Evaluation of elongated styloid process on digital panoramic radiographs

Elongated Styloid Process Evaluation Using Panoramic Radiography in Patients With Oral Submucous Fibrosis: A Retrospective Study

Background Oral submucous fibrosis (OSMF) is a chronic condition primarily affecting the buccal mucosa, characterized by fibrotic changes, scarring, and precancerous lesions. Pathologically, it involves inflammation, collagen deposition, and muscular degeneration. Objective This study aimed to assess the prevalence and distribution of elongated styloid process (ESP) in patients diagnosed with OSMF, contributing to the understanding of anatomical variations in this population. Methods A retrospective study was conducted at the Department of Oral Medicine and Radiology of Saveetha Dental College. We collected records of OSMF patients from 2021 to 2023, which included panoramic radiographs. We evaluated the presence, type, and grading of ESP alongside OSMF grades using standardized classifications. Results Out of 125 OSMF patients, 67 (53.6%) had ESP. Type I ESP was most prevalent (83.58%). Bilateral occurrences were more common (52.2%) than unilateral (41.79%). On both sides, type I ESP predominated significantly. Among unilateral cases, left-side occurrences were slightly more frequent. Type I ESP remained predominant regardless of laterality. Conclusion The study highlights the high prevalence of ESP, predominantly type I, in OSMF patients, with bilateral occurrences more common. These findings provide valuable insights into the anatomical variations associated with OSMF, contributing to clinical understanding and potential future research directions.

Eagle and Ernest syndromes: a scoping review

INTRODUCTION

Ossification disorders can affect the stylohyoid ligament as well the stylomandibular ligament. The symptomathology between those syndromes and other pathologies it has been a problem because there is not a guideline.

EVIDENCE ACQUISITION

With the aim to establish prevalence, diagnosis and etiopathogenesis of Eagle and Ernest syndromes, a scoping review was performed base on PRISMA criteria.

EVIDENCE SYNTHESIS

To review stylohyoid ligament and Eagle Syndrome 93 articles were selected. Three articles regarding the stylomandibular ligament and Ernest Syndrome were founded and selected.

CONCLUSIONS

Both syndromes should be clinically diagnosed and corroborate with imaging (2D or 3D), although imaging in Ernest Syndrome is not clear as well in Eagle Syndrome. A decisional algorithm for diagnosis of Eagle Syndrome and Ernest Syndrome is presented.

Evaluation of alterations in length and calcification of the styloid process in patients with end-stage renal failure

OBJECTIVE

This study compared alterations in length and types of elongation and calcification of the styloid process (SP) between patients with end-stage renal failure (ESRF) who received renal transplantation, patients with ESRF undergoing dialysis, and a healthy control group.

STUDY DESIGN

The SPs of 58 patients who had undergone renal transplants, 58 patients who received dialysis treatment, and 58 healthy individuals were examined with panoramic radiographs. Length measurements were made from the apex to the base of the SP. Elongation types were classified into 5 groups: normal, non-segmented, pseudo-segmented, segmented, and non-continuous. Calcification types were classified into 4 groups: external, partial, nodular, and complete.

RESULTS

SP length was significantly greater in the renal transplantation and dialysis groups than in the control group (P < .001) and significantly longer in the renal transplantation group than in the dialysis group (P < .001). There was a significant difference between the groups regarding elongation types (P < .001), with the non-segmented type more frequent in the dialysis and renal transplant groups than in the control group. There was no significant difference in calcification types between groups (P = .225). Elongation and calcification types differed between sexes (P ≤ .008) CONCLUSIONS: Orofacial pain complaints in patients with ESRF should raise the suspicion of abnormal elongation and calcification of the SP, perhaps a manifestation of Eagle syndrome. It would be useful to evaluate the SPs of these patients clinically and radiographically.

The prevalence of elongated styloid process in the population of Barcelona: a cross-sectional study & review of literature

BACKGROUND

Styloid process (SP) is a cylindrical bony projection that originates from the inferior part of the petrous temporal bone just anteriorly to the stylomastoid foramen. Several nerves, muscles, and ligaments are related closely to the (SP). It is considered elongated when the measurement exceeds 30 mm. The overall prevalence of the styloid process is between 3.3% to 84.4%. The elongation of the styloid process (ESP) is associated with the manifestation of Eagle's Syndrome (ES) which is characterized by various types of pain in the head and neck region such as headache, tinnitus, otalgia, and trigeminal neuralgia. Eagle's syndrome occurs in 4-10.3% of individuals with an elongated styloid process (ESP). The objective of the study is to determine the prevalence of (ESP) in the patients who were treated in the Dental Hospital University of Barcelona (HOUB), to review the literature to spot the light on the different demographic data worldwide.

