Elongated Styloid Process Research Articles

Elongated styloid process: planning the surgical approach using a three-dimensional jaw bone model

Elongated styloid process: planning the surgical approach using a three-dimensional jaw bone model

Is elongated styloid process a potential forewarning for failure in oral submucous fibrosis management?

<p class="abstract">Oral submucous fibrosis is a widespread, premalignant disorder causing severe difficulty in mastication and speech. With high rate of malignant conversion, it demands aggressive surgical therapy followed by mandatory long-term physiotherapy. An elongated styloid process, if present, could pose a strong hindrance to movement of mandible, leading to complete relapse of trismus in such cases. The purpose of this report is to elaborate on such co-existence in patients having oral submucous fibrosis using digital orthopantomogram. 3 patients suspected to have an elongated styloid process were referred to maxillofacial surgical unit and diagnosed with grade 4A oral submucous fibrosis. Digital orthopantomogram revealed elongated styloid process which was measured using the C. S. imaging software 7.0.3. Consequently, patients were operated by a team of maxillofacial surgeons and otolaryngologists to relieve trismus and tonsillo-styloidectomy respectively. The measured lengths of the styloid process on digital orthopantomogram were considered elongated, if exceeding the normal length of 30 mm. The measured lengths of the styloid process were found to be at 52.7 mm, 50.1 mm and 57 mm on the right side and 51 mm, 46.8 mm and 37 mm on left side respectively in our cases. These elongated styloid processes observed in all three cases of submucous fibrosis indicates that progressive fibrosis may exert significant influence on the ossification of styloid complex. Hence, a routine preoperative screening in all patients of oral submucous fibrosis is imminent to avoid postoperative failure, pain or discomfort to the patient owing to an elongated styloid process. </p>

Incidental findings detected with panoramic radiography: prevalence calculated on a sample of 2017 cases treated at a major Italian trauma and cancer centre

ObjectivesThis study aimed to assess the prevalence of incidental findings, not strictly related to dentistry, viewed with panoramic radiography.MethodsPanoramic radiographs performed between December 2013 and June 2016 were retrospectively collected. These images were analyzed, searching for incidental findings. All the information collected was statistically analysedResultsA total of 2307 Panoramic Radiograph were analyzed and 2017 of them were included in the study. 529 incidental findings were seen: 255 (48.2%) were ESP (Elongation of Styloid Process), 167 were CAC (Carotid Artery Calcification) (31.57%), 36 were maxillary sinus pathologies (6.8%) and 71 were other incidental findings (13.42%). The total prevalence of IF was 26, 23%., CAC was 8.28% in the total population, and it was higher in women (9.82%) than men (6.54%). 48.5% of CAC were bilateral. When unilateral, the right side showed a higher right side prevalence. The prevalence of ESP was 12.64% in total population (men: 13.82%; women: 11.60%). 84.71% of ESP were bilateral and, when present unilaterally, no side difference was seen. 13.33% of the ESP appeared segmented. The prevalence of maxillary sinus pathologies was 1.78% (men: 2.32%; women: 1.31%). Only 8.33% of these pathologies were bilateral, and, when unilateral, they were mostly present on the right side. Between the 71 other IF (prevalence: 3.52%), sialoliths and tonsilloliths were assessed most frequently.ConclusionDue to the high prevalence of incidental findings detected with panoramic radiography, dental practitioners should be aware of the various pathologic conditions seen on the panoramic radiographs.

Evaluation of Eagle's Syndrome and Assessment of Post-operative Outcome of Excision of Elongated Styloid Process: A Prospective Study, in Tertiary Care Centre, India.

