attachment

Okajimas Folia
of muscles
Anat. onto
Jpn., the hyoid
85(3): 79–90,
bone November,
in human 2008
79

Observation on the attachment of muscles

onto the hyoid bone in human adults
By

Naohiro SONODA and Yuichi TAMATSU

Department of Neurology, Gross Anatomy Section, Kagoshima University Graduate School of Medical and Dental Sciences
8-35-1 Sakuragaoka, Kagoshima 890-8544

– Received for Publication, June 23, 2008 –

Key Words: gross anatomy, hyoid bone, suprahyoid muscles, infrahyoid muscles

Summary: The attachments of muscles onto the hyoid bone were observed macroscopically, and the lengths and widths of
each muscles onto the hyoid bone were measured. The tongue-pharyngeal block as a whole obtained from 50 cadavers were
used. Each muscle was colored by acrylic pigments for identification. The results showed that the mylohyoid muscles were
attached onto the lower anterior surface of the hyoid bone body. The geniohyoid muscles had many types of attachment
forms and significant individual differences. The hyoglossal muscles showed various attachments at the posterior end of
the greater cornu. The middle pharyngeal constrictor muscles attached with two bundles in some cases. The sternohyoid
muscles and omohyoid muscles were classified by their positional relationship with each other. The thyrohyoid muscles
were classified by the conditions of their overlaps with the omohyoid muscles and the sternohyoid muscles. From the afore-
mentioned results, the following muscles were found attached to the hyoid bone in a further developed state: mylohyoid
muscles, geniohyoid muscles, hyoglossal muscles, thyrohyoid muscles and hyoglossal muscles.

Introduction a number of reports on abnormal cases of muscle attach-

The actions of chewing and swallowing are performed
by a delicate coordination of various muscles around the
oral cavity. In particular, the hyoid bone is one of the
impor­tant elements for mandibular movements for masti-
cation.
Particularly in the head and neck regions, the hyoid
bone is a distinct bone that has no synovial articulation
with circumjacent bones but connected to its adjacent
structures with ligaments and muscles. About a ligamen-
tous connection, the hyoid bone is connecting to the sty-
loid process of temporal bone with stylohyoid ligament at
the top and connecting to the superior border of the thy-
roid cartilage with thyrohyoid membrane at the bottom.
About a muscular connection, the suprahyoid muscles,
the infrahyoid muscles and the middle pharyngeal con-
strictor muscles are situated at the top, bottom and poste-
rior regions. Because of vacuity of joints, the movements
of hyoid bone mainly depend on the attached muscles.
Though previous anatomical textbooks include morpho-
graphic descriptions of the hyoid muscles attached onto
the hyoid bone, there are slight differences in each text-
book about the attachment area. Regarding the morphol-
ogy of the attachment of suprahyoid/infrahyoid muscles
to the hyoid bone, various description is reported in cases
of Japanese previously studies1−7). Furthermore, there are
ment to the hyoid bone8). However, there are few previ-
ous reports describing the results of measurements for
each muscle attachment area to the hyoid bone. From the
abovementioned aspects, it is important to clarify the de-
tailed forms of morphological attachment onto the hyoid
bone.
Materials and methods
In this study, 50 blocks of tongue-pharynx specimens
were obtained from 50 cadavers (25 males, 25 females)
for dissection course at Kagoshima University Dental
School.
Firstly, the connective tissues of the submandibular
part and the anterior neck were removed. Next, each at-
tached muscle were marked to identify clearly, the mus-
cles attached to the hyoid bone were carefully removed
under the stereomicroscope (SZX-12, Olympus). In ad-
dition, a mark was placed using the tip of a sharp scalpel.
For each muscle, the attachment area on the hyoid bone
was colored using acrylic pigments. The specimens were
then immediately placed in a hydrator to prevent defor-
mation of the hyoid body, and then dried gradually (Fig.
1, 2). Next, the forms of attachment of each muscle were
classified as appropriate and the width and thickness for
80 N. Sonoda and Y. Tamatsu

each muscle were measured using the slide caliper (Digi-

matic Caliper CD-S, Mitsutoyo) with 1/20-mm scale.
The width refers to the length in the horizontal direc-
tion, and the thickness was measured at the widest part
of the muscle attachment area (Fig. 3A, B, C, D). How-
ever the digastric muscles are indirectly attached to the
hyoid bone in a state of aponeurosis9). In addition, the
stylohyoid muscles are only attached to the hyoid bone
indirectly by forming a ring-shaped9) aponeurosis inside
to fix the intermediate tendon of the digastric muscles,
and no direct attachment of the muscle fibers onto the

Fig. 2.
Fig. 1. (A) The hyoid bone before extraction and a peripheral muscle
group in front. (B) The hyoid bone before extraction and a pe-
ripheral muscle group of lateral side. (C) The extracted hyoid
bone and muscles. C, lesser cornu; Da, anterior venter of di-
gastric muscle; Dp, posterior venter of digastric muscle; H,
hyoglossal muscle; M, mylohyoid muscle; MP, middle pharyn-
geal constrictor muscle; O, omohyoid muscle; S, sternohyoid
muscle; TH, thyrohyoid muscle.
(A) The anterior surface of the hyoid bone body, each attach-
ment site was colored with an acrylic color. (B) lateral side of
the greater cornu of the hyoid bone, each attachment site was
colored with acrylic color. (C) the medial side of the hyoid
bone, each attachment site was colored with acrylic color. C,
lesser cornu; G, geniohyoid muscle; H, hyoglossal muscle; M,
mylohyoid muscle; MP, middle pharyngeal constrictor muscle;
O, omohyoid muscle; S, sternohyoid muscle; TH, thyrohyoid
muscle.
 attachment of muscles onto the hyoid bone in human 81

