Since we have made the Hyoid Bone the celebrity of swallowing physiology, we should at least understand it! Here are a few facts:

• The hyoid bone is not a fan of other bones. It is the only bone in the human body that does not directly articulate/connect to another bone.

• It is also known as the ‘tongue bone’.

• It has more connections to a wider variety of external structures than any other bone, including the larynx, jaw, tongue, pharynx, skull, sternum, and scapula (shoulder blade).

• Given all of its connections to surrounding structures, it lives in a muscular throne.

• Think of it as a royal puppet. Its movement indicates which strings (muscles) are influencing its direction and position in the neck. Example: If it moves toward the jaw, then the suprahyoid/submental/floor of mouth muscles (mylohyoid, geniohyoid, anterior belly of the digastrics) are contracting. If it moves toward the sternum, then the infrahyoid muscles (sternohyoid, omohyoid) muscles are moving it.

• It moves during speech, swallowing, coughing, yawning, and almost all behaviors within the head and/or neck.

• During swallowing it follows an upward forward boomerang-like arc. The extent of this excursion is quite variable in normal swallowing (Molfenter, et al 2011). Hyoid forward movement ranges from 8 to 18mm and hyoid upward movement ranges from 6-25mm.

• Hyoid Bone Clinical Relevance: (1) It is a very important muscular attachment for many structures in the head and neck so it is involved in many functions of the head and neck. (2) Expert understanding of swallowing physiology involves extrapolating hyoid movement to induce the muscle groups that influence its direction. (3) Rudimentary and misguided understanding of hyoid movement involves noting whether its movement was normal or abnormal without understanding why, what is normal, whether it impacts the swallow, and using palpation alone to guess at adequate hyoid function (4) studies show that clinician may identify ‘abnormal’ hyoid movement when the hyoid is moving within normal ranges (Brates et al 2019).