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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Variations in the spatial relationship between the hyoid bone and the carotid arteries and their clinical significance
Nektaria Karangeli, George Triantafyllou, Panagiotis Papadopoulos-Manolarakis, Nikolaos-Achilleas Arkoudis, Georgios Velonakis, Alexandros Samolis, Maria Piagkou
Nektaria Karangeli, George Triantafyllou, Panagiotis Papadopoulos-Manolarakis, Alexandros Samolis, Maria Piagkou, Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens 11527, Attikí, Greece
George Triantafyllou, Maria Piagkou, “VARIANTIS” Research Laboratory, Department of Clinical Anatomy, Mazovian Academy in Płock, Płock 09-402, Poland
Panagiotis Papadopoulos-Manolarakis, Department of Neurosurgery, General Hospital of Nikaia-Piraeus, Athens 18454, Attikí, Greece
Nikolaos-Achilleas Arkoudis, Georgios Velonakis, Research Unit of Radiology and Medical Imaging, National and Kapodistrian University of Athens, Athens 11528, Greece
Nikolaos-Achilleas Arkoudis, Georgios Velonakis, Second Department of Radiology, General University Hospital “Attikon”, National and Kapodistrian University of Athens, Athens 12462, Chaidari, Greece
Co-corresponding authors: George Triantafyllou and Nikolaos-Achilleas Arkoudis.
Author contributions: Karangeli N was responsible for project development, data collection and management; Triantafyllou G contributed to conceptualization; Karangeli N, Triantafyllou G, Papadopoulos-Manolarakis P, Arkoudis NA, Velonakis G, Samolis A, and Piagkou M contributed to data analysis and manuscript writing; Maria Piagkou oversaw the project (supervision); Triantafyllou G and Arkoudis NA they contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of General Hospital of Nikaia-Piraeus, approval No. 56485.
Informed consent statement: Informed consent was obtained from the patients enrolled in the current study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All the data are available upon reasonable request to the authors.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Nikolaos-Achilleas Arkoudis, MD, PhD, Research Unit of Radiology and Medical Imaging, National and Kapodistrian University of Athens, 19 Papadia
mantopoulou, Athens 11528, Greece.
nick.arkoudis@gmail.com
Received: August 18, 2025
Revised: September 3, 2025
Accepted: November 7, 2025
Published online: November 28, 2025
Processing time: 102 Days and 10.5 Hours
BACKGROUND
The topography between the common carotid artery (CA), internal CA, and external CA (ECA) with the greater horn of the hyoid bone (GHHB) is of particular importance for anatomists, radiologists and neck surgeons.
AIM
To investigate these topographical relationships emphasizing anatomical classification, sexual dimorphism, and clinical significance.
METHODS
A retrospective study was performed on 224 computed tomography angiographies from a cohort comprising 161 male and 63 female patients, with a mean age of 63.2 years. Multiplanar and three-dimensional reconstructions were executed utilizing Horos software. The spatial relationships between the CA and hyoid bone were categorized based on the 12-type classification system delineated by Manta et al in 2023. The data were subsequently stratified by sex and laterality.
RESULTS
Type 0 (no arterial contact with the GHHB) was the most common configuration (46.9%), followed by type VI (ECA lateral to GHHB, 23.9%) and type VIII (internal CA and ECA lateral to GHHB, 13.2%). Bilateral symmetry was present in 54.02% of cases, mainly in males. Statistically significant sex-based differences were found (P = 0.012), while laterality was not significant (P = 0.779).
CONCLUSION
Carotid–hyoid topography displays significant anatomical variation with clinically essential patterns. Non-null variants, such as types VI and VIII, may increase the risk of dynamic carotid compression, especially in younger patients with cryptogenic cerebrovascular symptoms. Recognizing these variants during preoperative imaging is crucial to minimize surgical risk and inform patient care.
Core Tip: The spatial relationship between the hyoid bone and carotid arteries is highly variable and may predispose patients to vascular compression, stroke, or surgical complications. This retrospective computed tomography angiography-based study of 224 patients highlights common topographical variants, their sex-related distribution, and clinical implications. Recognition of these carotid-hyoid configurations in preoperative imaging can aid in preventing iatrogenic injury, improving diagnosis in cryptogenic cerebrovascular events, and guiding safer surgical planning.