hyoid bone is observed. Therefore, the digastric muscles
and the stylohyoid muscles were not included on the list
of items for measurement in this study, and were instead
only observed regarding their forms.
Findings and consideration
The morphology of the each muscle which is attached
to the hyoid bone is shown. We classified the form of the
attached area to the anterior surface, dorsal surface, and
no relationship was seen regarding the direct attachment
onto the hyoid bone.
1. The muscles attached to the anterior surface of the
body of hyoid bone
1) Mylohyoid muscle (Fig. 2A)
In all cases, the mylohyoid muscles were attached
onto throughout the entire length of the lower anterior
portion on the body of hyoid bone. On the superior bor-
der of this muscle attachment area, geniohyoid muscles
and hyoglossal muscles were attached.
The measurements of the attachment area showed
larger values in male than in female for the width at both
sides, while the thickness of the attached area resulted in
approximately similar in both sexes. When measuring the
ratio between the width/thickness and the length of the
body of the hyoid bone, there were no significant differ-
ences between the sexes in terms of width and thickness
(Table 1).

2) Geniohyoid muscle (Fig. 2A)

As a whole, the geniohyoid muscles were attached
onto the anterior surface of the body of the hyoid bone.
The superior border of the attachment reached the upper
part of the body, and the inferior border of the attachment
came into contact with the attachment area of the mylo-
hyoid muscle. Particularly strong attachments were seen
in the superior part of the attachment. In most cases (right
side: 47 cases 94%; left side: 45 cases 90%), geniohy-
oid muscle was attached so as to enfold the hyoglossal
muscle with representing a U-shape tilted 90° that opens
to lateral side.
In addition by observing whether the muscle extended
and reached the lesser cornu, the same morphology cases
where the muscle did not reach the lesser cornu were
classified as Type 1, while those where the muscle
reached the lesser cornu were classified as Type 2 (Fig. 4
–A, B). Type 1 was observed on the right side in 45 cases
(90%) and on the left side in 41 cases (82%). Type 2 was

Table 1. The diameter of width and thickness, sex differences (mm)

of mylohyoid muscle attachment area and a ratio (%) for the
hyoid bone body

Side Sex Mean (mm) S.D. Ratio (%)

Width Right Male (25) 15.8 4.7 75

Female (25) 14.9 3.6 76
Total (50) 15.4 76

Left Male (25) 14.8 3.9 70

Female (25) 13.8 3.2 71
Total (50) 14.3 70

Thickness Right Male (25) 3.0 0.9 25

Female (25) 2.8 1.0 27
Total (50) 2.9 26

Fig. 3. The measuring range of (A) the mylohyoid and geniohyoid Left Male (25) 3.0 1.3 25
muscle. (B) the hyoglossus muscle. (C) the middle pharyngeal Female (25) 2.9 1.0 27
constrictor muscle. (D) the sternohyoid, omohyoid and thyro­ Total (50) 3.0 26
hyoid muscle.
82 N. Sonoda and Y. Tamatsu

observed on the right side in 5 cases (10%) and on the quently, these morphology were classified between the
left side in 9 cases (18%). continuing pattern (Type 1) and the discontinuing pattern
Furthermore, regarding to the connection state of the (Type 2) (Fig. 5–A, B). Type 1 was observed on the right
geniohyoid muscle on both sides around the midline area side in 31 cases (62%) and on the left side in 22 cases
of the hyoid bone body, states in which the muscle did (44%). Type 2 was observed on the right side in 19 cases
not connect with both sides were classified as Type 1, (38%) and on the left side in 28 cases (56%).
while states where the muscle connected with both sides The forms of attachment were classified into two
were classified as Type 2 (Fig. 4–C, D). Type 1 was ob- types according to whether the muscle was attached so
served in 26 cases (52%), and Type 2 was observed in 24 as to enfold the posterior end of the greater cornu. The
cases (48%). enclosure-type muscle attachment was classified as Type
The measurements of attachment area indicated larger 1, and the type of attachment to the only lower posterior
values in males than in females for the width and thick- end was classified as Type 2 (Fig. 5–C, D). As a result,
ness at both sides. In the measurements of the ratio be- Type 1 was observed on the right side in 19 cases (38%)
tween width/thickness and the length of the hyoid bone and on the left side in 24 cases (48%). Type 2 was ob-
body, differences in width were slightly larger in males at served on the right side in 31 cases (62%) and on the left
both sides. The ratio of thickness was approximately the side in 26 cases (52%). Those attaching conditions of the
same between the sexes (Table 2). attachment area were not hardened and not difficult to
dissection.
3) Hyoglossal muscle (Fig. 2A, 2B) The measurements of the attachment area showed
The hyoglossal muscle was attached to the part be- larger values in males than in females for the width at
tween the geniohyoid muscles or across the entire length both sides. However, no significant difference was found
of the inferior border of the hyoid bone from both sides in thickness between the sexes. In addition, when mea-
of the geniohyoid muscles over the body/greater cornu suring the ratio between width/thickness and the length
joint in some cases. In other cases, the muscle bundles of the greater cornu, there was no significant difference
of hyoglossal muscles were not attached continuously in the width between the sexes. The larger thickness val-
throughout the entire body of the hyoid bone, and the ues were shown in females on both sides (Table 3).
muscle bundles of the thyrohyoid muscles, omohyoid
muscles and middle pharyngeal constrictor muscles were 4) Middle pharyngeal constrictor muscle (Fig. 2B)
attached to the greater cornu of the hyoid bone. Conse- This is a ring-shaped muscle that constitutes the poste-
rior wall of the pharynx. Upon dissection, the attachment
conditions of these muscles were relatively loose, thus
Table 2. The diameter of width and thickness, sex differences (mm) allowing for easy dissection to separate each muscle.
of geniohyoid muscle attachment area and a ratio (%) for the Numerous anatomical textbooks commonly state that
hyoid bone body
the middle pharyngeal constrictor muscle is attached con-
Side Sex Mean (mm) S.D. Ratio (%) tinuously from the posterior end to the middle part of the
greater cornu of the hyoid bone. However, in actual
Width Right Male (25) 17.6 5.1 82 observation of the morphological form, some cases indi-
Female (25) 14.3 4.5 74 cated that the muscle bundle attached to the anterior part
Total (50) 15.9 78
and posterior part of the greater cornu with separating
Left Male (25) 17.6 4.8 81 into two bundles. Therefore, cases of continuous muscle
Female (25) 13.2 3.6 68 bundles were classified as Type 1, while cases of discon-
Total (50) 15.4 75 tinuous muscle bundles were classified as Type 2 (Fig. 6–
A, B). As a result, Type 1 was observed on the right side
Thickness Right Male (25) 9.7 1.5 83
Female (25) 8.6 1.3 81
in 43 cases (86%) and on the left side in 45 cases (90%).
Total (50) 9.1 82 Type 2 was observed on the right side in 7 cases (14%)
and on the left side in 5 cases (10%).
Left Male (25) 9.6 1.4 82 The measurements of attachment area showed larger
Female (25) 8.4 1.3 87 values in males than in females for the width at both
Total (50) 9.0 80
sides. However, no significant difference was observed in

