Accuracy in the Diagnostics of Styloid Process - Panoramic Radiograph vs. Computed Tomography: A Comparative Study

BACKGROUND/AIM

The styloid process (SP) becomes clinically relevant when it shows enlargement (>30 mm) in the sense of an elongated SP (ESP) and/or increasing calcification leading to Eagle Syndrome (ES). Panoramic radiograph (PR) or computed tomography (CT) are part of the routine diagnostics in ES. Currently, CT is considered the gold standard. The aim of this study was to investigate the accuracy in the diagnostics/measurements of SP/ESP throughout a comparative study between PR and CT. Furthermore, in addition to measuring established parameters, this study aimed to determine the currently unexamined width in the base and tip of the SP.

PATIENTS AND METHODS

The present study examined the radiological findings of bilateral SP in 100 patients who received both PR and CT on the same day. Measurements of the length of the SP and width at the basis and tip were performed. Furthermore, calcification patterns, Langlais classification and the prevalence of ESP were analyzed.

RESULTS

There was a highly significant correlation between PR and CT measuring SP for every parameter. Males showed significantly longer SP than females among the age group between 18-75 years. The results of the length measurements of the SP (male: right SP=32.98 mm; left SP=35.21 mm; female: right SP=30.31 mm; left SP=30.92 mm) significantly exceeded the values of comparable studies.

CONCLUSION

Consequently, it can be concluded that PR provides accurate measurements when compared to CT for measuring and diagnosing SP/ESP/Eagle syndrome. This study was one of the first to examine the width of the SP in the base and tip, thus these measurements can serve as a baseline for further studies. Since the mean lengths of SP exceeded 30.0 mm in the present study, these findings raise the question of whether the cut-off of 30.0 mm is adequate for the diagnosis of ESP.

Evaluation of Styloid Process Elongation in Madinah, Saudi Arabia: A Retrospective Radiographic Investigation

OBJECTIVES

This study aimed to identify the prevalence of an elongated styloid process and analyze the presence of its calcification in the Saudi population using panoramic radiographs.

METHODS

The Taibah Outpatient Dental Clinic's OPG radiographs for 962 patients who attended screening clinics between December 2022 and October 2023 were all included in the study. Patients' demographics, such as age, gender, and nationality, as well as radiological data, were included in the following study variables: the presence of an elongated styloid on both sides of a panoramic radiograph, right side styloid length, left side styloid length, right side distal end thickness, and left side distal end thickness.

RESULTS

The study evaluated 438 (45.5%) processes found in individuals aged 16-80 years old. The elongated process length ranged from 30.0 to 40.1 mm, and the diameter ranged from 0.81 to 7.79 mm at the origin to 0.56-3.79 mm at the end. There was no statistically significant difference in process length across genders or age groups. The diameters of the styloid bones on the left side vary significantly across genders at the start and completion of the process.

CONCLUSION

The prevalence of elongated styloids in the studied population was 4.26%. The radiological evaluation of the styloid process is a crucial stage in dental surgery planning.

Minimally Invasive Cervical Styloidectomy in Stylohyoid Syndrome (Eagle Syndrome)

(1) Background: Stylohyoid syndrome, known as classical Eagle Syndrome (cES), is characterized by calcification of the stylohyoid chain with numerous nonspecific symptoms, mainly pain. This study introduces minimally invasive cervical styloidectomy (MICS). (2) Methods: MICS was performed on sixty-five patients diagnosed with classical Eagle Syndrome. Patients underwent meticulous differential diagnosis. Surgical plans were established based on the findings from neck angioCT. (3) Results: The healing process was uneventful, without significant complications. The overall success rate was 97.0%, with a follow-up of a minimum of six months. In one case, the surgery did not yield the desired improvement. In one case, a partial relapse of symptoms was observed. (4) Conclusions: MICS is a straightforward and efficient surgical treatment technique for stylohyoid syndrome.

Anesthetic Management of a Patient With Eagle's Syndrome: A Case Study

Eagle's syndrome is a condition characterized by elongation of the styloid process or calcification of the styloid ligament that can manifest as a constellation of symptoms including dysphagia, globus sensation, hoarseness, headache, and neck pain. Anatomically, this can impinge neurovascular structures, distort the hypopharynx, and stiffen the epiglottis and other pharyngeal structures, increasing the difficulty of airway management. The objective of this case study was to discuss the features of Eagle's syndrome and anesthetic considerations in the management of the condition. Intubation may be challenging and presents a scenario where a glidescope is the preferred tool over direct laryngoscopy. Smooth emergence and extubation strategies, including the novel use of lidocaine and dexmedetomidine, are followed to minimize the risk of surgical complications.

Extraoral Versus Intraoral Approach for Removal of Styloid Process in Treatment of Eagle's Syndrome: A Report of Two Cases

Eagle's syndrome, a condition associated with the elongation of the styloid process or calcification of the stylohyoid ligament, is clinically characterized by throat and neck pain radiating into the mastoid region. The diagnosis can be made through a thorough history, correct clinical and pathological correlation and radiographic examination. The elongated styloid process can be treated conservatively or surgically. Conservative treatment options include transpharyngeal injections of steroids and lignocaine, nonsteroidal anti-inflammatory drugs, diazepam, and the application of heat. The surgical management of Eagle's syndrome consists of two major approaches: the transoral and the transcervical approaches. In this paper, we present a comparative study of two cases of classic bilateral elongated styloid process syndrome, treated with transcervical styloidectomy and transoral styloidectomy, their surgical time, intraoperative difficulties and complications, and recovery time. In conclusion, the management of Eagle's syndrome requires a comprehensive approach that includes a thorough preoperative evaluation of the length of the styloid process via imaging and digital palpation. The choice of surgical approach, whether extraoral or transpharyngeal, should be based on factors such as the surgeon's experience and the patient's comorbidities, as well as the length and palpability of the styloid process. Our comparative study of two cases treated with transcervical and transoral styloidectomy demonstrated that the extraoral method offers a direct and well-controlled approach for excessive styloid processes, while the transpharyngeal approach is preferred for cases where the process can be easily identified by palpation. Therefore, proper patient selection and preoperative planning are essential to achieving successful outcomes with minimal complications.

Delayed Unilateral Eagle Syndrome with Fractured Styloid Process

PURPOSE

Minor injury to head and neck is usually neglected for potential neurological consequences. We report a woman who suffered left Eagle syndrome due to styloid process fracture two years after a minor motorcycle collision.