METHODS

The archived panoramic image in the University of Barcelona dental Hospital were consecutively retrieved to investigate the prevalence of (ESP). Of all digital panoramic radiographs (OPG), 400 met the inclusion criteria and were furtherly analyzed. The results are correlated with the participant's gender, age, and occurrence. Age is subcategorized into three groups. A chi-square test is used to measure the significant differences and the P-value is set at < 0.05 for the level of significance.

RESULTS

Among the included 400, we found 291 demonstrating (ESP). The prevalence of (ESP) which exceeds 30 mm is 72.75%. It is found that the most common morphological type is type 1 which is regarded as the uninterrupted (ESP) regardless of gender and age group. Concerning the calcification pattern, the most prevalent is the partial calcified (ESP) despite genders and age groups.

CONCLUSION

(OPG) is a sufficient tool for the screening of the elongated styloid process. Regarding the prevalence, our results are considered higher than previously reported prevalence in different populations using (OPG) radiography tool. A study on a wider spectrum of the Spanish population is recommended to further investigate the correlation between the elongated styloid process and the occurrence of Eagle's syndrome.

Prevalence and Characteristics of Eagle's Syndrome in a Syrian Population: A Cross-Sectional Descriptive Study

Objectives Elongation of the styloid process causes different symptoms with varying degrees of severity in some people. This elongation can be detected haply during routine reading of panoramic X-ray. The aim of this study is to determine the prevalence rate of Eagle's syndrome among a population from Damascus, Syria, and to evaluate the accompanying clinical symptoms. Methods This is a descriptive epidemiological study including 3,962 patients who attended one of the many dental clinics of educational and/or healthcare institutions in Damascus. All digital panoramic radiographs were reviewed, and the styloid processes were measured and assessed for elongation. Patients with styloid process of more than 3 cm in length were contacted and their consents were obtained to participate in the study to assess the presence of clinical symptoms. Results Radiographic elongation of the styloid process was found in 179 out of the 3,962 assessed dental records (prevalence rate was 4.5%). Length ranged from 30 to 90 mm, with an average of 55.9 mm. Of the patients with elongated styloid process, 10.2% had undergone tonsillectomy. All patients who underwent tonsil surgeries were symptomatic with at least three of the studied symptoms. Symptoms included peri-orbital pain (40.9%), orbital pain (35.2%), neck and shoulders pain (52.3%), ipsilateral headache (58%), earache (30.7%), tinnitus (37.5%), articular clicking (29.5%), throat pain (31.8%), globus sensation (22.7%), and dysphagia (21.6%). Conclusions The prevalence of Eagle's syndrome according to this study was 4.5%. Patients who had undergone tonsillectomy were more likely to be more symptomatic. The most common symptom was severe headache (migraine) on the same side of styloid elongation. Panoramic radiography is a low-cost means that can be helpful in the diagnosis of vague pain and symptoms caused by Eagle's syndrome in the head and neck regions.

Retrospective study of the styloid process in a Taiwanese population using cone beam computed tomography

Background/purpose

Review of literature, evaluation of the styloid process (SP) using cone beam computed tomography (CBCT) has not been performed in a Taiwanese population. Our study aimed to evaluate the different characteristics of SP using CBCT in a Taiwanese population.

Materials and methods

CBCT scans of 121 patients (55 males, 66 females; mean age, 27 ± 9.09 years) were evaluated to assess the length, morphological type, calcification pattern, and angulation of the SP. A SP length greater than or equal to 30.00 mm is considered to indicate an elongated SP (ESP). ESP was classified in terms of morphology as Type I: uninterrupted; Type II: pseudo-articulated; or Type III: segmented. The calcification pattern of SP was categorized as Type A: calcified outline; Type B: partially calcified; Type C: nodular; or Type D: completely calcified. The transverse and sagittal angles between the bilateral SP were also measured.