Fig. 4. Photographs and illustrations showing the attachment area of the geniohyoid muscle to the hyoid bone. (A) Type1. the geniohyoid muscle
without attaching to lesser cornu of the hyoid bone (B) Type 2. The upper border of the attachment area of the geniohyoid muscle reached
to the lesser cornu of the hyoid bone which arrow points. (C) Type 1. Both right and left geniohyoid muscles have no contact with each
other. (D) Type 2. The right and left geniohyoid muscles have touched mutually. G, geniohyoid muscle; H, hyoglossal muscle; M, mylo­
hyoid muscle;
attachment of muscles onto the hyoid bone in human 83
84 N. Sonoda and Y. Tamatsu

Table 3. The diameter of width and thickness, sex differences (mm)

of hyoglossal muscle attachment area and a ratio (%) for
greater cornu

Side Sex Mean (mm) S.D. Ratio (%)

Width Right Male (25) 37.7 5.0 119

Female (25) 31.9 8.7 112
Total (50) 35.6 116

Left Male (25) 35.4 4.4 113

Female (25) 30.4 9.1 110
Total (50) 33.9 111

Thickness Right Male (25) 4.0 1.4 69

Female (25) 4.1 1.1 81
Total (50) 4.1 75

Left Male (25) 4.3 1.2 71

Female (25) 4.0 1.1 81
Total (50) 4.1 76

2. Muscles attached to the dorsal surface of the hyoid

bone
5) Sternohyoid muscle (Fig. 2C)
In all cases, the sternohyoid muscle was attached and
localized to the outer edge or partial posterior surface
of the body on hyoid bone on both sides of the posterior
surface. The attachment condition was not firm. In some
cases, since the muscle crossed over with the omohyoid
muscle, it was necessary to perform dissections while
confirming each muscle.
The measurements showed larger values in males than
in females for the width at both sides. However, few dif-
ferences in thickness were observed between the sexes.
Furthermore, regarding the measurements of the ratio
of width/thickness to the length of the hyoid bone body,
there was no significant difference in width and thickness
between the sexes (Table 5).

6) Omohyoid muscle (Fig. 2C)

Fig. 5. Photographs and illustrations showing the attachment area of
the hyoglossal muscle to the hyoid bone. (A) Type 1. The at-
tachment area continues from anterior to posterior. (B) Type 2.
The attachment area was separated into two regions. (C) Type 1.
The muscle was attached so as to enfold the posterior end of
the greater cornu. (D) Type 2. The muscle was attached to the
only lower posterior end. G, geniohyoid muscle; H, hyoglossal
muscle; M, mylohyoid muscle; MP, middle pharyngeal constric-
tor muscle; O, omohyoid muscle; S, sternohyoid muscle; TH,
thyrohyoid muscle.
the thickness between the sexes. In addition, when mea-
suring the ratio of width/thickness to the length of the
greater cornu, there was no significant difference in width
and thickness between the sexes (Table 4).
This muscle was attached to the posterior part of the
hyoid body near the border between the body and greater
cornu. Part of the muscle bundle reached the lower an-
terior surface. The attachments were not very strong.
However, in some cases, the muscle crossed with the
sternohyoid muscle. For such cases, some rigidness was
felt during the dissection.
The forms of attachment were classified into three
types according to the relationship between the omohy-
oid muscle and the stylohyoid muscle. Cases where the
omohyoid muscle was adjacent to the sternohyoid muscle
were classified as Type 1, cases where the muscle bundle
entered the sternohyoid muscle were classified as Type 2,
and cases where this muscle was attached so as to cover
the sternohyoid muscle were classified as Type 3 (Fig. 7).
Type 1 was observed on the right side in 38 cases (76%)
and on the left side in 33 cases (66%). Type 2 was ob-
 attachment of muscles onto the hyoid bone in human 85