CASE REPORT

A 53-year-old woman complained pain at her left upper neck, lower face and periauricular area after minor motorcycle collision at 2 years ago. The pain usually occurred spontaneously but was occasionally triggered or exacerbated by specific postural changes, including looking up or turning head to right side. Moreover, a foreign body sensation occurred at throat during swallowing. Physical examination provoked pain at the left submandibular area. Carotid bruit was absent. Otherwise, other neurological function was preserved. Computerized tomography revealed linear fracture at the middle of left styloid process. After inform, patient preferred conservative treatments including abortive non- steroidal anti-inflammatory drugs and an avoidance of rapid head rotations. Since afterwards, the frequency and intensity of neck pain greatly decreased and she could tolerate and maintain a normal daily living.

CONCLUSIONS

Asymptomatic or paucisymptomatic styloid process fracture may be neglected in case of minor injury to head and neck. A careful evaluation of neck should be completed in traumatic individuals to reveal underlying damage and prevent further harmful consequence.

Styloid Jugular Nutcracker: The Possible Role of the Styloid Process Spatial Orientation-A Preliminary Morphometric Computed Study

Styloid Jugular Nutcracker (SJN, also known as Eagle Jugular Syndrome EJS) derives from a jugular stenosis caused by an abnormal styloid process, compressing the vessel in its superior portion (J3) against the C1 anterior arch. It could be considered a venous vascular variant of Eagle Syndrome (ES). Main clinical features of this ES variant are headache, pulsatile tinnitus and dizziness, possibly related to venous hypertension and impaired cerebral parenchyma drainage. In our opinion, conceptually, it is not the absolute length of the styloid bone that defines its abnormality, but its spatial direction. An elongated bone pointing outward far away from the midline could not compress the vein; vice versa, a short styloid process tightly adherent to the cervical spine could be pathological. To prove this hypothesis, we developed a semi-automatic software that processes CT-Angio images, giving quantitative information about distance and direction of the styloid process in three-dimensional space. We compared eight patients with SJN to a sample of healthy subjects homogeneous for sex and age. Our results suggest that SJN patients have a more vertically directed styloid, and this feature is more important than the absolute distance between the two bony structures. More studies are needed to expand our sample, including patients with the classic and carotid variants of Eagle Syndrome.

Endoscopic transoral approach to the lateral poststyloid space

The lateral poststyloid space (LPSS) located at the posterolateral aspect of the styloid process. This study aims to explore the anatomical relationships in LPSS via a transoral corridor, providing reference for addressing lesions extending to this region. An endoscopic transoral approach for exposure of the LPSS was performed on 6 cadaveric specimens (12 sides). Related landmarks were explored, and transoral extirpation of tumors extended into LPSS was employed in 12 patients. The deep lobe of the parotid gland, extratemporal facial nerve, and the accompanying artery in the LPSS were sufficiently exposed via the transoral corridor in all 12 cadaveric sides. The transoral corridor provided adequate exposure for tumors extending to the LPSS, and en bloc resection was achieved in these 12 patients. No facial nerve or vascular injury occurred, and no recurrence observed in this cohort with an average follow-up of 26 months. An endoscopic transoral approach provides a direct access to the LPSS. Appreciation of the anatomical relationships within the LPSS is valuable for employing a transoral extirpation of tumors extending to this specific region.

Dysphagia Due to an Extremely Long Styloid Process: A Case Report of Eagle Syndrome

Dysphagia is a relatively common condition in the general population and has a wide range of underlying etiologies. We present the case of a 58-year-old male who presented with a complaint of progressive difficulty swallowing for two years in duration associated with unintentional weight loss. He has been using a proton pump inhibitor therapy for more than one year, but he had only mild improvement in his symptoms. Recently, the patient started to experience neck pain during swallowing and he underwent a head and neck computed tomography scan, which demonstrated an extensive elongation of the left styloid process that measured 14.9 cm. The clinical and imaging findings were consistent with Eagle syndrome and the decision was made to perform a resection of the left styloid process. Excision of the left styloid process was made using the external cervical approach. At the follow-up visit, the patient reported a near-complete resolution of his complaints. Eagle syndrome is a very rare etiology of dysphagia. The case highlights an example of Eagle syndrome with an extremely long styloid process. This diagnosis should be considered when encountering a patient with dysphagia and neck pain.

Endonasal access to the lateral poststyloid space: Far lateral extension of an endoscopic endonasal corridor

The styloid process constitutes the posterolateral boundary for an endonasal exposure of the infratemporal fossa. This study aims to explore the feasibility of a far-lateral extension to the lateral poststyloid space via an endonasal corridor. An endonasal dissection was performed on six cadaveric specimens (12 sides). Following an endoscopic endonasal access to the parapharyngeal space, the styloid process and the tympanic portion of the temporal bone were removed to reveal the jugular bulb and the extratemporal facial nerve. Distances from the anterior nasal spine to the relevant landmarks were measured using a surgical navigation device. Through an endonasal corridor, only the anteroinferior aspect of the jugular bulb was exposed. Conversely, the extratemporal facial nerve could be sufficiently exposed, and the deep temporal nerve could be transposed to the stylomastoid foramen. The average horizontal distances from the nasal spine to the posterior tract of V₃ , styloid process, and facial nerve were 79.33 ± 3.41, 97.10 ± 4.74, and 104.77 ± 4.42 mm, respectively. Access to the lateral poststyloid space via an endonasal corridor is feasible, potentially providing an alternative approach to address select lesions extending to this region. The deep temporal nerve has a similar diameter to that of the facial nerve; thus, providing potential reinnervation of the facial nerve.

Carotid Artery Dissection and Aneurysm with Styloid Process Fracture

BACKGROUND

Mechanical stimulation may lead to internal carotid artery (ICA) dissection and aneurysm.

CASE DESCRIPTION

We encountered a rare case of ICA dissection and aneurysm with prolonged styloid process (SP) fracture. A 37-year-old sales worker presented with right-sided amaurosis fugax. After admission to a nearby optical clinic, he was admitted to our hospital. Computed tomography angiography (CTA) and digital subtraction angiography showed dissection and apparent aneurysmal change in the right cervical portion of the ICA. CTA also showed elongated SPs, so we diagnosed Eagle's syndrome, and fracture of the right-side process. After 2 weeks of antiplatelet therapy, the aneurysm enlarged and dissection remained, so we treated the patient with coil embolization and stenting.