Eagle's syndrome is one of the commonly overlooked cause of foreign body sensation in throat with referred otalgia. Incidence of symptomatic cases was rare. Elongated Styloid process may present with myriad symptoms. The diagnosis needs a cautious approach and the management is mainly aimed at reduction of the length of elongated section. Prospective study in the Department of ENT Stanley Medical College, Chennai. Study period-January 2018 to September 2018. Clinical examination followed by radiological investigations done to confirm the diagnosis. Stylo-tonsillectomy was done in the selected 20 subjects and post-operative outcomes were compared with pre-operative questionnaires. The progression of symptoms were evaluated for resolution and studied. Pharyngeal symptoms are more common. The length of styloid is associated with symptom complex presentation. The incidence was 0.17% in general population coming to ENT OPD and more common among women with mean age of 43years. Bilateral presentation was more common and the longest length recorded in the study was 78mm. Single investigation is not enough to confirm the diagnosis. A minimum of two investigations are needed for planning surgical management. Intra-oral approach with stylo-tonsillectomy was done with no major complications in post-operative period. Pre-operative symptoms were recoreded by use of McGill's pain questionnaire and compared with post-operative scores. Dysphagia was the major post-operative early symptom which took a week minimum to subside. Clinical findings and atleast 2 imaging studies needed for diagnosis of the disorder. OPG though economical can be aided to great extent by use of Conebeam CT or 3D CT to study the elongated styloid process. Stylo-tonsillectomy is a safer approach with minimum complications and earlier relief of pre-operative symptoms. Surgical management with reduction of length of elongated styloid followed by adequate analgesia remains mainstay in treatment.

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.

Oral Submucous Fibrosis and Elongated Styloid Process - Do they have an Alarming Inter-Connection?

Oral Submucous Fibrosis and Elongated Styloid Process - Do they have an Alarming Inter-Connection?

Styloidectomy: our experience with intraoral approach

<p><strong>Background:</strong> Eagle’s syndrome is a symptom complex arising due to elongated styloid process or calcification of stylohyoid ligament. Surgical treatment is regarded as the foremost option. The study aims to put forth our experience with intraoral approach to styloidectomy in 17 subjects.</p><p><strong>Methods:</strong> A retrospective study was conducted between January 2017 to December 2019. The study included 17 subjects with a diagnosis of elongated styloid process. All the subjects underwent styloidectomy by intraoral approach and were followed up.</p><p><strong>Results:</strong> In our study, the median age of the study group was 33.76 and out of 17 subjects 13 were female and 4 male. The procedure was done under local anesthesia in 13 subjects and under general anesthesia in 4 subjects. Styloidectomy by intraoral approach was done in all subjects among which 15 were bilateral and 2 unilateral. 88% of the subjects were symptom free by third week.</p><p><strong>Conclusions:</strong> The study suggests that styloidectomy by intraoral approach is minimally invasive and can be done under local anesthesia with an added advantage of quick recovery.<strong></strong></p>

Paratonsilar Approach to Styloid Process in Eagle's Syndrome-A Retrospective Analysis.

Eagle's syndrome, defined by Eagle in 1949, is characterised by morphological abnormality/ossification of the styloid process. Traditionally styloid process is approached after tonsillectomy or through an invasive external cervical approach. In the present study we propose a novel Paratonsillar approach for elongated styloid process in eagle's syndrome. The study was retrospective analysis of the medical records of patients who underwent styloid process excision through paratonsillar approach over 2years period. The present study included 26 patients who underwent paratonsillar styloid process excision. Elongated styloid process was mostly prevalent in the middle age group 30-50years constituting 73% of patients included in our study. 65% patients had symptomatic elongated on the right side and 35% had on left side. In 62% patients the procedure was over in 15-30min. There was no documented post operative complication. Paratonsillar approach for styloid process excision is a safe, minimally invasive, day care procedure with almost no postoperative complications.

Styloid process elongation in a sample of Lebanese population: a consideration for the prevention of Eagle syndrome.

BackgroundThe objective of this study was to investigate the prevalence and patterns of styloid process elongation in a general Lebanese population sample.MethodsDigital panoramic radiographs of 489 Lebanese adults (218 males and 271 females, mean age of 47.56 ± 16.149) were included in this retrospective study. First, we screened for detection of elongated styloid process, then we analyzed these cases and classified the elongation types. Data obtained were transformed into SPSS v24 and descriptive and inferential analyses were done.ResultsIn our sample, elongated styloid process was seen in 76 cases (15.5%) (45/271 women and 31/218 men). Despite no significant gender predisposition, females were slightly more affected than males (59.2% females to 40.8% males). As for the age, elongation was significantly more likely to be present at 45–64 years of age. The right side was slightly more affected than the left side (86.8% vs. 76.3% respectively), with type 1 elongation as the most common. Nevertheless, bilateral elongation was much more common than unilateral elongation (63.2%).Interestingly, females were more likely to suffer from bilateral elongation (64.58%) compared to men (35.41%).ConclusionElongated styloid process represents a common finding detected fortuitously on panoramic radiographs. Therefore, being a main feature in Eagle syndrome, dentists should be aware of this clinical entity and actively screen for it.