Table 4. The diameter of width and thickness, sex differences (mm)

of middle pharyngeal constrictor muscle attachment area and
a ratio (%) for greater cornu

Side Sex Mean (mm) S.D. Ratio (%)

Width Right Male (25) 19.4 6.8 61

Female (25) 17.2 5.7 57
Total (50) 18.3 59

Left Male (25) 17.2 5.9 55

Female (25) 15.0 6.3 50
Total (50) 16.1 52

Thickness Right Male (25) 1.1 0.4 19

Female (25) 1.0 0.5 20
Total (50) 1.1 20

Left Male (25) 1.1 0.5 19

Female (25) 1.1 0.5 22
Total (50) 1.1 20

Table 5. The diameter of width and thickness, sex differences (mm)

of sternohyoid muscle attachment area and a ratio (%) for
the hyoid bone body

Side Sex Mean (mm) S.D. Ratio (%)

Width Right Male (25) 6.9 1.5 32

Female (25) 5.7 1.6 29
Total (50) 6.3 31

Fig. 6. Photographs and illustrations showing the attachment area of Left Male (25) 6.9 1.4 32
the middle pharyngeal constrictor muscle to the hyoid bone. (A) Female (25) 6.1 1.4 31
Type 1. The attachment area continues from anterior to poste- Total (50) 6.5 32
rior. (B) Type2. The attachment area was separated at the middle
area of greater cornu. G, geniohyoid muscle; H, hyoglossal Thickness Right Male (25) 2.6 0.8 22
muscle; MP, middle pharyngeal constrictor muscle; Female (25) 2.6 1.0 25
Total (50) 2.6 24

served on the right side in 7 cases (14%) and on the left
side in 10 cases (20%). Type 3 was observed on the right
side in 5 cases (10%) and on the left side in 7 cases (14%).
The measurements of attachment parts showed larger
values in males than in females for the thickness at the
left side. However, at other sites, few differences were
found between the sexes. Furthermore, in the measure-
ments of the ratio of width/thickness to the length of the
hyoid bone body, no significant difference was found in
the width and thickness between the sexes (Table 6).
7) Thyrohyoid muscle (Fig. 2C)
The attachment condition of this muscle was the
strongest among the infrahyoid muscles. This muscle
was attached to the hyoid bone from the border between
the body and greater cornu to approximately 2/3 of the
entire length of the lower border of the greater cornu
of the hyoid bone in many cases (right side: 45 cases
– 90%, left side: 44 cases – 88%). In addition, when ob-
serving the attachment condition of adjacent sternohyoid
muscles and omohyoid muscles, in some cases the thyro-
Left Male (25) 2.7 0.8 23
Female (25) 2.7 0.9 25
Total (50) 2.7 24
hyoid muscle spread beyond borders between body and
greater cornu and attached so as to overlap with these
muscles. Accordingly, cases where the attachment part
did not overlap with the sternohyoid muscles and omo-
hyoid muscles were classified as Type 1, and cases where
the attachment part overlapped with them were classified
as Type 2 (Fig. 8). Type 1 was observed on the right side
in 33 cases (66%) and on the left side in 34 cases (68%).
Type 2 was observed on the right side in 17 cases (34%)
and on the left side in 16 cases (32%).
The measurements of the attachment parts indicated
larger values in males than in females for the thickness
at both sides. However, few differences were observed
in width at both sides between the sexes. Furthermore, in
the measurements of the ratio of width/thickness to the
length of the greater cornu, no difference was observed
86 N. Sonoda and Y. Tamatsu

Table 6. The diameter of width and thickness, sex differences (mm)

of omohyoid muscle attachment area and a ratio (%) for the
hyoid bone body

Side Sex Mean (mm) S.D. Ratio (%)

Width Right Male (25) 3.1 1.1 15

Female (25) 3.3 1.5 17
Total (50) 3.2 16

Left Male (25) 3.3 1.1 16

Female (25) 3.5 1.3 18
Total (50) 3.4 17

Thickness Right Male (25) 1.6 0.6 14

Female (25) 1.6 0.6 15
Total (50) 1.6 15

Left Male (25) 1.7 0.7 15

Female (25) 1.3 0.4 13
Total (50) 1.5 14

Fig. 7. Photographs and illustrations showing the attachment area

of the omohyoid muscle to the hyoid bone. (A) Type 1. The
omohyoid muscle was adjacent to the sternohyoid muscle. (B)
Type 2. The muscle bundle entered the sternohyoid muscle. (C)
Type 3. The muscle was attached so as to cover the sternohyoid
muscle. O, omohyoid muscle; S, sternohyoid muscle; TH,
thyro­hyoid muscle; ※, the attachment area shared by both omo­
hyoid and sternohyoid muscle.

in width and thickness between the sexes (Table 7).