CONCLUSION

We encountered a rare case of ICA dissection and aneurysm with Eagle's syndrome. Endovascular treatment was performed because the SP was fractured.

[Dissection of brachiocephalic arteries as a complication of open neurosurgery: case report and literature review]

BACKGROUND

Abnormal styloid processes cause dissection of supra-aortic arteries in some cases. In total, about 33 cases have been described in the world and national literature. However, there were no dissections associated with neurosurgery. At the same time, anomalies of styloid process may be an unidentified cause of many spontaneous dissections of brachiocephalic arteries.

OBJECTIVE

To analyze modern data on dissection of brachiocephalic arteries associated with anomalies of styloid process and describe dissection in a 44-year-old patient with deviated styloid processes after posterior cranial fossa surgery.

MATERIAL AND METHODS

Searching for literature data was performed using the keywords "dissection of the cervicocerebral arteries", "dissection of the brachiocephalic arteries", "stylocarotid syndrome" and "Eagle syndrome" in the PubMed and Medscape databases. We also describe a patient hospitalized for microsurgical resection of cystic-solid hemangioblastoma of medulla oblongata who developed postoperative dissection of both internal carotid and vertebral arteries.

RESULTS

We found 1777 papers between 01/01/1900 and 01/18/2021. In most cases, ICA dissection was not a result of stylocarotid syndrome. There were 121 full-text Russian- or English-language articles. We selected 46 most relevant publications. Analyzing these papers, we found that small distance between the tops of styloid processes and internal carotid arteries can be a risk factor of dissection of brachiocephalic arteries in addition to styloid process elongation. Our patient was diagnosed with just such an anomaly.

CONCLUSION

Anomalies of styloid processes can cause dangerous vascular complications. Therefore, the length and abnormal deviation of styloid process should be considered when planning intraoperative position of a patient associated with prolonged neck flexion.

Simplifying the Surgical Classification and Approach to the Posterolateral Skull Base and Jugular Foramen Using Anatomical Triangles

Introduction Lesions of the jugular foramen (JF) and postero-lateral skull base are difficult to expose and exhibit complex neurovascular relationships. Given their rarity and the increasing use of radiosurgery, neurosurgeons are becoming less experienced with their surgical management. Anatomical factors are crucial in designing the approach to achieve a maximal safe resection. Methods and methods Six cadaveric heads (12 sides) were dissected via combined post-auricular infralabyrinthine and distal transcervical approach with additional anterior transstyloid and posterior far lateral exposures. Contiguous surgical triangles were measured, and contents were analyzed. Thirty-one patients (32 lesions) were treated surgically between 2000 and 2016 through different variations of the retro-auricular distal cervical transtemporal approaches. Results We anatomically reviewed the carotid, stylodigastric, jugular, condylar, suboccipital, deep condylar, mastoid, suprajugular, suprahypoglossal (infrajugular), and infrahypoglossal triangles. Tumors included glomus jugulare, lower cranial nerve schwannomas or neurofibromas, meningiomas, chondrosarcoma, adenocystic carcinoma, plasmacytoma of the occipitocervical joint, and a sarcoid lesion. We classified tumors into extracranial, intradural, intraosseous, and dumbbell-shaped, and analyzed the approach selection for each. Conclusion Jugular foramen and posterolateral skull base lesions can be safely resected through a retro-auricular distal cervical lateral skull base approach, which is customizable to anatomical location and tumor extension by tailoring the involved osteo-muscular triangles.

Eagle's Syndrome as a Cause of Discomfort and the Subjective Presence of a Foreign Body in the Throat

Eagle syndrome consists of symptoms resulting from the elongation and excessive calcification of the styloid process of the temporal bone and calcification of the ligaments associated with this process. The main symptoms of this syndrome are the feeling of a foreign body in the throat, dysphagia and pain localized in the temporomandibular region, neck and ear. The authors describe the case report of a previously healthy 39-year-old Caucasian male that complained of discomfort and foreign body sensation in his throat. Computed tomography (CT) showed the presence of an elongated styloid process bilaterally with clear predomination at the left side. The patient underwent laryngological and surgical consultation. Due to the lack of symptoms related to the compression of the carotid arteries, no surgery was recommended. In summary, Eagle’s syndrome is a rare condition characterized by craniofacial pain or foreign body sensation that should be considered, especially if the pain is unilateral. CT imaging in his case was a perfect tool and enabled a suitable diagnosis of this rare syndrome.

Traumatic Events and Eagle Syndrome: Is There Any Correlation? A Systematic Review

Background: Eagle syndrome occurs when elongated styloid process or ossification of the stylohyoid ligament interfere with the surrounding anatomical structures giving rise to various symptoms. Watt W. Eagle identified two types: stylo-hyoid classic syndrome and stylo-carotid artery syndrome. The aim of this systematic review of the literature is to evaluate correlations between Eagle syndrome and traumatic events or teeth extractions. Methods: out of 294 articles, the final study allowed the identification of 13 studies focusing on traumatic events. Out of 342 articles, the final study allowed the analysis of two studies regarding extractive dental events. Results: 13 articles showed correlations between the onset of symptoms in Eagle syndrome and traumatic events and highlighted two possibilities: traumatic event could fracture the already elongated styloid process or calcified stylohyoid ligament; trauma itself triggers the pathophysiological mechanisms that lead to lengthening of styloid process or calcification of stylohyoid ligament and therefore the typical symptoms. The only two case reports concerning Eagle syndrome symptoms after extractive dental events describe the onset of classic type. Conclusions: The analyzed articles confirm correlation between traumatic event and onset of typical symptoms of Eagle syndrome. There is not enough literature linking extractive dental events to Eagle syndrome. Trial registration: CRD42020185176.

A gross anatomical study of the styloid process of the temporal bone in Japanese cadavers

BACKGROUND

The incidence of an elongated styloid process (SP) and average length and diameter of SP have not been reported using Japanese cadavers. Data on the female-to-male ratio of an elongated SP vary. We calculated the average length and diameter of SP in Japanese cadavers and compared SP lengths between sexes.

MATERIALS AND METHODS

Twenty-seven sides (right and left of bodies) in males and 51 sides in females were analyzed. Measurements were obtained from the inferior external acoustic meatus to the distal tip of the SP. SP diameters at the proximal base, midpoint, and distal tip were measured. SP >30 mm was considered elongated. We used Welch's t-test for the statistical analysis. Fisher's exact two-tailed test was also performed to analyze the female-to-male elongation ratio. A p-value <0.05 was considered statistically significant.