Elongated styloid process in a dry human skull and its relation to the Eagle’s Syndrome: case report and biometrical assessment

The purpose of the present study was to report a case of an elongated styloid process in a dry human skull and present its biometrical values. The styloid processes of the skull from an 80-year-old Brazilian female individual were inspected and 10 measures were performed bilaterally. Despite small differences between the right and left styloid processes regarding the antero-posterior and lateral-medial widths on the three thirds measured, one must highlight the considerable differences showed on the total length of the styloid process (left side: 65.94; right side: 28.90) and on the length of the sheath of the styloid process, which was of 30.01mm on the left side and it was not acquired on the right side because of its small dimensions. The paper discusses its findings from an anatomical and clinical perspectives, providing anatomical basis for a better understanding of the Eagle’s syndrome.

Own experience in the diagnosis and treatment of elongated styloid process syndrome.

<b>Introduction:</b> The aim of the study was to present selected cases with Eagle's syndrome diagnosed and treated at the Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics, Medical University of Lodz, in the years 2016-2020. <br><b>Material and method:</b> Five selected clinical cases with Eagle's syndrome are presented, including three male patients and two female patients, aged 28 to 42 years. <br><b>Results:</b> The prevalence of Eagle's syndrome was similar for both female and male patients. The carotid artery syndrome, which is characterized by: visual disturbances, unilateral pain located along cervical vessels, headache and migraine, was more common. Lack of proper diagnosis of Eagle's syndrome often significantly delays the implementation of proper treatment and thus exposes patients to long-term struggle with pain. Our observations have shown that the time between the onset of symptoms and correct diagnosis in patients averaged about five years. 3D-CT scan is the gold standard for detecting Eagle's syndrome. An intraoral approach was used in surgical treatment. Although this approach offers shorter treatment time and better cosmetic effect, there is also a greater risk of complications associated with limited visibility of the surgical field and infection. <br><b>Conclusions:</b> Although styloid syndrome usually occurs bilaterally, these patients reported unilateral symptoms. No correlations were found between the prevalence of Eagle's syndrome and sex, the length of the styloid process or age, nor side of the body. The best healing effect is obtained by surgical correction/reduction of the elongated styloid process.

Styloid Process Elongation, Shape and Calcification Pattern According to Age and Gender

Background: Styloid process (SP) is a slender pointed part of the temporal bone, which is closely related to the stylomastoid foramen. As many important neurovascular structures located near the tip of SP, the elongation or ossification of stylohyoid ligament may be associated with pain related to orofacial region known as Eagle’s syndrome. Aim of this study was to assess the prevalence of elongated SP, its morphology and calcification pattern on digital panoramic radiographs in patients attending the dental clinic of the University of Benghazi. Material and Methods: The digital panoramic radiographs with visible styloid processes of the studied group of patients were studied for their visibility, length and pattern of calcification. The length of styloid processes was measured in the radiograph and was considered elongated if that length exceeded 30 mm. The prevalence and pattern of elongation and calcification were determined according to Langlais classification. Results: Out of the 304 patients (164 are males and 140 are females) examined radiographically, the elongation of SP was detected in 156 (51.31%) of the patients. It was bilateral in 151 (96.79%) cases. There were no significant differences between males and females in regard to the length and shape of SP between in all age groups in both sexes, but the calcification pattern was significantly different between the age groups in both sexes. The outlined pattern of calcification of SP was the most prevalent especially in the younger age group (10-19 years), while the complete calcification pattern was most commonly detected in the older age group (≥ 60 years). Conclusion: elongated SP whether it is accompanied by pain symptoms or asymptomatic, can easily be detected on a digital panoramic radiograph and should be considered in the differential diagnosis of orofacial pain.