3. Muscles which have no direct attachments to the hy-

oid bone
8) Digastric muscle
Among all specimens recognized in this observation,
the digastric muscle was in the state of an intermedi-
ate tendon passing through 1 to 2 cm above the hyoid
bone without any direct attachments to the hyoid bone.
Regarding connections with the hyoid bone, attachment
to mylohyoid muscles was found in 10/22 cases (45%),
Fig. 8. Photographs and illustrations showing the attachment area of
the thyrohyoid muscle to the hyoid bone. (A) Type 1. the attach-
ment part did not overlap with the sternohyoid and omohyoid
muscles. (B) Type 2. the attachment part overlapped with the
sternohyoid and omohyoid muscles. O, omohyoid muscle; S,
sternohyoid muscle; TH, thyrohyoid muscle; ※, the attachment
area shared by both omohyoid and sternohyoid muscle.
 attachment of muscles onto the hyoid bone in human 87

Table 7. The diameter of width and thickness, sex differences (mm) 1. Mylohyoid muscle
of thyrohyoid muscle attachment area and a ratio (%) for There are a few reports on the mylohyoid muscles of
greater cornu
Japanese subjects. According to Suzuki (1918)10), when
Side Sex Mean (mm) S.D. Ratio (%) no mylohyoid muscle exists and when the muscle be-
comes extremely thin, the muscle may be separated into
Width Right Male (25) 21.0 4.2 66 the anterior and posterior parts, and the submandibular
Female (25) 21.3 4.6 71 glands enter the gap. On the other hand, in a report on
Total (50) 21.1 69
the form relationship between the mylohyoid muscle and
Left Male (25) 19.5 3.4 62 the hyoid bone, Tanaka (1958)11) classified the forms of
Female (25) 19.3 4.2 65 mylohyoid muscle-attachment to the hyoid bone into the
Total (50) 19.4 64 following seven types: both ends reached the greater
cornu (Type 1); the left end reached the greater cornu
Thickness Right Male (25) 4.5 1.1 79
Female (25) 3.9 0.9 76
and the right end reached the border of the body and the
Total (50) 4.2 78 greater cornu (Type 2); the reverse of Type 2 (Type 3);
the same as Type 3 except that the left end did not reach
Left Male (25) 4.6 1.2 78 the border of the body and the greater cornu (Type 4);
Female (25) 3.7 0.9 77 both ends reached the border of the body and the greater
Total (50) 4.2 77
cornu (Type 5); the right end did not reach the border of
the body and the greater cornu and the left end did not
reach the border (Type 6); both ends did not reach the
attachment via tendinous or fibrous connective tissues border of the body and the greater cornu (Type 7). It was
was found in 7/22 cases (32%), attachment to stylohyoid reported that among these types, Type 5 was observed
muscles was observed in 4/22 cases (18%), and attach- most frequently. In addition, according to a report by
ment to omohyoid muscles was found in 1/22 case (5%). Saka et al. (1958)12), they classified the attachments into
Attachments to the mylohyoid muscles include those at- two types: one type in which both ends terminated at
tached to the part of the fine muscle fibers of the digastric the border of the body and the greater cornu, as well as
muscles or aponeurosis. Some of them were not clearly another type in which the attachment part was situated
differentiated from those attached via tendinous or fi- on the geniohyoid muscles and thyrohyoid muscles, ex-
brous connective tissues. tending outward by 4 mm or so. It was reported that the
former type was the most frequently observed. In most
9) Stylohyoid muscle cases of this study, both ends reached the border of the
Similar to the digastric muscle, the stylohyoid muscle body and the greater cornu. In Tanaka’s report, Type 5
was bundled into an aponeurotic state 1 to 1.5 cm above (the form in which both ends reached the body and the
the hyoid bone and attached to the surrounding muscles greater cornu) was observed in more than half of all cas-
or connective tissues in most cases. In 3/22 cases (14%), es. In the report from Saka et al., the type in which both
the stylohyoid muscle extended to enfold the venter pos- ends reached the body and the greater cornu was found
terior of the digastric muscles. Although it was extremely in most cases as well. Consequently, our findings were
tenuous, direct muscle attachment was seen in only one fairly close to the reports by both Tanaka and Saka et al.
case. Regarding connections with the hyoid bone, attach-
ment to the peripheral connective tissues that included 2. Geniohyoid muscle
the hyoid bone in the tendinous or aponeurotic state was Anomalies in the geniohyoid muscle were rarely re-
seen in 10/22 cases (45%), attachment to mylohyoid ported. According to Suzuki (1918)10), when both sides
muscles was seen in 7/22 cases (32%), joints with the at- of a muscle are fused or separated into bundles, a further
tachment part of the omohyoid muscles were seen in 4/22 separated outer muscle bundle may reach the greater
cases (18%), and joints with the attachment part of the cornu of the hyoid bone. In addition, according to Ogata
sternohyoid muscles and thyrohyoid muscles were seen (2002)13), despite the variety of forms of the attachment
in 1/22 cases (5%). parts, they were approximately symmetric at both sides.
According to Tanaka (1985)11), there are three types for
the superior border of the geniohyoid muscle termination
Discussion part: one in which the muscle bundle on the upper part of
the geniohyoid muscle extended outward and reached the
Using a gross anatomic method, the forms of attach- lesser cornu (Type A), one in which the muscle bundle
ment of hyoid muscles were observed. In contrast to past came into contact with the lesser cornu (Type B), and one
reports, each muscle will herein be discussed individu- in which the muscle bundle did not come into contact
ally. with the root part of the lesser cornu (Type C). On the
other hand, Saka et al. (1958)12) also reported classifica-
88 N. Sonoda and Y. Tamatsu
tions for the superior border of the geniohyoid muscle
