Elongated Styloid Process Research Articles

A study on assessment of the length of styloid process in digital panoramic radiographs

Introduction: The styloid process (SP) is an anatomical structure whose clinical importance is not well understood. Aims and Objectives: This study aimed to study the type of SP as per Langlais' classification and to assess the feasibility of digital panoramic radiographs in measuring the length of SP. Materials and Methods: Eighty digital panoramic radiographs of patients with dental problems were retrieved from archives of our department as soft copies. The radiographs were taken using a digital panoramic system. The radiographic length of SP was measured on both sides using measurement toolbars on accompanying analysis software. The type of elongation patterns of SP was classified as per Langlais' classification. Finally, the data were subjected to statistical analysis. Results: The average length of the left and right side SPs was 29.1882 ± 6.86 and 28.16 ± 6.44, respectively. Majority of patients were found to be asymptomatic, and Langlais' Type I elongated SP was more common than others. Conclusion: Digital panoramic radiographs are valuable tools in early detection of elongated SP. Digital radiographs help in avoiding a misdiagnosis of tonsillar pain or pain of dental, pharyngeal, or muscular region.

Elongated Styloid Process Revisited

ABSTRACT Elongated styloid process is one of the many causes of pain in throat. Yet, it is often overlooked. When the throat looks normal on examination, the entity should be kept in mind, to clinch the diagnosis. Management and review of literature are discussed. How to cite this article Acharya A. Elongated Styloid Process Revisited. Int J Phonosurg Laryngol 2015;5(1):15-16.

Investigation of the Prevalence of Styloid Process Elongation on Digital Panoramic Radiographs in Turkish Population

Objective: The aim of the study was to investigate the prevalence of elongated styloid process (SP) on panoramic radiographs and evaluate the relationship between SP length and subject age and gender. Methods: 1000 panoramic radiographs of patients (500 males, 500 females) who referred to Selcuk University, Faculty of Dentistry, Oral and Maxillofacial Radiology Department for an initial visit between 2012-2014 years was collected from the database. The individuals were divided into five age groups (≤20, 21-30, 31-40, 41-50, >50 years). Length of SPs was measured on both side and it was considered 30 mm as a threshold for elongation of the process. The data were analyzed by using Wilcoxon, Kruskal-Wallis, Mann-Whitney U and Chi-squared tests. Results: Out of 2000 measurable SPs (1000 panoramic radiographs) 327 (16,3%) SPs were elongated (>30 mm). Significant association was obtained between SP length and different age subgroups and subject gender (p<0,05). Conclusion: The panoramic radiographs are economical, easily accessible and useful diagnostic tool for detection of elongated styloid process with or without symptoms. However, we considered that studies with larger sample size would further help to assess the prevalance of that.

Prevalence of Elongated Styloid Process in a Central Brazilian Population.

Eagle's syndrome comprises a rare disorder caused by compression of an elongated or deformed styloid process or ossified/calcified stylohyoid ligament on neural and vascular structures. It is characterized by facial and neck pain and can be confused with a wide variety of facial neuralgias, oral and dental diseases and temporomandibular disorders. An imaging evaluation associated with a careful clinical examination, are mandatory in structuring a correct differential diagnosis and in the establishment of a proper therapeutic protocol. To investigate the prevalence of the elongated styloid process in a Central Brazilian population and its relation to gender, age and side. Digital panoramic radiographs of 736 patients (412 female and 324 male, with a mean age of 35.03 years) were consecutively selected from a private radiology clinic's secondary database. The apparent length of the styloid process was measured from the point where the styloid left the tympanic plate to the tip of the process by two specialists in dental radiology, with the help of the measuring tools on the accompanying software. Styloid process measuring more than 30 mm was considered elongated. The statistical analysis included frequency distribution and cross tabulation. The data were analysed by using Chi-squared tests. The level of significance was set at 5% for all analyses. A total of 323 (43.89%) radiographic images were suggestive of elongated styloid process. No statistically significant difference was found between the genders, although a higher prevalence was noticed in female participants. Approximately, 31% of the elongated styloid process was observed in 18-53-year-old participants (p < 0.05). Two hundred and sixty seven styloid processes (36.28%) were elongated on both right and left sides. The prevalence of elongated styloid process was high and no statistically significant correlation was found between the presence of elongated styloid process and the studied variables with the exception of the age.