STYLOID PROCESS ON PANORAMIC RADIOGRAPHS

Objective: To determine the prevalence of elongated and calcification of styloid process in panoramic radiographs. Study Design: This study included 432 panoramic radiographs from 3 different radiology clinics (Santa Catarina, Brazil) performed in the years from 2014-2016. The styloid process was analyzed by a graduate student and measured using the software Softmanager RadioMange, version 8.19. The styloid process was classified according to the length and calcification pattern. The data were analyzed by using SPSS, version 21. Descriptive analysis was performed to determine mean and standard deviation (SD). To determine the distribution between sex, elongation, and calcification, the χ2 test was used, considering a statistically significant P < .05. Results: Three hundred thirteen (72.5%) patients were female and 119 (27.5%) were male. The mean ± SD age was 40.72 ± 15.63 years and the mean value for the right-side styloid process was 45.03 ± 15.36 mm and left-side styloid process was 44.63 ±15.03 mm. An elongated styloid process was seen 406 (94%) of 432 patients. External calcification was present in 421 (97.5%) patients. There was no statistically significant dependence of sex on styloid process elongation or calcification. Conclusion: There was a prevalence of elongated and partially calcified STYLOID PROCESS. Development: Programa UNISUL de Iniciação Científica (PUIC). Objective: To determine the prevalence of elongated and calcification of styloid process in panoramic radiographs. Study Design: This study included 432 panoramic radiographs from 3 different radiology clinics (Santa Catarina, Brazil) performed in the years from 2014-2016. The styloid process was analyzed by a graduate student and measured using the software Softmanager RadioMange, version 8.19. The styloid process was classified according to the length and calcification pattern. The data were analyzed by using SPSS, version 21. Descriptive analysis was performed to determine mean and standard deviation (SD). To determine the distribution between sex, elongation, and calcification, the χ2 test was used, considering a statistically significant P < .05. Results: Three hundred thirteen (72.5%) patients were female and 119 (27.5%) were male. The mean ± SD age was 40.72 ± 15.63 years and the mean value for the right-side styloid process was 45.03 ± 15.36 mm and left-side styloid process was 44.63 ±15.03 mm. An elongated styloid process was seen 406 (94%) of 432 patients. External calcification was present in 421 (97.5%) patients. There was no statistically significant dependence of sex on styloid process elongation or calcification. Conclusion: There was a prevalence of elongated and partially calcified STYLOID PROCESS. Development: Programa UNISUL de Iniciação Científica (PUIC).

Endoscope-Assisted Surgery of the Elongated Styloid Process Using the Retroauricular Approach: An Anatomic Study for Clinical Application

Surgical shortening of the styloid process (SP) mainly involves intraoral and transcervical approaches. A retroauricular incision was performed by our surgical team in endoscope-assisted shortening of the SP. This study aimed to clarify the important anatomic landmarks and adjacent structures around the SP through a retroauricular approach. Fifteen fresh corpses (30 sides) were dissected via a retroauricular approach, and indexes were measured. The great auricular nerve (GAN) was divided into the anterior ear branch, lobe branch, and posterior ear branch. The distance from the branch of the GAN to the root of the ear lobe was 21.96±2.55mm. In the space around the SP, the vertical distance from the junction of the diabetic posterior belly and the mastoid tip to the SP was found to be 12.29±2.46mm, with a total distance between the skin in front of the mastoid and the facial nerve of 21.63±3.27mm. The distance between the facial nerve across the SP and the root of the SP was 11.93±2.32mm. The retroauricular incision starts from the level of the notch between the tragus and extends backward in an arc to avoid injury to the retroauricular branch of the GAN. The posterior fascia of the parotid gland and the leading edge of the sternocleidomastoid muscle, posterior belly of the digastric muscle, and styloid hyoid muscle are regarded as landmarks for the SP.

Of Eagle's Syndrome and Finding Some Clarity on Its Management.