Results

One-hundred and nine patients had a bilateral SP and 12 patients had a unilateral SP. The mean SP length was 26.34 ± 7.44 mm. Forty-two (34.71%) patients had an ESP. The most common ESP morphology was Type 1, followed by Type II, then Type III, while the calcification pattern prevalence was of the descending order Type B, Type A, Type C, and Type D. The mean transverse and sagittal angles were 66.90 ± 5.41° and 26.67° ± 6.50°, respectively.

Conclusion

The present study was the first to evaluate the characteristics of SP in a Taiwanese population using CBCT. The data contribute a useful basis for clinical investigation of the SP in future.

Diagnostic and therapeutic dilemma in orofacial pain: A rare case of bilateral Eagle syndrome

Eagle’s syndrome is a collection of symptoms due to abnormal and/or elongated styloid process. This can irritate the various neurovascular structures that lie in its close proximity, mainly the glossopharyngeal nerve, leading to odynophagia, dysphagia, foreign body sensation, cervicofacial pain, and headache. It is a diagnosis of exclusion and needs high degree of clinical suspicion. It is a rare condition with no reported incidence in the Bhutanese population so far. In this article, we present a case of elongated styloid process that was causing persistent and troublesome orofacial pain in a patient, which was not relieved by medication. The patient underwent trans-oral styloidectomy, which helped cure his symptoms.

Comparison of the length of styloid process in panoramic radiographs to computed tomography as the gold standard

Aims:

To compare the length of styloid process assessed using computed tomography (CT) and panoramic radiographs (PAN).

Materials and Methods:

PAN were taken for 15 patients requiring CT reporting to PMS Dental College or metro scans, after obtaining informed consent and fulfilling all the inclusion and exclusion criteria. CT images were taken in metro scans. The apparent lengths of styloid process were measured in both CT and PAN using software provided with the respective machines. Ethical committee approval was obtained from PMS Dental College, Trivandrum.

Results:

The length of left styloid process in CT was observed 20–30 mm in 4 (27%) patients and same in PAN was observed in 5 (33%) patients. Out of 15 patients, abnormal styloid process (length >30 mm) was observed in 11 (73%) patients when measured with CT and 10 (67%) patients in PAN. In CT, the length of the styloid process on the right side was observed between 20 and 30 mm, in 3 (20%) patients. PAN of 2 (13%) patients were found between 20 and 30 mm. On the right side, abnormal styloid process (length >30 mm) was noted in 12 (80%) patients using CT and 13 (87%) patients in PAN. The length of styloid process in the combined sample (both right and left side) was found to be between 20 and 30 mm in 3 (10%) patients and styloid process >30 mm long (in both CT and PAN) was observed in 12 (40%) patients.

Conclusions:

This study demonstrated positive correlation between CT and panoramic measurements. “P” values were statistically significant on both sides with values of right side (P = 0.01) and left side (P = 0.002), respectively. Hence, PAN, which are routinely taken, cost-effective and involving relatively low radiation dose, may be used as substitute for CT for the purpose of diagnosis of elongated styloid process. However, for precise measurement of the length of styloid process, CT is still the imaging modality of choice.

Prevalence and features of elongated styloid process on imaging studies: a systematic review and meta-analysis

OBJECTIVE

To determine the prevalence of the elongated styloid process (ESP) and its characteristics, such as sex and age of the patient, unilateral and bilateral incidence, besides variations between different populations and panoramic and CBCT examinations.

MATERIALS AND METHODS

A search was performed in six databases (PubMed, Web of Science, Scopus, Cochrane, Lilacs, and Embase) to identify observational studies that used imaging exams and assessed ESP prevalence among panoramic radiograph CBCT examinations, whose transversal prevalence studies were included. Furthermore, studies with a specific group of patients or symptomatic patients were excluded. Additionally, Joanna Briggs Institute checklist was used to evaluate the quality of the studies. A meta-analysis was conducted, then subgroup analyses were performed by grouping studies according to the secondary outcomes, with a significance level set at 5%. The Grading of Recommendations Assessment, Development, and Evaluation system was used to rate the certainty in the evidence.

