1. Bone Haemangioma Of
The Hyoid Bone
Dr. Ghulam Saqulain
Head of Department of ENT
Capital Hospital, Islamabad
A Case Report:

2. Abstract & Key Words
 Abstract
Occurrence of bone Haemangioma in association with long bones,
short tubular bones and ribs is extremely rare. In this article, we report
a case of hyoid bone Haemangioma. The present case is the first
reported case of bone Haemangioma arising from the hyoid bone
without bleeding tendency. A literature search did not reveal any
precedence in world literature for such a Haemangioma arising from the
hyoid bone.
 Key Words:
Hyoid bone
Haemangioma
Primary bone neoplasm

3. Introduction
 Haemangioma are benign vascular lesions with 4 histological
variants:
 cavernous,
 capillary,
 Arterio-venous and
 venous.
 Bone Haemangioma constitute less than 1% of all primary bone
neoplasms.
 They are predominantly of the cavernous and capillary varieties.
 They occur most frequently in the vertebral column & Skull,
followed by facio-maxillary skeleton. Involvement of long bones,
short tubular bones and ribs is extremely rare. There is no
reported case of bone hemangioma arising from the hyoid bone.
 Accurate diagnosis and surgical excision is the key to
management.
 Prognosis is good with recurrence rare.

4. Case Report
 A Thirty year old male presented,
to the ENT Department at Capital
Hospital, Islamabad, with a
swelling in right submandibular
region of five months duration with
no other symptom.
 Examination showed a 8 cm x 5
cm, ovoid, non pulsatile mass in
submandibular region extending to
the retromandibular area.
 The swelling lacked signs of
inflammation. It was firm in
consistency with well defined
rounded margins and moving with
the movement of the hyoid bone.
 Cranial nerve examination did not
reveal any involvement.
 No other positive finding Ear Nose
and throat examination.

5.  Routine investigations were all
normal save for a opaque
shadow in sub-mandibular area
observed on plain films.
 Fine needle aspiration for
cytology failed due to non
yielding nature of the swelling.
 Incision biopsy also failed due
to the fact that we did not take
a deep biopsy due to the hard
nature of the swelling.
 CP
 WBC 7.2 10^3/uL
 NE% 52.2
 Ly% 34.4
 MO% 8.7
 EO% 4.7
 Hb 15.7 g/dl
 PLT 348 10^3/uL
 ESR 05mm/1st
hr.
 Blood Group A +ve.
 HCV Ab Negative
 HBsAgNegative
 LFT’s
 ALAT 37 U/l
 Alk. Phos 106 U/l
 Total Bilirubin 0.8 mg/dl
 RFT’S
 Urea 31 mg/dl
 Creatinine 0.7 mg/dl
 RBG 84 mg/dl

6. CT Scan
14.6.2004, Iran
 There is an ill-defined and heterogenous
enhancing mass in rt. Parapharyngeal space
extending caudally to the anterior aspect of
the neck with erosion and expansion of the
hyoid bone.
 Possibility of salivary gland masses is
suggested. Possibility of hyoid bone
originating primary or secondary masses
could be in the DDX. Biopsy on the guide to
sonography would be helpful.

7. MRI
12.12.2005 NIHd
 MRI neck shows a well
defined, iso-intense,
moderately enhancing mass
lesion occupying the right
sub mandibular and retro
mandibular region,pressing
on adjacent structures, It
measured 3.2 x 2.2 cms.
The mass isslightly indenting
the nasopharynx on the right
side. The mass showed
heterogeneous signal on
T2W1 sequence. The mass
was slightly indenting the
nasopharynx on right side.

8. CT Scan

10.  Having taken advice from an pathologist, an excision
biopsy was planned.
 Keeping in view the immobile nature of the mass,
after due preparation including arrangment for blood
transfusion patient was operated on under
General Anaesthesia with endotracheal intubation.

11.  The mass was
approached through a
wide submandibular
incision 2-3 cm below
the mandibular margin.
 On exposure a hard
ovoid mass with well
defined rounded
margins was
encountered arising
from the hyoid bone
and involving the
greater cornu.

13.  The muscular
attachments were
removed from the
swelling, as if it were
a giant greater cornu
of the hyoid.

14.  The mass had to be
pulled out from the
deep sub-mandibular
and retro-mandibular
area.
 There was no extension
into soft tissue of neck.
 The mass was removed
in toto including part of
hyoid bone.
 There was fortunately
no significant bleeding.

16. Gross Examination
 Gross examination of the
specimen revealed a bony
mass measuring 4.5 x3 x 1.5
cms.
 After decalcification the
mass was cut into two.

17.  Its cut surface was bony
in appearance and
showed dark brown and
grayish white areas..
Part bearing muscle attachment
Part separate from healthy hyoid bone.

19. Histology
Bone Haemangioma
 Histology revealed proliferation of thin walled
blood vessels lined by a single layer of
endothelial cells interspersed by trabeculae of
mature bone. The lamina of blood vessels
were filled with RBCs. The marrow showed
fibrosis. There was no evidence of
malignancy. The features are compatible with
Hemangioma, Hyoid Bone.

20. Post Operative Treatment
 Antibiotic
 Analgesics
 Stitches Removed after a week