Eagle’s syndrome - a report of two cases

Eagle's syndrome is defined as elongation of the styloid process or the stylohyoid ligament mineralization complex which consist of styloid process, stylohyoid ligament and lesser horn of hyoid bone. It is a rare entity, is not commonly suspected in clinical practice. It is characterized by recurrent facial and throat pain, dysphagia, odynophagia, parapharingeal foreign body sensation, otalgia and neck pain. Eagle's syndrome can be treated conservatively (lacing local anesthetic into the styloid process and stylomandibular ligament attachment) or surgically. Its pathogenesis and threatment modalities are still being debated while different theories have been presented. The two traditional surgical approaches to styloidectomy (removal of the elongated portion of the styloid process) were presented the intraoral approach and the extraoral approach. We presented two cases (49 years and 34 years old males), with bilateral and unilateral elongated styloid process. The surgical treatment included unilateral right side stiloidectomy by intraoral approach in the first case and right styloidectomy by extraoral approach in the second case. In both eases post-operative course passed regularly with no complaints at regular postoperative control. Surgical techniques for treatment of Eagle's syndrome have many advantages and disadvantages. We believe that the length of the styloid process or the calcified ligament is a decisive parameter for the selection of techniques and approach.

Incidental Finding of an Elongated Styloid Process during Tonsillectomy Procedure

Patients with recurrent throat pain, dysphagia, or facial pain symptoms might have Eagle’s syndrome due to abnormal length of the styloid process or calcification of stylohyoid ligament complex. In adults, the styloid process is approximately 2.5 cm long. The etiology of this disease is not well understood, and usually asymptomatic. In some cases, the styloid tip, which is located between the external and internal carotid arteries, compresses the perivascular sympathetic fibers, resulting in a persistent pain. The disease can be diagnosed by physical examination through digital palpation of the styloid process in the tonsillar fossa or by radiographic workup that includes anterior-posterior and lateral skull films. We report a 33-year-old woman with an incidental finding of an elongated styloid process during a routine tonsillectomy procedure.

Eagle’s Syndrome

Eagle's Syndrome (ES) refers to a symptomatic anomaly due to elongation of the styloid process or mineralization of the styloid complex. If not diagnosed timely and treated properly, elongation of the styloid process or the hyper-mineralization of the stylohyoid ligament may eventually lead to complete ossification of the stylohyoid complex. Non-specific head and neck symptoms of the ES may pose diagnostic challenges to the clinician. Therefore it is crucial to include ES among differential diagnosis when evaluating patients with similar head and neck symptoms. Once the diagnosis is confirmed, treatment plan should be tailored in accordance with the individual requirements of the case and performed without delay. Both pharmacological and surgical methods have been described for the treatment of the patients with ES. However for those who suffer from persistent symptoms, surgical removal of the elongated styloid process is the treatment of choice and can be done with an intraoral or an extraoral approach. The aim of this work is to present unusual clinical symptoms and radiologic findings of ES due to complete ossification of the stylohyoid complex. The importance of a correct diagnosis and appropriate treatment are highlighted.

Is there a relationship between the presence of ponticulus posticus and elongated styloid process?

This study aimed to determine if there is a possible relationship concerning the presence of ponticulus posticus (PP) in patients with elongated styloid process (ESP) on three-dimensional cone beam computed tomography (CBCT) images. The presence or absence of the PP (whether partial or complete) was determined and noted as a positive or negative finding. Then, the patients with PP were evaluated for ESP. For this purpose, 3-D CBCT scanning digital images of 542 patients having ESP (247 males and 295 females) were examined retrospectively. There was a significant relationship between the presence of PP and ESP (P=.03). The results of this study suggest that there is a significant correlation between the presence of PP and ESP. To our knowledge, this is the first study investigating the relationship between the two disorders in the literature.

Resection of calcified elongated styloid process (Eagle's syndrome) with Piezosurgery: A case report and review of literature

Eagle’s syndrome is the term given for the symptomatic elongation of the styloid process or mineralization of the stylohyoid or stylomandibular ligament. The basic symptoms are recurrent neck, throat, and hemifacial pain; sensation of a foreign body in the throat; dysphagia; change in voice; otalgia; and pain radiating to the upper extremities. Treatment usually involves a medical approach (e.g., administration of non-steroidal anti-inflammatory medications or even carbamazepine) or surgical intervention. The main treatment approach involves partial excision of the styloid process. A 58-year-old woman visited Chosun University Dental Hospital with a foreign body sensation and pain in the oropharyngeal area during swallowing, as well as a headache and radiating pain to the ear. Operation was performed under general anesthesia via an intra-oral approach with resection via Piezosurgery. The patient had no postoperative complications and was free of symptoms for 9 months after the operation.

Tinnitus Associated with Eagle Syndrome: A Case Report

Introduction: Eagle syndrome is a condition characterized by elongated styloid process or calcification of the stylohyoid ligament associated with cervicofacial painful symptoms. Incidence varies from 4 to 28% prevailing in adult women. The classic syndrome leads to pharyngeal pain and earache, relating to healing after tonsillectomy or cervical trauma. The syndrome styloid apophysis with carotid artery involves compression of the carotid arteries, predominantly dysphagia, earache, and headache, with few reported symptoms such as dizziness and tinnitus. The diagnosis is clinical and radiographic. Treatment may be conservative or surgical. However, the most effective is surgical resection of the styloid apophysis.