Eagle's Syndrome is a much discussed yet controversial and debatable diagnosis of exclusion which is treated by many specialities with often unsatisfactory results. Due to entrapment/impingement on surrounding neurovascular structures by elongated styloid process patient may present with multitude of symptoms. Treatment is controversial and opinions are divided on choice of conservative and surgical management. Aim was to study outcomes of conservative and surgical modalities of treatment of Eagle's Syndrome and bring some clarity on management, what to offer, to whom and when. This prospective observational descriptive study included 15 patients of Eagle's Syndrome, 7 were treated with conservative method and 8 underwent resection of styloid process with intraoral approach. With objectives in mind to study efficacy of both management modalities, pain visual analogue scale (VAS) scores were recorded pre-intervention, post-intervention and during follow up on 1, 3 and 6months and compared. Conservative management resulted in up to 70% reduction in pain VAS scores till 3months of therapy (mean pre-intervention score being 3.71, 3months-1, 6months-1.29), while surgical modality resulted in nearly 99% reduction in mean pain VAS scores up to 3months and even improved after 6months (mean pre-intervention score being 6.75, 3months-0.5, 6months-0.13). With this we can conclude that conservative management provide satisfactory short-term (up to 3months) results but recurrences are known, while surgical resection of elongated styloid process gives better long-term results (6months and beyond).

Eagle syndrome- An underdiagnosed diagnosis

Eagle syndrome occurs when an elongated styloid process or calcified stylohyoid ligament causes recurrent throat pain or foreign body sensation, dysphagia, or facial pain. Diagnosis is usually made on physical examination by digital palpation of styloid process in tonsillar fossa.To study the significance of chronic throat pain and elongated styloid process. 60 patients with chronic throat pain (excluding other causes) were assessed by palpation of styloid process was recorded according to age, gender of patients. The prevalence of elongated styloid process in age groups and gender determined correlation and significance of chronic throat pain, along with palpable styloid process in tonsillar fossa and length of styloid process in tonsillar fossa and length of styloid process was determined..The maximum number of patients having chronic throat pain were between 40-49 years age group. The male to female ratio was 0.62:1. The prevalence of elongated styloid process was seen more in 50-70 years of age. There was a higher prevalence of elongated styloid process with moderate to severe pain. 76% patients with elongated styloid process had tonsillar fossa tenderness. 96.4% of patients with elongated styloid process had palpable styloid process in tonsillar fossa. There is a significant correlation between patients having chronic throat pain and elongated styloid process. X ray Skull-Towne’s view is very cost effective as a baseline radiological investigation to diagnose elongated styloid process in patients with chronic throat pain for which cause is unknown.

Eagle Syndrome-an Incidental Finding in a Case of Maxillofacial Trauma, a Case Report

Eagle syndrome is a rare condition that is difficult to diagnose due to the myriad of non-specific symptoms related to orofacial and cervical region and is a result of an abnormal elongation of styloid process causing compression of surrounding nerves or vessels. Patient can present with oropharyngeal, cervical, temporomandibular or auricular pain, globus sensation, dysphagia, transient ischemic attack and syncope. Diagnosis is established by correlating the symptoms with radiologic confirmation. This case report depicts a 50 year old male patient who reported with multiple facial fractures. His radiographs showed a markedly elongated styloid process of the right side and his medical history revealed that he experienced mild dysphagia, transient voice changes and right sided jaw pain occasionally and hence the diagnosis of Eagle syndrome was confirmed during the evaluation of maxillofacial injuries.

Cervico-facial pain associated with Eagle's syndrome misdiagnosed as cranio-mandibular disorders. A retrospective study

Aim of studya retrospective study was done to assess symptoms correlated with and responsible for the misdiagnosis of Eagle's syndrome with Cranio-Mandibular Disorders. Materials and methodsOur study comprised patients suffering from vague craniofacial pain resulting from elongated styloid processes, presented to the outpatient clinic of the oral and maxillofacial surgery department, October 6 University Hospital. The length of styloid processes was measured on 3D-CT X-rays. All our patients were operated by surgical treatment in the form of shortening of the styloid process (styloidectomy) under general anaesthesia and followed up clinically as well as radiographically for 12 months. ResultsPatients were assessed preoperatively as well as postoperatively throughout the following scheduled regular follow up intervals at 1 week and at 1,3,6 and 12 months postoperatively for the following parameters. VAS pain score gradually decreased from a median of 9, with a minimum of 7 and a maximum of 10 pre-operatively to a median of 1.5, with a minimum of 0 and a maximum of 3 at twelve months. Freidman test revealed a statistically significant difference by time. Maximum unassisted mouth opening was assessed. Mouth opening significantly decreased from 30.23 ± 3.28 pre-operatively to 26.08 ± 2.83 after one week, then gradually increased to reach its highest level (43.56 ± 0.72) at twelve months. ConclusionWhen dealing with cases of vague craniofacial pain, possibility of Eagle syndrome should be considered.

