Hyoid Bone Position in Relation to Vertical Skeletal Pattern: A Systematic Review and Meta-Analysis

Abstract

Objectives: This study aimed to determine whether hyoid bone position differs across vertical skeletal growth patterns through a systematic review and meta-analysis using cephalometric and CBCT measurements. Methods: Four electronic databases were searched up to June 4, 2026. Twenty-three reports were included in the qualitative synthesis (22 comparative studies and one normative reference report; 3404 participants), and 22 comparative studies underwent NIH quality assessment. Six studies contributed to the H-MP meta-analysis. For H-C3, four studies reporting vertical-pattern contrasts formed the primary pool, although residual sagittal confounding remained; two sagittal-proxy studies were added only in the sensitivity analysis. Results: For H-MP, pooled SMD was 0.185 (95% CI: −0.231 to 0.601; p = 0.383; I2 = 87.2%; k = 6). For H-C3, the primary pooled MD was −1.30 mm (95% CI: −2.32 to −0.28; p = 0.013; I2 = 48.6%; k = 4); the sensitivity pool yielded −1.45 mm (95% CI: −2.51 to −0.38; p = 0.008; k = 6). Conclusions: H-MP did not differ significantly between patterns. The pooled H-C3 estimate indicated a more posterior hyoid position in groups classified as hyperdivergent; however, residual sagittal confounding prevents its attribution to vertical divergence alone. Cranial-base or coordinate-based measurements independent of mandibular-plane inclination should be prioritised.