Elongated styloid process - a cause for cervical pain

AbstractThe normal length of the styloid process is 20-25 mms. A diagnosis of Eagle's syndrome is made when the styloid process measures more than 30 mms.The symptomatology associated with an elongated styloid process is called Eagle's syndrome. Abnormal elongation of styloid process causes compression of important neurovascular structures situated in close relation to it resulting in chronic neck pain, referred pain to the ear, jaw and orbit, and globus hystericus. We report here two cases of elongated styloid processes found during our routine osteology demonstrations. The etiopathogenesis and clinical implications of an elongated styloid process are discussed.

Abnormal Length of the Styloid Process: An Anomaly Underestimated of the Temporal Bone with Surgical and Clinical Relevance

Objective: We conducted an osteometric study in humans on styloid process of temporal bone to determine the average length and the frequency of a process excessively long that can cause unrecognized cerebrovascular syndromes or a form of neuralgia of the glossopharyngeal nerve: “Eagle syndrome.” Study Design: Measurement of styloid process was conducted on a significant part of the entire collection of skulls which showed the whole process. To highlight differences in the length of the process related to sex we have divided the skulls in two different groups by gender. Material and Methods: We measured the length of the styloid process by a digital caliper on a sample of 153 dried skulls of local museum “Leonetto Comparini.” Data was analyzed through statistical software (Salstat2, Sourceforge, Dice Holdings Inc.): average and standard deviation (SD) were calculated. A t-test was applied to the means of the two groups different for sex. Results: The average length of styloid process is 27 mm. The range of normality (average + 2st) was 42 mm. An abnormal long styloid process > 42 mm is present in 6% of items. The greatest length observed for the styloid process was 52 mm. In one case of a stylohyoid calcified ligament the styloid process was long length being 70 mm. The difference between the averages of different groups by sex was not significant. Conclusion: The presence with a certain frequency of an elongated styloid process must lead to find out this anomaly radiologically in the case of suspected “Eagle syndrome.”

Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

ObjectiveThe purpose of this paper is to present a case of a patient with neck pain, tinnitus, and headache in the setting of bilateral elongated styloid processes (ESP) and calcified stylohyoid ligaments (CSL), how knowledge of this anatomical variation and symptomatic presentation affected the rehabilitation management plan for this patient, and to discuss the potential relevance of ESPs and CSLs to carotid artery dissection. Clinical featuresA 29-year-old male military helicopter mechanic presented for chiropractic care for chronic pain in the right side of his neck and upper back, tinnitus, and dizziness with a past history of right side parietal headaches and tonsillitis. Conventional radiographs showed C6 and C7 spinous process fractures, degenerative disc disease at C6/7, and an elongated right styloid process with associated calcification of the left stylohyoid ligament. Volumetric computerized tomography demonstrated calcification of the stylohyoid ligaments bilaterally. Intervention and outcomeGiven the proximity of the calcified stylohyoid apparatus to the carotid arteries, spinal manipulation techniques were modified to minimize rotation of the neck. Rehabilitation also included soft tissue mobilization and stretching, corrective postural exercises, and acupuncture. An otolaryngologist felt that the symptoms were not consistent with Eagle syndrome and the tinnitus was associated with symmetric high frequency hearing loss, likely due to occupational noise exposure. Initially, the patient's symptoms improved but plateaued by the fifth visit. ConclusionNeck pain in the presence of ESPs and CSLs can be associated with Eagle syndrome, which can include ipsilateral head and neck pain, odynophagia, dysphagia, and cerebrovascular symptoms. This case, initially thought to be Eagle syndrome, highlights proper diagnostic workup for this condition and presents potential contraindications to consider with regard to cervical spine manipulation in such patients. Manual therapy precautions pertaining to cervical spine manipulation may be appropriate in cases involving ESPs and calcified stylohyoid ligaments.