RESULTS

SP elongation prevalence was 29.5% in our sample. The average full length was 27.04±7.88 mm overall; the average diameters were 5.41±1.77 mm at the proximal base and 2.21±1.22 mm at the distal tip. The average SP measurement was 26.81±5.92 mm in males and 27.16±8.79 mm in females (p=0.74). The female-to-male ratio of SP elongation was 1:2 (p=0.041). Females had longer full lengths of non-elongated SPs than males (p=0.004). Males had wider diameters at the proximal base of elongated SPs than females (p=0.017).

CONCLUSIONS

The average length of SP was 27.04 mm in the Japanese population and about 30% of the Japanese presented SP≥30 mm. Male had significantly higher rate than female among the SP≥30 mm, and female had significantly longer SPs than male among the SP<30 mm. Anatomically, the SP gets narrow as distally goes. Our anatomical findings would be beneficial to creating treatment plans, diagnosis, and surgery.

The role of the styloid apophysis of the temporal bone in the biomechanics of the tongue, mandible, hyoid system: a case study

Temporomandibular disorders are characterized by ear pain, tinnitus, difficulty in chewing, dysphagia and dizziness, cervical limitation of range of movement (ROM) and other less common disorders. Numerous recent studies associate the presence of these signs and symptoms with an elongated styloid apophysis, as in the case of Eagle syndrome. The purpose of this clinical case is to support the thesis of a common syndrome that temporomandibular joint (TMJ) disorders with an elongated styloid process affirming the relationship between temporal bone, mandible, hyoid bone and tongue. The patient was a 57-year-old woman who reported having ear algia and tinnitus all on the right side with difficulty chewing accompanied by odynophagia and dysphagia of solid and liquid foods, as well as cervical disorders. Computed tomography (CT) scans of the neck showed elongation and ossification of the styloid processes of the temporal bone. Magnetic resonance imaging (MRI) showed an anterior right dislocation of the TMJ articular disc. The patient presented classic symptoms of temporomandibular disorders, with the primary examinations showing an anterior right dislocation of the articular disc of the TMJ, as well as a longer styloid process on the same side. We therefore suggested that, in this case report, TMJ disorders might be associated with a longer styloid process on the same side.

Eagle's syndrome mimicking dental pain: A case report with a novel surgical approach

PAIN in the craniofacial and neck region can be both intriguing and equally frustrating for the surgeon. This is principally because there is a multitude of related pain syndromes in this region, many of which are lacking in physical signs. Diagnosis then becomes even more dependent on an accurate description of the pain in terms of character, localization, duration, radiation, relieving and exacerbating factors. Familiarity and identification of a more obscure causative factor in a particular case lends itself not only to liberate the patient but also an increased awareness of the practitioner for the need to consider the coinciding minute diagnostic points of otolaryngology, ophthalmology and rhinology besides dentistry and oral surgery. The characteristic elongation of a styloid process may explain some occasions of pharyngeal, ear pain and sometimes headache, which have defied exhaustive diagnostic studies. A large spectrum of signs and symptoms has been mentioned in various reports of Eagle's syndrome. Diagnosis can be made with careful clinical evaluation and confirmed with radiographs showing an elongated styloid process or calcification of the stylohyoid complex. Styloidectomy is the procedural choice for Eagle's syndrome having high success rate. In our case, the intraoral approach for styloidectomy was not the routine one, for which the post-operative outcome was exceptionally good without any complications.

Modified Craniocervical Approach for Resection of the Styloid Process in Patients with Eagle's Syndrome

Objective  Surgical treatment of Eagle's syndrome remains the mainstay of treatment. Palsy of the marginal mandibular branch of the facial nerve is the most significant complication encountered in transcervical resections, due to direct compression during the approach. We proposed a modification of the craniocervical approach to the jugular foramen to resect the styloid process avoiding the marginal mandibular branch and subsequent palsy. Design  This is a single-center retrospective cohort study. Setting  The research was conducted at a tertiary medical center. Participants  From November 2008 to October 2018, 12 patients with Eagle's syndrome underwent treatment using our modified approach. Main Outcome Measures  Demographic data, type of Eagle's syndrome, symptomatic side, size of the styloid process, clinical outcomes, and complications were analyzed. Results  Mean size of the styloid processes was of 3.34 cm on the operated side (2.3-4.7 cm) and 2.98 cm on the other (2-4.2 cm). Intraoperative facial nerve irritation occurred in one case. Resection of the entire styloid process was achieved in all cases. Eight cases experienced complete improvement, three cases had a partial response, and one case failed to improve. There were no cases of recurrence. Two patients presented transient postoperative auricular paresthesia. There were no cases of mandibular branch palsy, nor any other complications in our series. Conclusions  Our modified transcervical approach is effective in avoiding the marginal mandibular branch of the facial nerve, avoiding postoperative palsy.

A computed tomography-based morphometric study of the styloid process

BACKGROUND

The styloid process (SP) refers to a cylindrical piece projecting from the inferior of the temporal bone, situated anterior to the stylomastoid foramen. It is an anatomic formation close to major vessels and nerves, and its excessive elongation results in pathologies leading to anatomical disorders, such as Eagle's syndrome. Several studies have been conducted on SP in relation to its close proximity to vessels and nerves, but there is no study that reveals its distance to important anatomical formations, such as the internal auditory meatus (IAM), carotid canal (CC), cochlea, tegmen tympani (TT) and tragus. In the current study, we aimed to investigate the incidence of Eagle's syndrome based on morphometric measurements of SP.

MATERIALS AND METHODS

The patient files archived in the Radiology Department of Adiyaman University Training and Research Hospital were retrospectively examined. The study was carried out on the data of patients for whom specialist radiologists found no pathology findings on the computed tomography images. A total of 77 individuals (36 females and 41 males) aged 22 to 54 years were included in the study. The length of SP and its distances to IAM, cochlea, CC, TT and tragus were obtained using computed tomography radiological measurements.

RESULTS

When the individual measurements performed on computed tomography images were evaluated in men and women, no significant difference was found concerning the distance between SP and various anatomic structures in close proximity to SP (p > 0.05). However, there was a statistically significant difference between the genders in length of the right SP (p = 0.003) and left SP (p = 0.006).

