journal

1. Journal club
Medicine science & law
Journals.sagepub.com
Dr.Nafeeya
Department of Forensic Medicine
&Toxicology

2. Age Related Changes In The
Hyoid Bone: An Autopsy
Based Radiological Analysis
Devendra Jadav et al….
Department Of Forensic Medicine
& Toxicology ,AIIMS
Jodhpur.India

3. Overview
• Introduction
• Aim of the study
• Methods
• Results
• Limitations
• Discussion
• Medicolegal importance
• Conclusion

4. Introduction
• Age estimation ,Sex identification, Stature estimation –
human identification
• Age estimation is routinely conducted –in both dead &
living
• Deceased –generating a biological profile
• Living – Sports,jobs,pension,adoption,sex With Minor

5. Aim of the study
• To evaluate age-related changes in the
hyoid bone
• To ascertain whether these changes
may be utilised for age estimation in
forensic examinations
• To assess the utility of these changes
in the science of forensic age
estimation

6. Method of age estimation
• Juvenile-Visualisation & Calculation of rate of Skeletal
maturation
• Measurement of the rate of development of certain
ossification centers
• Dental maturation

7. • Adults
• Rate of obliteration of cranial sutures
• Assessing morphological changes to the pubic
symphysis
• Assessment of changes in the teeth .
• Understanding the time of ossification of the hyoid
bone

8. Hyoid bone
• Anatomical region that undergo age related changes
• Age advances – body & greater coruna fuse
• Age related changes we can note both in the living as
well as dead
• Radiological study
• Forensic anthropologists and medico-legal
professionals in estimating age of an individual

9. Methods
• Prospective Cross-Sectional
• July 2018 and February 2020
• The study involved dissecting the laryngeal apparatus
of 75 cadavers(65males &10 females)
• 17-65 yrs

10. Exclusion criteria
• Injury
• Deformity
• Defect of the neck region
• Unidentified cadavers
• Individuals < 16 yrs of age

11. Dissection of laryngeal apparatus
• As a part of routine neck dissection the laryngeal
cartilage & hyoid bone was removed
• Skin ,sc ,fat – flayed off
• Neck muscles ,thyroid gland – dissected
• Bilateral CCA incised & examined
• Larynx, trachea ,pharynx & oesophagus –mobilised &
pulled away from prevertebral fascia

12. Dissection of laryngeal apparatus
•Hyoid bone was
freed from muscular
attachments
•Radiological
examination

13. Radiological examination
• Digital radiography solution
• Hyoid bone was Radiographed with its superior surface
• After Radiographing the hyoid bone sample was placed
back inside the body

14. • Harjeet et al
• 200 adults (133 males and 67 females)
varying in age from 18 to 85 years
• Body and greater cornu was measured
from size to size with the help of
precision divider and vernier caliper

15. Grading of hyoid bone-4 stages
• Stage 1: Non-fusion (score zero)
• Stage 2: Commencement of fusion (score 1)
Fusion has just started at either side.
• Stage 3: Partial fusion (score 2) – The extent
of fusion is more than a quarter but not
showing complete fusion.
• Stage 4: Complete fusion (score 3)
• Stage 4a: Complete fusion with visible
radiopaque white scar at the site of fusion
• Stage 4b: Complete fusion without visible scar
at the site of fusion

17. Hyoid bone fusion
Complete Bilateral fusion
Complete unilateral fusion
Bilaterally unfused
Unilaterally unfused
1. Unilateral partial fusion
2. Bilateral commencement of
fusion
3. Unilateral commencement of
fusion
Number (male)-65
6
11
26
9
Remaining –Partially
fused
Results of statistical analysis – previous grading methods

18. Hyoid bone
Unilateral fusion
Bilateral non fusion
Unilateral non fusion
Unilateral commencement of
fusion
Number
(female)-10
2
7
Remaining

20. Wilcoxon signed rank test-Used to calculate
bilateral differences in hyoid bone
In a single paper, proposed both it and
the rank-sum test for two independent samples
•Non-parametric statistical hypothesis test used
either to test the location of a population based
on a sample of data, or
•To compare the locations of two populations
using two matched samples.

21. Fusion score were assigned to each of the fusion stage
For further analysis
Wilcoxon signed rank –the difference between left & right
side of hyoid bone ossification was calculated .
No significant bilateral development was observed
between the fusion scores of right & left sides of the
hyoid bone

22. Mann-whitney U test –used to calculate sex
differences in respect to fusion score of
hyoid bone –No significant sex differences
were observed regarding age related changes
in hyoid
Spearman correlation –used to calculate
fusion score of the hyoid bone &
chronological age of all 75 .No statistically
significant correlation was observed .

23. BOX & WHISKER PLOT OF FUSION –AGE WISE DISTRIBUTION OF
THE STUDY POPULATION –Age related changes in the hyoid
bone

24. Limitation of the Journal
1. Female score
2. Methodology not clear
3. Sample size

25. Discussion

26. Hyoid bone
Human hyoid

27. Anatomy
• Horizontal bone
• Superior to larynx
• At the level C3

29. • Fibrous joints
• Sometimes with synovium
• Get calcified at40 yrs
• Often confused with #
• Ossification Centres-2 centres for the body
• 4 Centres for each coruna
• Greater coruna-20-30 yrs
• Body-40-60 yrs

30. MLI
• Hyoid bone fusion for age estimation
• Limited studies only available for utility of hyoid bone
fusion in age estimation
• Only few studies in India
• USA,UK,JAPAN ,TURKEY

31. • Gupta et al. / Legal Medicine 10 (2008)
253–256
• 170 cases
• Department of Forensic Medicine,
University College of Medical Sciences,
located in Delhi.

32. • D’Souza et al-medicine science & law
• 130 cases 81 males 49 females
• Yenepoya Medical College – Forensic
Medicine and Toxicology, Mangalore

33. • Ito k et al
• 600 cases (310 males aged 20~87
years, mean 59.7 years; 290 females
aged 20~94 years, mean age 59.6
years)
• Department of Radiological Sciences,
Graduate School of Medical Health
Sciences, Komazawa University-Japan

34. Comparision of mean age in yrs of male & female hyoid bone fusion
across different studies

35. Hyoid bone fusion in strangulation &
hanging
• The degree of fusion of the hyoid bone is also
correlate with the possibility of fracture
• As the degree of fusion increases the chances of
possibility of hyoid bone fracture will be more
because of flexibility

36. • Pollanen & chaisson et al…
• Conducted study on 20 victims of homicidal
strangulation with or without hyoid fracture
• Concluded that chances of fracture of hyoid bones are
higher in older victims of strangulation ( > 40 years)
than in younger victims (<30 years).
• Indicating a correlation between the degree of
fusion and fracture of the hyoid bone.

37. • Dominic Gascho et al…
• Non-invasive detection of laryngeal fractures and
fusion can be performed
• Post-mortem computed tomography
• Conducted on an unevenly distributed study
population (65 males, 10 females)
• Role and potential value of CT for the assessment of
DANGER TO LIFE in cases of nonfatal strangulation.

38. Identification –skeletal remains
An Unusual Finding of the Hyoid Bone

39. Conclusion
• The increasing number of radiological examination in
autopsy may help the clinical doctors to provide support
in diagnosis of medicolegal cases involving pressure to
the neck region.
• Up to now, there is no measurement of hyoid bone
which uses a three-dimensional CT imaging.
• By using MDCT, we can measure and observe the
hyoid bone very easily with high accuracy.