Eagle's syndrome with type III segmented styloid process: A case report

Abstract Eagle's syndrome is not an uncommon condition, but it is less known to Physicians where an elongated styloid process or calcified stylohyoid ligament compresses the adjacent anatomical structures leading to orofacial pain. Pain often gets relieved by surgical reduction of styloid process. Recently depending on the calcification it has been classified as three types. A case of Eagle's syndrome is reported here. How to cite this article Usha VA, Mamatha GP, Maria PD. Eagle's syndrome with type III segmented styloid process. A case report. CODS J Dent 2014;6;61-63

Eagle's Syndrome- A case report

Eagle’s syndrome represents a group of symptoms that includes recurrent throat pain, globus hystericus, dysphagia, reffered otalgia, and neck pain possibly caused by elongation of the styloid process or ossification of stylohyoid or stylomandibular ligament. We present a case of 21 yrs old female having chief complaint of bilateral preauricular tenderness since one year. Her clinical signs resembled the presentation of Eagle’s Syndrome, which were radiologically confirmed by Orthopantomogram and Computed Tomography. Patient underwent surgical excision of caudal part of the elongated styloid process (styloidectomy). Postoperatively 10 months later, the patient had significant reduction of pain. DOI: http://dx.doi.org/10.3126/ijls.v8i3.10228 International Journal of Life Sciences Vol.8(3): 2014: 1-4

Atypical presentation of Eagle syndrome with hypoglossal nerve palsy and Horner syndrome

Many nerve injuries have been associated with Eagle syndrome. The cranial nerves V, VII, IX, and X have been reported to be injured by the elongated styloid process in this syndrome. We describe a case of Eagle syndrome with atypical symptoms of hypoglossal nerve palsy and Horner syndrome. A 56-year-old woman presented with right hypoglossal nerve palsy, right Horner syndrome, right neck pain, and symptoms mimicking transient cerebral ischemia. An angioscan showed elongated styloid process bilaterally with the right process compressing the right carotid artery causing a 75% stenosis. After an en bloc resection of the right styloid process, there were no further episodes of paresthesias. The neck pain completely disappeared, as well as the Horner syndrome. As for the hemitongue, the fasciculations disappeared but the atrophy remained. This is the first Eagle syndrome case report describing a motor paralysis of a cranial nerve.

Elongated styloid process as a cause of facial pain

Joint Bone Spine - In Press.Proof corrected by the author Available online since vendredi 18 avril 2014

The styloid process in a Greek population: an anatomical study with clinical implications

The study determines the variability of the length of the styloid process in a Greek population and investigates how it is affected by gender and age; it also evaluates the side asymmetry, highlighting clinical implications. One hundred and forty-nine dry adult modern skulls (94 male and 55 female) were divided into subgroups according to their age: 20-39, 40-59 and older than 60 years. The lengths of 262 styloid processes (127 right and 135 left-sided) were measured. The lengths of right-sided styloid processes ranged from 6.4 to 70.2 mm and left-sided styloid processes from 5.2 to 69.0 mm. The processes were classified according to their lengths as short <18 mm, normal 18-33 mm and elongated >33 mm. The majority of the processes were normal (45.8 %), 27.5 % were short and 26.7 % elongated. No statistical significant correlation was established among the lengths of the styloid processes, gender and age. Side asymmetry was found only in the group with elongated styloid processes (right processes were longer, 28.3 %, than the left ones 25.2 %; p = 0.016). Our study contributes to the literature, adding important information about the length of the styloid process and its diversity in the Greek population. It also confirms the existence of an osseous landmark as a starting point for the measurement of the length of the styloid process and proposes a method of measurement for the evaluation of the actual length of the styloid process.

Cone-beam computed tomographic evaluation of styloid process: a retrospective study of 208 patients with orofacial pain

IntroductionThe purpose of this study was to assess the structural characteristics of styloid process (SP) by cone-beam computed tomography (CBCT) examination in a patient population suffering from orofacial pain. The second aim was to assess the prevalence of elongated SP and its relation to gender, site and subjective symptoms in the study population.MethodsClinical and radiographic records of 208 patients were evaluated retrospectively. Radiological examinations including measurements of the structure, length, and medial angulations of SP were performed on CBCT images.ResultsOut of 208 patients, 96 (46%) had not-elongated SP, 28 (13%) had left side, 16 (8%) had right side, and 68 (33%) had bilateral elongation of SP. The patients with elongated SP had significantly decreased angle values. There were no statistically significant differences in length values of SP between males and females in both groups. Significantly increased prevalence of symptoms except headache was observed in patients with elongated SP.ConclusionsThis study presents the CBCT as an alternative method to CT or panoramic radiographs for the measurement and the assessment of the styloid process. Patients suffering from orofacial pain, who also had elongated SP, had increased rate of corresponding neurological complaints compared with non-elongated ones.

Eagle’s Syndrome: A case report

Eagle’s syndrome result from elongation of styloid process or mineralization of styloid ligament. Eagle’s syndrome include symptoms such as foreign body sensation, pain in the area of tonsillar fossa, pain which spreading toward ear. Diagnosis of Eagle’s syndrome can usually be made on physical examination by digital palpation of the styloid process in the tonsiller fossa. The treatment of Eagle’s syndrome is primarily surgical. In this article, we presented a 57-year-old male patient who was have a trauma of lower partial denture with of Eagle’s syndrome.