CONCLUSIONS

This anthropometric study revealed the standard morphometric measurements of SP. We believe that the data obtained will help clinicians to identify and diagnose pathologies more easily.

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.

Deconstruction of the Surgical Approach to the Jugular Foramen Region: Anatomical Study

Introduction  The jugular foramen occupies a complex and deep location between the skull base and the distal-lateral-cervical region. We propose a morphometric anatomical model to deconstruct its surgical anatomy and offer various quantifiable target-guided exposures and angles-of-attack. Methods  Six cadaveric heads (12 sides) were dissected using a combined postauricular infralabyrinthine and distal transcervical approach with additional anterior transstyloid and posterior far lateral exposures. We identified anatomical landmarks and combined new and previously described contiguous triangles to expose the region; we defined the jugular and deep condylar triangles. Angles-of-attack to the jugular foramen were measured after removing the digastric muscle, styloid process, rectus capitis lateralis, and occipital condyle. Results  Removing the digastric muscle and styloid process allowed 86.4° laterally and 85.5° anteriorly, respectively. Resecting the rectus capitis lateralis and jugular process provided the largest angle-of-attack (108.4° posteriorly). The occipital condyle can be drilled in the deep condylar triangle only adding 30.4° medially. A purely lateral approach provided a total of 280.3°. Cutting the jugular ring and mobilizing the vein can further expand the medial exposure. Conclusion  The microsurgical anatomy of the jugular foramen can be deconstructed using a morphometric model, permitting a surgical approach customized to the pathology of interest.

Ultrasound-guided glossopharyngeal nerve block via the styloid process for glossopharyngeal neuralgia: a retrospective study

Objective

To examine the effectiveness and safety of ultrasound-guided glossopharyngeal nerve block via the styloid process for primary glossopharyngeal neuralgia.

Methods

This retrospective study included all patients receiving glossopharyngeal nerve block via the styloid process under ultrasound guidance for primary glossopharyngeal neuralgia between January 2015 and May 2018 at our hospital. The primary outcome of the study was pain relief as assessed using the visual analog scale (VAS). Treatment was considered effective if the VAS score decreased by more than 2 points.

Results

Twelve patients were included in the analysis. The baseline VAS scores ranged from 5 to 9. All patients received previous pharmacotherapy. Other previous treatments included pulsed mode radiofrequency (n=4), microvascular decompression (n=2), and glossopharyngeal nerve block (not under ultrasound guidance; n=2). The patients completed a total of 48 injections for glossopharyngeal nerve block. At discharge from the hospital, and at 6, 12, and 18 months thereafter, 10/12, 10/12, 7/12, and 4/12 patients achieved pain relief and the effective rate was 83.3% at discharge, 83.3% at 6 months, 58.3% at 1 year, and 33.3% at 18 months, respectively.

Conclusion

Ultrasound-guided glossopharyngeal nerve block via the styloid process is a safe, radiation-free, repeatable, convenient, and effective treatment. It can provide a treatment option for patients with glossopharyngeal neuralgia.

Evaluation of Styloid Process and Its Anatomical Variations: A Digital Panoramic Study with Systematic Review

Aims and Objectives:

To evaluate the styloid process (SP) and its anatomical variations on digital panoramic radiographs from the database and also to synthesize the current evidence of literature on SP and anatomical variations along with the systematic review of the relevant studies after making the necessary exclusions.

Materials and Methods:

A total of 500 panoramic radiographs from the database were examined and evaluated for the length of SP using OmniVue software and for the calcification patterns which were categorized into three types as described by Langlais. The obtained values were analyzed using t-test and Chi-square tests with a significance level of 0.005 and SPSS version 20.0 software.

Results and Conclusion:

The mean length of the SP in females was found to be 3.7 cm on the right side and 3.8 cm on the left side. The mean length of the SP in males was found to be 3.4 cm on the right side and 3.3 cm on the left side with significant difference between the genders with the P values of 0.0002 and 0.0001, respectively. The length of the SP was significantly longer in females than in males. Type I was the most common SP and was more prevalent in females. The results of the present study along with the wide range of reported incidence of anatomical variations in the form of elongation from the literature extracted through the systematic review suggests the need to reevaluate the range of the normal length of the SP.

Assessment of surgical treatment of Eagle's syndrome

INTRODUCTION

The aim of the study was to assess the effectiveness of surgical treatment of patients with Eagle's syndrome, taking into account both early and late results.

MATERIAL AND METHODS

The study group consisted of 15 patients who underwent resection of the styloid process due to Eagle syndrome in the period of 2005-2017. During the follow-up visit, the patients were asked to fill in a post-operative questionnaire that compared the pre-operative symptoms and their severity with the patients' current health condition. The VAS pain scale was used to assess each symptom, and the Laitinen scale was used to assess the quality of life. Data from patients' medical records were also included. The results of the surveys were subjected to statistical analysis.

RESULTS

The study showed that in 11 out of 15 cases there was a significant improvement in the level of pain (70.5% on average) and an improvement in quality of life (on average 65%) comparing to the pre-operative condition. The Wilcoxon test for binding pairs, the Mann-Whitney test, the Kruskal-Wallis test and the Spearman correlation coefficient were used in the statistical analysis. There were statistically significant correlations between the recorded improvement rate and the length of the resected styloid process and its setting.

DISCUSSION

The study proved that resection of prolonged styloid process from extraoral approach in most cases is an effective method of treatment of Eagle syndrome, that carries low risk of complications.

Investigation of the styloid process length in a Greek population

BACKGROUND

The styloid process (SP) is a slender cylindrical bony projection of the temporal bone with 2 ligaments and 3 muscles attached to it. Symptomatic SP elongation is also referred to, as Eagle's syndrome. The aim of the present study is to investigate the distribution of the SP length in a young adult Greek population.

MATERIALS AND METHODS

Moreover, we provide a comparison of the results by using two different methods for assessing SP elongation, as described in the lite- rature. Finally, we explore the possibility of using orthopantomograms (OPGs), as a diagnostic aid by investigating inter-examiner, intra-examiner and inter-exami- nation variability and we propose a limit for SP elongation measurable in OPGs.