RESULTS

The initial search resulted in 1635 studies, from which 39 articles met the inclusion criteria, encompassing 50,655 participants. The sample size varied between 82 and 5,000 participants. The prevalence of the ESP ranged from 1.3 to 94.8%, with an overall prevalence of 30.2%. The bilateral occurrence was higher than the unilateral one, but no significant predilection was observed according to sex, age, or population. The type of imaging examination also showed no difference in its detection.

CONCLUSION

The overall prevalence of ESP was 30.2%, with a propensity for bilaterality, but not for any sex, age, or population geographic location. The imaging examination modality did not influence the diagnosis of ESP. However, the quality level of the studies evaluated was very low, demonstrating the need for more homogeneous primary studies on the prevalence of the ESP with a more standardized methodology.

CLINICAL RELEVANCE

There is no consensus in the literature regarding the prevalence of the ESP and the characteristics of the affected patients that can cause chronic and debilitating discomfort in the head and neck region. Therefore, knowledge about the prevalence and characteristics of this condition would help dental clinicians reach the correct diagnosis.

An overview of Eagle's syndrome

Eagle's syndrome is a condition that typically does not present to pain clinics. It consists of an elongated styloid process greater than 25 mm and/or stylohyoid ligament calcification causing an unusual array of symptoms, relating to anatomical involvement. Multiple specialities may be involved with the diagnosis of this rare condition. Three-dimensional reconstructive computed tomographic (CT) scan remains the gold standard for diagnosis. Depending on the presenting symptoms, care should be directed to an appropriate specialist. Pain surrounding Eagle's syndrome does not typically resolve using simple pharmacological methods. Eagle's syndrome should remain a diagnosis to be considered when faced with non-resolving head/facial pain.

An evaluation of the prevalence of elongated styloid process in Taiwanese population using digital panoramic radiographs

Background/purpose

Materials and methods

Results

Conclusion

The effect of styloid process medial angulation on Eagle's syndrome's self-reported symptoms: A preliminary cross-sectional study

OBJECTIVE

The aim of this study was to investigate whether the medial angulation of the styloid process (SP), regardless of its length, has an association with self-reported symptoms of Eagle's syndrome.

STUDY DESIGN

In this cross-sectional study, we measured the length and medial angulation of the SP, including ossification of the stylohyoid ligaments, in archived cone beam computed tomography scans. Patients with valid contact details were interviewed by telephone and asked about the clinical symptoms related to Eagle's syndrome.

RESULTS

Eighty-eight patients participated in this study. Their median age was 39.0 years and ranged from 18 to 75 years. Thirty-one (35.2%) of the participants reported cervicalgia with at least one other symptom related to Eagle's syndrome. The mean length and angulation of the right SP were 37.2 mm and 36.3°, respectively, with both readings showing positive correlation with the left SP (r = 0.746 and r = 0.670, respectively; P < .001). Medial angulation of the SP was a predictor of Eagle's syndrome self-reported symptoms (odds ratio, 1.082; 95% confidence interval, 1.003-1.167; P = .042), adjusted for SP length and the patient's age.

CONCLUSIONS

Self-reported clinical symptoms of Eagle's syndrome appear to be more associated with the medial angulation of the SP than with its length. Further research on larger samples is needed to establish the medial angulation cutoff angle and the specific symptoms that are attributed to that angulation.

Cone beam computed tomographic evaluation of styloid process: A retrospective study of 1000 patients

Objective:

The styloid process (SP) is a bony projection, located just anterior to the stylomastoid foramen, the normal length of which is approximately 20–30 mm. The length of SP when exceeds 30 mm it is said to “elongated.” The purpose of this retrospective study was to assess the prevalence of elongated SP (ESP) by cone beam computed tomography (CBCT) examination in Turkish subpopulation and its relation to gender and age.

Materials and Methods:

This study analyzed CBCT of 1000 patients who were randomly selected to participate and were aged from 14 to 78 years. Any radiograph with questionable SP was excluded from the study. The apparent length and thickness of the SP were measured by two dental and maxillofacial radiologists. The ESP was classified with radiographic appearance-based morphology of elongation. The data were analyzed with the IBM SPSS Statistics 20.0.

Results:

The mean age of patients was 42.49 ± 14.83 years. The length of SP was measured over 30 mm in 151 patients (15.1%). A total of 151 CBCT showed ESP, of which 87 (57.6%) were noticed in males and 64 (42.4%) in female patients. The length of right-sided SP ranged from 30.05 to 85.49 mm and left-sided SP from 30.14 to 83.72 mm.