termination part, including one in which the outer end
came into contact with the root part of the lesser cornu of
the hyoid bone, and another in which there was a gap be-
tween the outer end and the root part of the lesser cornu.
In these reports, Tanaka stated that Type B (in which the
muscle reached the root part of the lesser cornu) was ob-
served most frequently among the types of the superior
border of the geniohyoid muscle termination part, while
Saka et al. reported that the type in which the outer end
came into contact with the root part of the hyoid bone
of the lesser cornu was observed most frequently among
those of the superior border of the geniohyoid muscle
termination part. In this observation, for the classification
of the forms of joints at both termination parts, only two
types were used: “jointed” or “unjointed”. This is be-
cause the forms of attachment parts varied between broad
groups, and individual differences were also significant.
The wide variety of attachment conditions of geniohyoid
muscles is believed to be due to considerable changes
depending on the attachment conditions of hyoglossal
muscles entering from the outside.
3. Hyoglossal muscle
In Tanaka’s report (1985)11), there are two types, in-
cluding one in which the hyoglossal muscle originates
from the lower posterior end of the greater cornu, and
one originating from the upper posterior end. Saka et al.
(1985)12) classified two types, including one in which the
hyoglossal muscle reached the posterior end ampullar
part and another in which the hyoglossal muscle origi-
nated from an area slightly ahead of the ampullar part. In
this observation, we found cases where the attachment
terminated at the lower posterior border of the greater
cornu, as well as cases where the hyoglossal muscle was
attached so as to enfold the posterior end of the greater
cornu. However, according to Tanaka (1985)11), there
were no observed cases where the attachment part of
the hyoglossal muscle split off in the middle. Saka et al.
(1985)12) classified cases into ones in which the attach-
ment part to the outer inferior border of the greater cornu
was clearly separated and others in which the attachment
part continued. On the other hand, Ogata et al. (2002)13)
reported that the muscle bundle separated into an anterior
part and a posterior part.
In the results from our observations, cases where each
muscle bundle separated into two parts were seen on the
right side in 19 out of 50 cases (38%) and on the left side
in 28 cases (56%).
4. Middle pharyngeal constrictor muscle
Although there are few reports on the middle pharyn-
geal constrictor muscle, the individual differences are be-
lieved to be significant (Suzuki, 1918)10). Tanaka (1985)11)
classified the attachment conditions of the muscle on the
greater cornu of the hyoid bone into the following types:
one in which the attachment part extends along almost
the entire length of greater cornu and the anterior end
reaches the root part of the lesser cornu (Type 1); one in
which the attachment part spreads forward, exceeding
half of the greater cornu (Type 2); one in which the at-
tachment part does not extend to half of the greater cornu
(Type 3); and one in which the attachment part is situ-
ated only around the posterior end of the greater cornu
(Type 4). Subgroups were created for each type for cases
in which the muscle was torn, thus resulting in a total of
8 types. In addition, Saka et al. (1985)12) classified cases
into three types: one in which muscles were attached
only to the apical part of the greater cornu (Type I); one
in which muscles were attached on the greater cornu
to 1/3 ahead of the apical part, around the outer end of
thyrohyoid muscle (Type II); and one in which muscles
reached close to the lesser cornu at a position further
ahead (Type III). In these reports, Tanaka observed Type
I (cases where the attachment part extended along almost
the entire length of the greater cornu and the anterior
end reached the root part of the lesser cornu) most fre-
quently, while Saka et al. observed Type II (cases where
the attachment part extended to 1/3 ahead of the apical
part of greater cornu, around the outer end of thyrohyoid
muscles) most frequently. In this study, we observed the
muscle in terms of continuity and discontinuity. Similar
to Tanaka’s report, many of the muscle attachments had
continuity. The report by Saka et al. did not observe any
cases of discontinued muscles. In our observation, based
on the attachment conditions of pharyngeal muscles, it
seemed that this muscle should be supported by attach-
ments on the greater cornu of the hyoid bone.
5. Sternohyoid muscle/Omohyoid muscle
There are a number of reports on abnormal cases of
omohyoid muscles by Yamada (1934)14), Fukuyama & Li
(1941)15), Sekido & Takahasi (1953)16), Yamada & Nishi-
jima (1954)17), Yonekura (1854)18), Takano & Adachi
(1954)19), Yamada et al. (1960)20), Sato et al (1969)21).
Examples include cases where the muscle is either en-
tirely or partially missing, where the intermediate tendon
is absent, where the muscle bundle originates from the
clavicle, where the superior belly and the sternal muscles
are fused, and where muscle fibers diffuse into the cervi-
cal fascia. As mentioned above, there are a number of re-
ports on muscle shape. With attention paid to the attach-
ment condition of these muscles and the tongue, Tanaka
(1985)11) reported the following four classifications: a
type in which, depending on the overlapping status of
omohyoid muscles and sternohyoid muscles, the anterior
part of omohyoid muscle is situated above the sternohy-
oid muscle (Type 1); a type in which more than half of
the omohyoid muscles are situated on the sternohyoid
muscle (Type 2); a type in which less than half of the
omohyoid muscles are situated on the sternohyoid mus-
cle (Type 3); and a type in which the attachment parts