RESULTS

The sample comprised 805 digital OPGs, taken from student pilots and engineers entering the Hellenic Air Force Academy, from 2008 onwards. Two measuring approaches were selected, one using the temporal bone, as a cranial landmark and the other, using the external auditory meatus. The end tip of the process was always the caudal landmark. The mean SP length was 28.42 ± ± 8.48 mm in males and 26.04 ± 7.69 mm in females, when measured from the temporal bone. The mean SP length was 38.35 ± 8.90 mm in males and 34.24 ± ± 8.63 mm in females, when measured from the external auditory meatus. The length of 30 mm is most commonly used as a starting point for SP elongation. In the total sample, 30.6% of the measured SPs exceeded the length of 30 mm. In males, 33.12% of the SPs were elongated; while in females the corresponding incidence was 20%. One hundred and nineteen (14.8%) SPs were not traceable.

CONCLUSIONS

The SP is typically detectable and measurable in OPGs. An elonga- ted SP should be kept in mind, since symptoms of elongation may overlap with clinical manifestations of temporomandibular joint disorders.

Ischemic Stroke Secondary to Stylocarotid Variant of Eagle Syndrome

Eagle syndrome is a rare cause of stroke and results as a complication of the elongated styloid process (ESP), which can cause carotid dissection and consequent ischemic stroke. We report a case of a 42-year-old woman with a past medical history of rheumatoid arthritis who developed left hemispheric ischemic stroke after deep tissue massage. Imaging studies revealed an intimal tear of the left carotid artery bulb and bilaterally ESPs, measuring approximately 6 cm on the right and 4.5 cm on the left. It seems that direct vascular compromise by the anomalous styloid process was the cause of her carotid artery dissection and stroke. Moreover, neck manipulation may have been a contributing factor.

Anatomical characteristics of the styloid process in internal carotid artery dissection: Case-control study

Introduction Pathophysiology of cervical artery dissection is complex and poorly understood. In addition to well-known causative and predisposing factors, including major trauma and monogenic connective tissue disorders, morphological characteristics of the styloid process have been recently recognized as a possible risk factor for cervical internal carotid artery dissection. Aims To study the association of the anatomical characteristics of styloid process with internal carotid artery dissection. Methods Retrospective, multicenter, case-control study of patients with internal carotid artery dissection and age- and sex-matched controls. Consecutive patients with internal carotid artery dissection and controls with ischemic stroke or transient ischemic attack of any etiology excluding internal carotid artery dissection, who had performed computed tomography angiography, diagnosed between January 2010 and September 2016. Two independent observers measured styloid process length and styloid process distance to internal carotid artery. Results Sixty-two patients with internal carotid artery dissection and 70 controls were included. Interobserver agreement was good for styloid process length and styloid process-internal carotid artery distance (interclass correlation coefficient = 0.89 and 0.76, respectively). Styloid process ipsilateral to dissection was longer than left and right styloid process in controls (35.8 ± 14.4 mm versus 30.4 ± 8.9 mm and 30.3 ± 8.2 mm, p = 0.011 and p = 0.008, respectively). Styloid process-internal carotid artery distance ipsilateral to dissection was shorter than left and right distance in controls (6.3 ± 1.9 mm versus 7.2 ± 2.1 mm and 7.0 ± 2.3 mm, p = 0.003 and p = 0.026, respectively). Internal carotid artery dissection was associated with styloid process length (odds ratio = 1.04 mm^-1, 95% confidence interval = 1.01-1.08, p = 0.015) and styloid process-internal carotid artery distance (OR = 0.77 mm^-1, 95% confidence interval = 0.64-0.92, p = 0.004). Conclusion Longer styloid process and shorter distance between styloid process and cervical internal carotid artery are associated with cervical internal carotid artery dissection.

A Case of a Very Elongated Styloid Process

Eagle syndrome is characterized by recurrent pain in the oropharynx and face due to an elongated styloid process or calcified stylohyoid ligament. In this article, we experienced a case of an elongated styloid process which is very rare in size and detailed treatment process. The patient was a 53-year-old Chinese woman with a chief complaint of frequent episodes of radiating pain in left preauricular region for 2 years. An intraoral approach was chosen to shorten part of her styloid process, and the chief complaint disappeared immediately after the operation.

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.

Eagle syndrome

Although rare, Eagle syndrome should be always considered in the differential diagnosis in patients with chronic orofacial pain refractory to conventional treatments. Treatment is surgery and exeresis of the styloid process via a transoral or cervical approach depending on clinical and radiological features.

Eagle's syndrome veiling as pain of odontogenic origin: Report of two cases with cone beam computed tomography illustration

Eagle's syndrome, also known as an elongated styloid process, is a condition that may be the source of craniofacial and cervical pain. It is infrequently reported but is probably more common than generally considered. The symptoms related to Eagle's syndrome can be confused with those attributed to a wide variety of facial neuralgia and or oral, dental, and temporomandibular joint diseases. In this paper, there are two cases, which reported to the Department of Oral Medicine, Diagnosis, and Maxillofacial Radiology, with a chief complaint of radiating pain in the preauricular region of the face. After radiographic investigation, these cases are considered as a case of Eagle's syndrome because of increase in the size of the styloid process.

An unusual etiology of posttraumatic Collet-Sicard Syndrome: a case report

Posttraumatic Unilateral paralysis of the last four cranial nerves (IX-XI), known as collet-Sicard syndrome, is rare following closed head injury. A 21-year-old man presented with slurred speech, hoarseness voice and difficulty swallowing his saliva following closed head trauma. The cranial nerve examination revealed left sided severe dysfunction of cranial nerves VII, IX, X, XI, and XII. A CT-Scan of the neck was performed demonstrating a fracture of the left styloid process at the base of the skull. The Magnetic Resonance Imaging showed unusually well seen lower cranial nerves due to nerve edema. The patient was managed conservatively with steroids and regular sessions of neuromuscular and orthophonic rehabilitation. The nutrition had to be administered by gastrostomy since he was unable to swallow. Six months after the injury a total neurological recovery was noted. We present the exceptional case of Collet-Sicard Syndrome caused by styloid process fracture.

A case of elongated styloid process in a modern-age skull from Puerto Cabello, Venezuela

BACKGROUND

The styloid process (SP) arises from cartilage of the second branchial arch and tends to calcify during later life. If the length of the SP is more than 30 mm, it can be considered abnormally elongated. Clinical symptoms associated with elongation of this type are defined as Eagle's syndrome. The paper presents a case of an elongated SP in a modern skull from Puerto Cabello, Venezuela, obtained from a series of skulls of African slaves kept at the Department of Anthropology, Polish Academy of Sciences in Wroclaw.

