Elongated Styloid Process Research Articles

Eagle’s syndrome in tertiary health institution, southern region of Nigeria

Eagle’s syndrome is a condition caused by elongation of the styloid process or ossification of the styloid ligament resulting in non-specific symptoms related to pressure on vital blood vessels of the neck, the internal carotid artery, internal jugular vein, and nerves; the glossopharyngeal and vagus nerves. Eagle’s syndrome may have varied presentations with numerous symptoms: Pain in the throat/neck radiating to the ear and pharynx, foreign body sensation in the throat, dysphagia, otalgia, trismus, and intense facial pain. A high index of suspicion with a prompt resort to a three-dimensional CT skull could be helpful to give a quick diagnosis of Eagle’s syndrome amid numerous differential diagnoses. We present a 59-year-old male with an 18-month history of left-sided neck pain, cheek pain, and the feeling of a foreign body in the throat. He had pain relievers and other drugs to no avail. A three-dimensional CT scan of his skull revealed features of Eagle’s syndrome. The excision of the styloid process through the extraoral route relieves his symptoms. The second patient is a 42-year-old female with symptoms of peptic ulcer disease, dysphagia, pain in the throat, and sometimes fainting attacks when she moves her neck swiftly to the left side. A three-dimensional CT skull scan confirmed features of an elongated styloid process bilaterally suggestive of Eagle’s syndrome. Treatment offered to her was conservative, with a diclofenac suppository only because she refused surgery. Restricted and limited neck movement relieved her of syncope attacks.

Eagle jugular syndrome: a morphometric computed study on styloid process orientation

Cerebral venous drainage impairment is related to a wide spectrum of pathologies, both acute or chronic. Among the most intriguing and less explained there are those caused by a long-lasting compression on internal jugular vein (IJV), mono or bilaterally. Recently, a jugular variant of the Eagle syndrome has been described,1,2 in which an elongated styloid process, coming from the mastoid tip down through the neck, compresses the IJV (more frequently J3) in its passage on the C1 anterior arch. Interestingly, those patients often complaint of typical symptoms of intracranial hypertension, such as headache (not frequent in classic Eagle syndrome), tinnitus, dizziness. They also seem to have an increased risk of perimesencephalic hemorrhages. Conceptually, it is not the styloid process length in itself to determine the compression, but rather its spatial orientation. We could therefore expect to find patients suffering from Eagle jugular syndrome who present normal or short styloid process, but in close proximity to C1. To test this hypothesis, we are developing a novel software to analyze 3-D spatial orientation of styloid process in patient with a previously diagnosed Eagle jugular syndrome compared to healthy controls. Methods We collected cervical computed tomography angiography (CTA) images from 8 patients with EJS confirmed by venous angiography at our institution, and a control group of 7 random patients, homogenous for sex and age. A blind operator created with a dedicated pre-existing software3, an editable 3-D model (.stl file) of the 3 main region of interest (ROI), namely: right styloid, left styloid, C1 anterior arch. Starting from this dataset, our software, written using the open-source package management system Anaconda4 ver. 2-2.4.0, compares all the possible couples of points between each styloid process and the C1 arch, detecting the minimum and maximum distance. Then, it provides the mean spatial orientation of the process respect the CT-axis: x-axis (from left to right), y-axis (from occiput to nose) and z-axis (cranio-caudal). Results By now we included 15 patients (8 cases, 7 controls), homogeneous for sex and age. Preliminary data (Table 1), although not statistically significant yet, seems to indicate that Eagle jugular patients effectively have a more vertical styloid process, meaning an angle between styloid and y-axis greater than controls, rather than a longer one. Conclusions Our preliminary results could confirm that spatial orientation is more important in Eagle jugular patients than styloid process length. This study is currently ongoing and we planned to enroll at least 20 subjects for each arm. At the same time, we are collecting data from patients with carotic variant of Eagle syndrome, to better characterize morphometric structure of styloid in various subset of this pathology.