of the omohyoid muscles and the sternohyoid muscles
comes into contact with each other (Type 4). Saka et al.
(1985)12) reported three classifications: a type in which
the omohyoid muscle covered the sternohyoid muscle,
passing the inferior border to reach the outer surface (Type
I), a type in which the omohyoid muscle covered the ster-
nohyoid muscles, terminating at the inferior border (Type
II), and a type in which both muscles came into contact
with each other (Type III). Tanaka reported that Type 4
(the type in which the attachment parts of the omohyoid
muscles and the sternohyoid muscles came to contact)
was observed most frequently. Saka et al reported that
Type I (the type in which the omohyoid muscle covered
the sternohyoid muscles, passing the inferior border to
reach the outer surface) was observed most frequently. In
our observation, cases where the omohyoid muscle was
adjacent to the sternohyoid muscle were observed on the
right side in 38 cases (76%) and on the left side in 33
cases (66%), cases where the muscle bundle entered into
the sternohyoid muscle were observed on the right side
in 7 cases (14%) and on the left side in 10 cases (20%),
and cases where the omohyoid muscle was attached so
as to cover the sternohyoid muscles were observed on
the right side in 5 cases (10%) and on the left side in 7
cases (14%). Tanaka observed cases where the omohy-
oid muscle was adjacent to the sternohyoid muscle most
frequently. However, in our observations, cases where
the muscle bundle of the omohyoid muscles entered into
the sternohyoid muscle were observed on the right side
for 10% and on the left side for 14% of observed cases.
Such observed cases were not described in the reports by
Tanaka and Saka et al. This is believed to be due to the
various forms of omohyoid muscles, as it is said that the
omohyoid muscle terminates at the outer border of the
lower anterior surface of the hyoid bone body, and that
the intermediate tendon is covered by the cervical fascia
and fixed8), and it is well known that there are many ab-
normal cases involving these muscles.
6. Thyrohyoid muscle
Regarding the attachment parts of thyrohyoid muscles,
based on the overlapping condition of omohyoid muscles
and sternohyoid muscles, Tanaka (1985)11) classified
cases into three types, including one in which the thyro-
hyoid muscle was covered by sternohyoid muscles and
omohyoid muscles (Type 1), one in which the thyrohyoid
muscle was covered by omohyoid muscles only (Type 2),
and one in which the thyrohyoid muscle was not covered
by either of the two muscles (Type 3). It was reported
that Type 2, in which the thyrohyoid muscle was covered
by omohyoid muscles only, was frequently observed.
However, in our observations, we classified cases where
the thyrohyoid muscle did not overlap with sternohyoid
muscles and omohyoid muscles as Type 1 and cases
where the thyrohyoid muscle overlapped as Type 2. In
relation to Tanaka’s report, Type 1 is equivalent to Type
attachment of muscles onto the hyoid bone in human 89
3 and Type 2 is equivalent to Types 1 and 2. In our ob-
servations, Type 1 was seen on the right side in 33 cases
(66%) and on the left side in 34 cases (68%). Type 2 was
observed on the right side in 17 cases (34%) and on the
left side in 16 cases (32%), thus contradicting Tanaka’s
report.
Consequently, it was found that the following four
muscles were firmly attached to the hyoid bone: mylo-
hyoid muscles, geniohyoid muscles, hyoglossal muscle,
and thyrohyoid muscles. This is also true in terms of the
width and thickness of the muscle attachment parts mea-
sured in this study. The abovementioned four muscles
indicated high values in the measurements reported
by Tanaka (1985)11) and Saka et al (1985)12). However,
because Tanaka measured both sides of the hyoglossal
muscles as a block, we could not compare it with our
measurements. Regarding geniohyoid muscles, similar
results were reported. As to the hyoglossal muscles,
higher values for the muscle venter part were reported by
Tanaka. In our observations, there were cases where the
attachment forms of the hyoglossal muscles were divided
in two. On the other hand, such cases were not confirmed
in the report by Tanaka. Therefore, the measurements by
Tanaka seemed to be larger. Regarding the thyrohyoid
muscle, in comparison to the measurements by Tanaka,
our measurements indicated larger values (Table 8).
For our study, we measured the ratio between the size
of the attachment area for each muscle and the size of
the hyoid bone. No significant difference was observed
between the sexes. This is believed to be because the
size of the hyoid bone affects the attachment area of each
muscle, and the size is larger for males.
On the other hand, according to the report by Sato
et al22) on the constitution of the muscle fiber of hyoid
muscles, the most developed muscles (in terms of the
total number of muscle fibers, thickness, and density) are
the anterior belly of digastrics muscles and the geniohy-
oid muscles. Moderately developed muscles include the
mylohyoid muscles, the thyrohyoid muscles and the ster-
nohyoid muscles.
In our observations of the forms of attachments to the
hyoid bone, the attachment conditions, and the constitu-
tion of each muscle fiber, the geniohyoid muscles are
considered to perform the most significant action among
the muscles that are attached to the hyoid bone, function-
ing to pull the hyoid bone upward together with the my-
lohyoid muscles and the digastrics muscles. This seems
rational, since when the geniohyoid muscle is attached