MATERIALS AND METHODS

The skull belonged to a male individual, aged ca. 55 years at death (maturus). In terms of basic anthropometric features it had slightly greater facial width parameters in comparison to the cerebral part, and a shorter length of neurocranium when compared to average values of morphological features in African skulls from Uganda.

RESULTS

Further macroscopic analysis revealed the presence of an elongated SP (ca. 70.1 mm) with secondary lesions remaining after a healed fracture. Imaging of the bone structure of the elongated SP was carried out using a computed to-mography scan, with multilevel image analysis without contrast. The elongation and calcification of the left ligament in anterior orientation could have caused irritation to the structure of cranial nerves, running within the parapharyngeal space, and to sympathetic fibres running in the wall of cervical arteries.

CONCLUSIONS

Analyses of craniological materials recovered during excavations or as part of old osteological collections are rare due to the fragility of this bone structure, and for that reason they may be a valuable source of information on the health status of historic human populations.

Eagle's syndrome - Masquerading as ear pain: Review of literature

The name styloid process (SP) was derived from the Greek word "stylos" meaning a pillar. It is a bony, cylindrical, needle-shaped projection, which originates from the posterior-inferior side of the petrous bone, immediately in front of the stylomastoid foramen, and goes obliquely down and forward. When elongated leads to pain and discomfort called Eagle's syndrome. Elongated SP accounts approximately to 4-7% of the population, 4% only are symptomatic.

Styloid/C1 transverse process juxtaposition as a cause of Eagle's syndrome

BACKGROUND

The purpose of this case report was to characterize styloid/C1 transverse process juxtaposition as a cause for Eagle's syndrome.

METHODS AND RESULTS

A case series was conducted with a chart review of 5 patients with radiographic evidence of jugular vein compression who underwent styloid process excision between 2010 and 2013. There were 4 men and 1 woman, aged 35 to 62 years (mean, 46 years). Cervicalgia (4 of 5 patients) and otalgia (4 of 5 patients) were the most commonly reported symptoms. Styloid process length ranged from 2.4 to 8.5 cm. The distance between the styloid process and the transverse process of C1 ranged from 0.05 to 0.46 cm. All patients underwent a transcervical approach for the excision of the styloid process with immediate postoperative resolution of symptoms and good cosmetic results.

CONCLUSIONS

Styloid/C1 transverse process juxtaposition can produce symptoms of cervicalgia and otalgia even in the setting of a normal length styloid process. The transcervical approach is safe and effective for excision of the styloid process and has good functional and cosmetic results.

Easy and Safe Method for Facial Nerve Identification in Parotid Surgery

Background A safe and easy anatomical landmark is proposed to identify the facial nerve in parotid surgery. The facial nerve forms the center point between the base of the styloid process and the origin of the posterior belly of the digastric muscle. Objective To evaluate the consistency, accuracy, and safety of the landmark in identifying the facial nerve. Methods The study was designed in three steps: a cadaver study, a radiologic study, and a prospective clinical study. Anatomy was initially studied in two cadavers. Then the images of 200 temporal styloid regions were studied for consistency of the presence of the styloid base. In the second part of the radiologic study, the distance between the styloid base and the origin of the posterior belly of the digastric muscle was studied in 50 parotid regions. The clinical study involved 25 patients who underwent parotidectomy. Results The styloid base was present in all the images studied. The mean distance between the styloid base and the origin of the posterior belly of the digastric was found to be 0.72 cm (range: 0.45-0.99 cm). The facial nerve could be identified consistently and safely in all patients. Conclusion This trident landmark provided safe, accurate, and easy identification of the facial nerve using two fixed bony landmarks.

Transoral endoscopic-assisted styloidectomy: How should Eagle syndrome be managed surgically?

Eagle syndrome, or calcification of the stylohyoid ligament, is a rare condition that may present a clinical diagnostic dilemma for those unfamiliar with its existence and its typical presenting signs and symptoms. Management of this disease process may involve either non-surgical or surgical treatment options. When surgery is indicated, the choice of a specific surgical modality is highly variable and is generally dependent upon individual surgeon preference and experience, since the location of the styloid process is consistent between patients, and the required surgical access is also similar depending upon the specific surgical plan. This paper reports a case of Eagle syndrome managed with a transoral endoscopic-assisted approach, explores the advantages and disadvantages of each surgical approach, and reviews the literature regarding surgical management options for Eagle syndrome.

The Origin of the Variations of the Hyoid Apparatus in Human

Currently, theories based on acquired calcification of the stylohyoid ligament are believed to be a pathogenesis of syndromes associated with the hyoid apparatus (HA) and its variations. We studied the development of the HA from Reichert´s cartilage using serial sections of 25 human embryos and 45 fetuses. We ensured a fact that, at the initial stage, the HA appeared as two independent cartilage segments, that is, the cranial or styloid segment and the caudal or hyoid segment of Reichert's cartilage, those are connected by a mesenchymal structure. However, between 8 and 10 weeks of development, the mesenchymal connection was lost. We hypothesize that this disconnection is likely to be one of the major factors to make a descent of the hyoid bone in evolution. The stylohyoid ligament was not observed. The variations of the HA, should be considered variations of the development of Reicherts cartilage. If these variations are maintained in the adult, are likely to explain a major symptom associated with Eagle's syndrome.

Carotid type of Eagle's syndrome

Eyes don't see what mind does not know. It is important for a clinician to refresh his knowledge frequently to recognize some of the conditions that one may come across rarely no matter how insignificant the condition may seem. Especially in a dental outpatient department setting, individuals may complain of varied symptoms which the clinician, often tends to correlate to one of the oral diseases. We present a case of Eagle's syndrome with vague clinical presentation which could have easily gone undiagnosed if not for the application of simple diagnostic procedures and aids like Orthopantamogram (OPG).

Conventional and 3-Dimensional Computerized Tomography in Eagle's Syndrome, Glossopharyngeal Neuralgia, and Asymptomatic Controls

OBJECTIVE

Eagle's syndrome (ES) is an aggregate of symptoms, including recurrent throat pain, foreign body sensation, dysphagia, or facial pain related to an elongated styloid process (SP). It resembles glossopharyngeal neuralgia and has been linked to irritation of the glossopharyngeal nerve. This study was designed to determine whether computerized tomography (CT) imaging of the stylohyoid chain (SHC) differs between asymptomatic controls (ACs), patients with glossopharyngeal neuralgia (GN), and patients with ES.

