A Case of Abnormal Findings in the Course of the Vertebral Artery Associated with an Ossified Hyoid Apparatus . a Contraindication for Manipulation of the Cervical Spine?” Journal of Manipulative and Physiological Therapeutics 28 (5): 346–351.
Vancouver
1.
Cagnie B, Barbaix E, Vinck E, D’Herde K, Cambier D. A case of abnormal findings in the course of the vertebral artery associated with an ossified hyoid apparatus . a contraindication for manipulation of the cervical spine? JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS. 2005;28(5):346–51.
IEEE
[1]
B. Cagnie, E. Barbaix, E. Vinck, K. D’Herde, and D. Cambier, “A case of abnormal findings in the course of the vertebral artery associated with an ossified hyoid apparatus . a contraindication for manipulation of the cervical spine?,” JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS, vol. 28, no. 5, pp. 346–351, 2005.
@article{350299,
  abstract     = {Objective: To describe a case of a simultaneous occurrence of an ossified stylohyoid ligament in a 56-year-old male cadaver and anomalies of the vertebral artery, and to consider the clinical implications for manipulative therapists. 
Intervention and Outcome: Dissection showed a simultaneous occurrence of complete developmental ossification of the left hyoid apparatus, variants of the vertebral artery, and a left superior vena cava in a 56-year-old male cadaver. 
Discussion: Developmental variants, posttraumatic and degenerative changes of the hyoid apparatus may result in variable degrees of ossification or calcification. 
Conclusion: This unusual disorder should be considered in the differential diagnosis of facial and neck pain especially within the scope of manipulation of the upper cervical spine. Cervical spine manipulation may exacerbate existing pathological conditions of the stylohyoid apparatus, thereby irritating neurovascular structures, and induce a fracture. Developmental ossification of this apparatus might be associated with anomalies in the atlantic section of the vertebral artery which make the patient more susceptible to vertebrobasilar insufficiency. We conclude that extreme care should be taken in the presence of such an ossification to avoid trauma to the stylohyoid apparatus and maybe even because of increased vertebrobasilar risk.},
  author       = {Cagnie, Barbara and Barbaix, Erik and Vinck, Elke and D'Herde, Katharina and Cambier, Dirk},
  issn         = {0161-4754},
  journal      = {JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS},
  keywords     = {hyoid bone,neck muscles,vertebral artery,vena cava,superior,cervical vertebrae,manipulation,spinal,STYLOHYOID CHAIN OSSIFICATION,EAGLES-SYNDROME,STYLOID PROCESS,CAROTID-ARTERY,LIGAMENT,MORPHOLOGY,ETIOLOGY,FRACTURE},
  language     = {eng},
  number       = {5},
  pages        = {346--351},
  title        = {A case of abnormal findings in the course of the vertebral artery associated with an ossified hyoid apparatus . a contraindication for manipulation of the cervical spine?},
  url          = {http://dx.doi.org/10.1016/j.jmpt.2005.04.007},
  volume       = {28},
  year         = {2005},
}

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