Eagle's syndrome, elongated styloid process and new evidence for pre-manipulative precautions for potential cervical arterial dysfunction

IntroductionSafety with upper cervical interventions is a frequently discussed and updated concern for physical therapists, chiropractors and osteopaths. IFOMPT developed the framework for safety assessment of the cervical spine, and this topic has been discussed in-depth with past masterclasses characterizing carotid artery dissection and cervical arterial dysfunction. Our masterclass will expand on this information with knowledge of specific anatomical anomalies found to produce Eagle's syndrome, and cause carotid artery dissection, stroke and even death.Eagle's syndrome is an underdiagnosed, multi-mechanism symptom assortment produced by provocation of the sensitive carotid space structures by styloid process anomalies. As the styloid traverses between the internal and external carotid arteries, provocation of the vessels and periarterial sympathetic nerve fibers can lead to various neural, vascular and autonomic symptoms. Eagle's syndrome commonly presents as neck, facial and jaw pain, headache and arm paresthesias; problems physical therapists frequently evaluate and treat. PurposeThis masterclass aims to outline the safety concerns, assessment and management of patients with Eagle's syndrome and styloid anomalies. By providing evidence of this common anomaly found in almost one-third of the population, hypothesis generation and clinical reasoning with patients presenting with head and neck symptoms can improve. ImplicationsIncluding styloid anomalies as potential hypotheses for patients with head and neck complaints can assist therapists in safe practice and expedite referral. The authors recommend updating the IFOMPT framework to incorporate Eagle's syndrome, a comprehensive autonomic assessment, and palpation of the stylohyoid complex to avoid potentially serious complications from conceivably hazardous interventions.

Bilateral carotid artery dissection due to Eagle syndrome in a patient with vascular Ehlers-Danlos syndrome: a case report

BackgroundPatients with vascular Ehlers-Danlos syndrome (EDS) occasionally suffer from arterial dissection. Eagle syndrome, which is caused by an elongated styloid process and also causes arterial dissection, is difficult to diagnose and could sometimes be overlooked. Little is known of the coexistence of these two diseases, and treatment strategy is not established. Here, we present a case of bilateral internal carotid artery (ICA) dissection due to Eagle syndrome in a patient with vascular EDS.Case presentationA 30-year-old man was admitted to our hospital because of sudden onset of mild sensory disturbance in his left limbs. He had a history of Ehlers-Danlos syndrome (EDS) and also had left cervical internal carotid artery (ICA) dissection 3 years before. Diffusion-weighted imaging showed acute cerebral infarcts in the right hemisphere. Cervical computed tomography angiography (CTA) revealed the right ICA narrowing at the cervical portion in addition to the previous left cervical ICA dissection. Cervical magnetic resonance imaging (MRI) revealed double-lumen and intramural hematoma at the narrowing portion of the right cervical ICA, which indicates arterial dissection. CT also revealed bilateral elongated styloid processes which are close to each side of cervical ICA. We diagnosed him as bilateral ICA dissection due to bilateral Eagle syndrome. Considering vascular complications due to vascular EDS, we performed closer follow-up with transoral carotid ultrasonography (TOCU). In 4 months, his right ICA dissection gradually improved without stroke recurrence or deterioration of dissection.ConclusionsSince patients with vascular EDS easily develop arterial dissection, Eagle syndrome may be overlooked. Clinicians should consider Eagle syndrome in the case of vascular EDS with extracranial ICA dissection and close follow-up should be prioritized in cases of Eagle syndrome with vascular EDS.