STUDY DESIGN

Case series with chart review.

SETTING

Tertiary otolaryngology practice.

SUBJECTS AND METHODS

Conventional and 3-dimensional CT reconstructions of the SHC were reviewed for 10 ES, 17 GN, and 30 AC patients. Demographic and clinical symptom data were recorded. Anatomic data collected from CT scans included length of the ossified SP, anterior-posterior and medial-lateral styloid process angulation, ossification pattern of the SHC, and minimum distances between the SP tip, the internal carotid artery, and the tonsillar fossa.

RESULTS

The average distance from the SP tip to the tonsillar fossa was significantly shorter in ES (12.7 mm) compared with GN (21.4 mm; P = .027) or AC (24.8 mm; P < .0005) patients. No other variables were significantly different between groups, including average SP length (ES: 48.0 vs GN: 40.3 vs AC: 40 mm; P > .05).

CONCLUSION

The SP was significantly closer to the tonsillar fossa in patients with ES compared with ACs. No significant differences were found in other measures. Distance to the tonsillar fossa may be a more appropriate diagnostic criterion for ES than SP length and may contribute to the pathophysiology of ES.

Elongated styloid process: A study

The styloid process (SP) on the temporal bone is a highly variable formation. The normal length of the SP ranges from 20 to 30 mm. In spite of its being normally distributed in the population, SPs could be divided into two groups - short SPs with >20 mm and long SPs with <20 mm in length. The SP is often denoted as elongated when it is longer than 30 mm or 33 mm. These dimensions, based on early reports, do not respect the natural variation of the SP. The aim of this study is to investigate the natural variation of the length of the SP.

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.

Facial pain due to elongated styloid process

Pain is the most frequent cause of suffering and disability. The etiology of orofacial pain is still elusive. However, the etiology has to be ascertained for definitive treatment. Only after a systematic and careful evaluation can a treating surgeon be aware of the underlying cause. Though dental causes predominate in the diagnosis of orofacial pain, the rare cause of facial pain have to be excluded, which would prevent unnecessary and fruitless dental treatment. The present case is an example of a rare condition that may be overlooked during examination. This paper will describe a case of vague unilateral orofacial pain, the diagnosis of which zeroed down to an elongated styloid process.

Fracture of the styloid process associated with the mandible fracture

Fracture of the styloid process (SP) of temporal bone is an uncommon injuries. Fracture of the SP can be associated with the facial injuries including mandible fracture. However, injury to the SP may be concealed and missed diagnosis may lead to the improper or various unnecessary treatments. A rare case of SP fracture associated with the ipsilateral mandibular fracture and also the diagnostic and management considerations of the SP fracture are discussed.

Eagle's syndrome: A rare case of young female

Eagle's syndrome is a condition that causes pain in the Craniofacial and cervical region of the neck. Symptoms related to the Eagle's syndrome may be confused with the variety of neuralgias, oral, dental and temporomandibular joint (TMJ) conditions. In this paper, a case of the very young female suffering with the difficulty in swallowing and recurrent dull pain in the throat with restriction of the movement of head to the left side was presented. A thorough past medical and dental history, extra oral and intra oral examination coupled with the panoramic radiographic interpretation were used to diagnose Eagle's syndrome.

Relationship between the elongated styloid process in panoramic radiographs and some of the general health conditions in patients over 40 years of age in the Iranian population

BACKGROUND

The styloid process and the attached ligaments have the potential for calcification and ossification in specific conditions. The purpose of this study was to evaluate the relationship between the elongated styloid process (ESP) frequency and some of the systemic health factors of patients over 40 years of age.

MATERIALS AND METHODS

In this analytical-descriptive study, 296 panoramic radiographs of patients over 40 years of age (165 female and 131 male) referred to the Dental School of Khorasgan Azad University were selected. The length of the styloid process was measured by a special ruler and recorded in a questionnaire form. Other data such as sex, age, height, weight, blood pressure, heartbeat and the number of teeth present in the mouth were also recorded. The lengths equal to or more than 30 mm on the radiographs were considered as ESP. Data analysis were done by independent t-test, Pearson correlation coefficient and Chi-square test at a significance level of < 0.05.

RESULTS

ESP was observed in 135 cases (45.6%). There was a significant relationship between ESP and the body height, weight and the blood pressure, but there was no significant correlation between ESP, the heartbeat and the number of teeth present in the mouth.

CONCLUSION

Because of the significant relationship between the length of the styloid process and the blood pressure, height and weight it is reasonable to evaluate a patient's systemic health conditions when radiographic signs of ESP are observed.

Evaluation of the styloid process on digital panoramic radiographs

Background:

The styloid process is an anatomical structure, whose clinical importance is not well understood. Proper clinical and radiographic evaluation can detect an elongated styloid process and calcification of the stylohyoid ligament. It has been reported that 2 – 28% of the general population show radiographic evidence of mineralization of a portion of the stylohyoid chain. The elongated styloid process may be symptomatic in many cases. Panoramic radiography is the best imaging modality to view the styloid process bilaterally.

Aim:

To assess the styloid process on digital panoramic radiographs.

Materials and Methods:

The study was conducted on 500 digital panoramic radiographs available in the archives of our department as soft copies. These radiographs were taken using a digital panoramic system. The radiographic length of the styloid process was measured on both sides using the measurement toolbars on the accompanying analysis software. For statistical analysis we used the unpaired t test, Chi-square test, and one-way ANOVA test, as necessary.

Results:

The average length of the left styloid was 25.41 ± 6.32 mm and that of the right styloid was 25.53 ± 6.62 mm. The length of both styloids increased with age and males had longer styloids than females. Elongated styloids were present in 19.4% of the panoramic radiographs. Langlais type I elongated styloids and a partial calcification pattern were more common than others.

Conclusion:

Panoramic radiography is useful for detection of an elongated styloid process and / or ossification of the stylohyoid ligament in patients with or without symptoms, and helps avoid a misdiagnosis of tonsillar pain or pain of dental, pharyngeal, or muscular origin.

Epidermal inclusion cyst of the styloid process: a case report

We report an unusual case of epidermal inclusion cyst of the styloid process which presented to us with decreased hearing and tinnitus. The patient underwent complete excision via a combined postaural cervical approach. The unusual location of the tumor and the absence of a history of trauma or intervention in that area added confusion to the diagnosis, which was finally made on histopathology.