onto the hyoid bone, the attachment extends from the
upper anterior to the anterior surface of the hyoid bone
body broadly in terms of both width and thickness, and
the attachment strength is high.
Mylohyoid muscles serve as jaw-opening muscles that
pull the mandible downward. In addition, during the lat-
eral movements of the tongue, these muscles are believed
90 N. Sonoda and Y. Tamatsu
to support an appropriate position of the hyoid bone.
Furthermore, upon swallowing, the mylohyoid muscles
carry out the function of tensing the bottom of the oral
cavity to lift the tongue. The attachment conditions to
the hyoid bone range broadly between the upper anterior,
upper lateral and the inferior surfaces of the hyoid bone
body, and the degree of attachment is strong. Therefore,
it is assumed that the mylohyoid muscles perform signifi-
cant actions.
Thyrohyoid muscles act to pull the hyoid bone down-
ward and fix the bone in cooperation with the sternohy-
oid muscles upon opening the mouth. When the hyoid
bone is fixed, the thyrohyoid muscles lift the thyroid car-
tilage to pull up the pharynx. It has been shown that the
main actions of thyrohyoid muscles include ensuring the
closure of the laryngeal inlet together with the epiglottis
to prevent accidental ingestions and asphyxiation.
Although it was not described in the report by Sato
et al.22) on hyoglossal muscles, which are extrinsic
muscles, the attachments to the hyoid bone were firm
compared to the attachments to the greater cornu. These
muscles originate in the hyoid bone body and the greater
cornu. When hyoglossal muscles constrict when the
hyoid bone is fixed, it acts to pull the tongue toward the
lower posterior. Other middle pharyngeal constrictor
muscles, sternohyoid muscles and omohyoid muscles
have small attachment areas and weak attachment condi-
tions. Even though it is necessary to take the shape of the
hyoid bone, differences between the sexes23, 24), individual
differences, etc., into consideration, based on the gross
anatomical observations of this study.
References
1) Leonhardt H, Tillmann B, Töndury G and Zilles K. Rauber/
Kopsch Anatomie des Menschen Band1. Georg Thieme Verlag
Stuttgart New York, 1987; 666–667.
2) Anderson JE. Grant’s Atlas of Anatomy; Williams & Wilkins Bal-
timore, 1983; figure 7–86, 87.
3) Romanes GJ. Cunningham’s Textbook of Anatomy; Oxford Uni-
versity Press Oxford, 1981; 130.
4) Petra Köpf-Maier. Wolf-Heidegger’s Atlas of Human Anatomy
Volume 2; Karger Basel, 2000; 34–35.
5) Williams PL, Warwick R, Dyson M and Bannister LH. Grey’s
Anatomy; Churchill Livingstone London, 1989; 371.
6) Dubrul EL. Sicher’s oral anatomy; The C. V. Mosby Company St.
Louis, 1980; 55.
7) Mitsui T, Shimai K, Yasuda K, Kato S, Kubota K and Inoue Y.
Okajima’s Anatomy New Edition; Kyorin Shoin Japan, 1986; 204
–205 (in Japanese).
8) Sato T and Akita K. Anatomic variations in Japanese; University
of Tokyo Press Tokyo, 2000; 75–76 (in Japanese).
9) Shigemasa K and Moriyama H. Morphology of the human digas-
tric muscle emphasizing the intermediate tendon. Showa Univ J
Med Sci 1999; 59:549–556 (in Japanese with English abstract).
10) Suzuki B. Jintai Keito Kaibogaku; Maruzen Tokyo, 1918; 117–
123 (in Japanese).
11)  Tanaka M. Anatomical study of a Japanese hyoid bone (Part1)
About muscle adhesion department of a hyoid bone. Tokyo Dental
College Kaibogakugyosekisyu 1958; 9:1–20 (in Japanese).
12) Saka M and Tanaka M. About muscle adhesion department in a
hyoid bone. Tokyo Dental College Kaibogakugyosekisyu 1958;
7:1–7 (in Japanese).
13) Ogata S, Mine K and Simada K. Attachments of the geniohyoid
and hyoglossus muscles on the hyoid bone with special reference
to oral rehabilitation. Bull Sch Health Sci Kagoshima Univ 2002;
13:5–8 (in Japanese with English abstract).
14) Yamada S. Üder Einige Variationen der Mm. Infrahyoidei und
Anomalien des Clavicularen Ansatzes des M. Trapezius an den
Japanischen Foeten und Neugeborenen. Acta Anatomica Nip-
ponica 1934; 7:337–347 (in Japanese).
15) Fukuyama U and Me-Lin Li. Üder Gehäuft Aufgetretene Vari-
etäten der Halsmuskulatur an Einem Individuum. Acta Anatomica
Nipponica 1941; 18:395–408 (in Japanese with German abstract).
16) Sekido K and Takahasi M. Unprecedented several examples of
neck muscle other. Nihon Univ J med 1953; 12:789–793 (in Japa-
nese).
17) Yamada H and Nishijima T. A rare case of abnormity in the M.
omohyoideus. Kyushu-Shika-Gakkai-zasshi 1957; 11:1–2 (in
Japanese with English abstract).
18) Yonekura S. A study of the muscles of the neck chest, abdomen
and back in Japanese fetuses. Igakukenkyu 1954; 24:1607–1700
(in Japanese).
19) Takano T and Adati H. On the anomalies in the infra-hyoid
muscles especially in the omohyoid muscle. Acta Anatomica Nip-
ponica 1954; 29:5–6 (in Japanese).
20) Yamada H, kuga H and Ozumi K. Case report of abnormities in M.
omohyoideus and M. sternothyreoideus. Kyushu-Shika-Gakkai
-zasshi 1960; 14:390 (in Japanese with English abstract).
21) Sato Y, Oota Y and Yokota A. La anomalio de M. omohyoideus ĉe
japanoj. Nihon Univ J med 1969; 28:431–444 (in Japanese with
Esperant abstract).
22) Sato I, Kozu M, Onda S and Inokuchi S. Myofibrous organization
of the anterior neck muscles (Mm. hyoidei). Showa Univ J Med
Sci 1983; 43:657–668 (in Japanese with English abstract).
23) Murata H. Studies on the hyoid bone of Japanese people from
viewpoint of individual identification. Jpn J Legal Med 1963; 17:
257–283 (in Japanese with English abstract).
24) Houga T. Anthropological study measurement of a Japanese hyoid
bone; Tokyo Dental College Kaibogakugyosekisyu 1957; 3:1–9
(in Japanese).