Conclusion:

CBCT is a valuable diagnostic imaging tool which makes accurate length measurements. It is important for the clinicians to be aware of natural variations of the SP whose clinical importance is not well understood.

Prevalence and pattern of the elongated styloid process among geriatric patients in Saudi Arabia

OBJECTIVE

The objectives of this study were to assess the elongation of the styloid process on digital panoramic radiographs and to evaluate the prevalence of the elongation according to age, sex and types.

PATIENTS AND METHODS

Digital panoramic radiographs of 198 geriatric edentulous patients were analyzed. The radiographic length of the styloid process was measured on both sides using the measurement toolbars on the accompanying analysis software. For statistical analysis, Student's t-test, chi-square test and analysis of variance test were used.

RESULTS

The elongated styloid process was seen in 87 of the 198 patients. It was observed that as age increased, elongation of the styloid process increased with a male predominance. Type I elongation was more common than other types of elongation. Bilateral elongation was most commonly found than unilateral elongation, and both types of elongation were frequently seen in males compared with females.

CONCLUSION

The prevalence of the elongated styloid process in the present study was higher in comparison to the other reports from edentulous patients.

Unusually elongated styloid process: A report of two cases with literature review

Eagle's syndrome is most often associated with an elongated styloid process or ossified stylohyoid ligament, which may result in cervicofacial pain. Since the symptoms are vague and nonspecific, patients with the Eagle's syndrome are difficult to diagnose. We here report two cases of Eagle's syndrome, one case with unusually elongated styloid process of size 6.97 cm, in whom imaging with computed tomography established the diagnosis and managed by local infiltration of lidocaine and steroid; in another case the length of styloid processes were 3.47 cm and 3 cm respectively and was managed surgically.

Morphological study of styloid process of the temporal bone and its clinical implications

The objective of this study was to study the morphometry of the styloid process of temporal bone and prevalence of elongated styloid process. The morphology of elongated styloid process along with its embryological and clinical importance are discussed. The present study included 110 human dry skulls which were procured from the bone collections of the department of anatomy. The styloid process was observed macroscopically on both sides of all the skulls, the elongations if any were noted. All the styloids were measured for their length, thickness at different levels and interstyloid distance at various levels. Out of 110 specimens, only 5 skulls (4.5%) exhibited the elongated styloid process. Among them, 3 skulls (2.7%) had unilateral elongation and 2 skulls (1.8%) had bilateral elongation of the styloid process. The mean length of the styloid process was 17.8±9.3 mm and 18.2±5.6 mm for the right and left sides, respectively. The prevalence of elongated styloid process in the present study was 4.5%. The clinical anatomy of this congenital variant is important to the neurosurgeon and radiologist, while interpreting the computed tomogram and magnetic resonance image scans. The morphological knowledge of elongated styloid process is clinically important since the course of the vertebral artery may be distorted in such situations.

Prevalence of elongated styloid process in Saudi population of Aseer region

Objective:

The study was performed to investigate the prevalence, morphology and calcification pattern of elongated styloid process in Saudi population of Aseer (Southern) region and its relation to gender and sub-age groups.

Materials and Methods:

This study was analyzed digital panoramic radiographs of 1,162 adults. Any radiograph with questionable styloid process was excluded from the study. The apparent length of the styloid process was measured by a single experienced dental and maxillofacial Radiologist. The elongated styloid process was classified with the radiographic appearance based on the morphology and calcification pattern. The data were analyzed by using Student's t-test and Chi-square test with P value less than 0.05.

Results:

A total of 1,085 Digital panoramic radiographs showed elongated styloid process of which 686 (63.2%) were noticed in males and 399 (36.8%) were noticed in female patients. There was a statistical significant difference noticed in the mean difference of elongated styloid process between 20-29, 50-59 and 60 years and above sub-age groups. The elongated styloid process was more prevalent in elderly aged male patients (P < 0.05). Type I morphology with calcified out line (a) was the most frequent pattern of calcification noticed in the present study.

Conclusion:

The panoramic radiographs are economical, easily accessible and useful diagnostic tool for early detection of elongated styloid process with or without symptoms. However, studies with larger sample size would further help to assess the prevalence of this elongated styloid process in Saudi population of various other regions.