Roentgenologic Visualization of the Fractured Temporal Styloid Process

Abstract

Fracture of the temporal styloid process may occur in diffuse head and neck injuries or in the operative removal of the palatine tonsils. In the former event, it is but a single incident in a group of more important injuries. These may include fractures of the skull and of the cervical spine, atlanto-axial subluxation, sprain of the neck, loosening or tearing of the meniscus of the temporomandibular joint, and fractures or other injuries elsewhere. Fracture of the styloid process may be suspected when the patient has difficulty in swallowing or experiences pain between the mastoid process and mandibular condyle. The styloid process of the temporal bone develops from two centers of ossification and may consequently be bipartite or multipartite. Its roentgenologic demonstration is often difficult, usually only the lower part being seen. It may be adequately shown in the open-mouth view of the edentulous patient (Fig. 1). Pancoast, Pendergrass, and Schaeffer, in their book on roentgen examination of the head and neck, stated that the bone is easily seen in posterior-anterior roentgenograms, especially those used for the examination of the maxillary sinuses. A lateral view of the nasopharynx and upper neck also shows it well. If the head is rotated a little, the two styloids are dissociated from each other. We became interested in the roentgenologic visualization of the styloid process in connection with the following case, and a radiographic technic to show the full length of the bone was devised. Case I: J. V., male, 30 years old, was struck on the left side of his head by the swinging doors of a speeding truck on March 19, 1940. The blow was a glancing one to the left frontal region, the skin being lacerated at that point. The patient was thrown to the ground so that he struck the right side of his head. He was unconscious for several hours and remained in a hospital for one day. Two neurologists who examined him because of constant dizziness and headaches agreed that he had sustained a cerebral concussion (with probable encephalopathy and right facial paresis). No roentgenographic signs of fracture of the skull were found. Some teeth and a denture were broken. Severe pain occurred in the region of the right mastoid process when the jaw was shifted to the left, increasing in intensity when the same maneuver was done with the mouth open. Because of this, roentgenograms were taken of the jaw by the patient's dentist, Dr. H. H. Kaplan, Jr., and a fracture of the styloid process was revealed. When the case first came to our attention April 15, 1940, pain still persisted. It had become dull but constant, with occipital radiation. With the mouth open 1/2 inch, and with no deviation of the jaw, pain was experienced in the region of the fracture. The patient heard a cracking sound in the right temporomandibular joint when he opened his mouth or when he ate hard food.