Eagle’s Syndrome: An Unusual cause of throat pain-Case Study

Eagle's syndrome or styalgia is characterised by the anatomical bone deformity of the styloid process, as identified by Wat W. Eagle in 19491. An aggregate of symptoms caused by the elongation and severe calcification of the temporal bone's styloid process, as well as calcification of the ligaments attached to this process, including the styloid and stylomandibular ligaments, have been identified2. The styloid process is typically 20 to 30 mm in length, and patients with elongated styloid processes of 40 mm or longer have clinical distress 1,3 . This styloid process elongation could be unilateral or bilateral 4. It affects around 4% of the general population, with 3:1 female predominance, however only 4% of these people experience associated symptoms 3. Eagle mainly characterized two syndromes: “classic styloid syndrome” following tonsillectomy, and “stylocarotid syndrome” unrelated to tonsillectomy6. The “styloidogenic jugular compression syndrome”, a third variation of Eagle syndrome, was recently identified, in which the jugular vein is squeezed, resulting in cerebral venous hypertension and, most commonly, headaches1.

Eagle’s syndrome –A case report

Eagle’s syndrome is a condition associated with the elongation of the styloid process or calcification of the stylohyoid ligament, clinically characterised by throat and neck pain, radiating into the ear. A styloid process is considered elongated or abnormal when it exceeds a normal length of 25-27 mm. However, elongation of the ossified styloid ligament is insufficient for diagnosing Eagle’s syndrome. Instead, a constellation of symptoms in history, as mentioned above, and physical and radiographic examinations contribute to diagnosis. In this report, we describe the case of a 71-year-old man who presented with long standing orofacial pain due to unilateral elongated styloid process on the right side.

Calcification of Stylohyoid Ligament Leading to Eagle’s Syndrome: An Atypical Presentation

Background Elongated styloid process is seen in 5% of individuals. This elongation presents with oropharyngeal pain and dysphagia; however 50-55% cases are asymptomatic. The proposed aetiology is osseous hyperplasia of the styloid process and styloid ligaments secondary to surgical intervention or pharyngeal trauma. Elongated styloid process or calcification of styloid ligament may impinge on cranial nerves and compress the carotid artery. Case Presentation Here we present a case of 48-year old male who presented with neck pain and foreign body sensation for last two months. To diagnose the cause of pain, the patient underwent a CT scan that revealed calcification of bilateral styloid ligaments. Conclusion CT scan is the ideal imaging investigation in Eagle syndrome for diagnosis and surgical planning

Fracture of the Elongated Styloid Process by Hanging

It is a routine protocol to examine the soft tissues, cartilage and bone tissues of the neck during post-mortem examinations performed in the cases of hanging-related deaths. Fractures of the hyoid bone and thyroid cartilage, as well as bleeding and ecchymoses around the first fracture are practically of great importance in establishing the case as live hanging. The styloid process is a thin bone at the base of the skull that extends downward, medially, and anteriorly from the temporal bone. Elongated variations of styloid process are encountered in society. In literature, there are no reported cases of elongated styloid process fractures due to hanging. In hanging-related deaths, along with hyoid bone and thyroid cartilage tissues, styloid process should also be evaluated for fractures.

Elongation pattern of styloid process in Saudi population: a factor to remember in the prevention of eagle syndrome.

The aim of this study is to determine the prevalence of styloid process (SP) patterns in Saudi population. This retrospective, cross-sectional study included 2010 digital panoramic radiographs (PRs) selected randomly for adult patients who visited five major hospitals in the Qassim region, Saudi Arabia, PRs were examined to detect any SP elongation. Data were collected and analysed using SPSS v22. In this study, positive SP elongation was seen in 25.4% of the total cases, 14.2% and 11.2% male and female, respectively. The mean age was 34.3 ± 13.9 years. Type I was found in 19.1%, type II in 1.7%, and type III in 4.6% of the cases. Normal SP was seen in 74.7%. Patients between 30 and 50 years were significantly more affected with type I pattern. Normal SP was reported mostly in the youngest age group 18-24 years, in 31% of total cases. Styloid process has many patterns and variations that could be detected on digital PRs taken daily in most of dental clinics. Dentists should be trained to detect patients with such variation so that signs associated with Eagle syndrome are not misinterpreted.

Eagle Syndrome: A Case Report and Review of the Literature

Eagle's syndrome, stylo-carotid syndrome, elongated styloid process syndrome or American syndrome is a rare and controversial entity. It is characterized by a long styloid process causing irritation of the surrounding structures. We report a case of Eagle's syndrome of incidental discovery in a 53-year-old patient, with no particular history, who presented with intense left retro-mandibular pain evolving for two years. A computer tomography angiography (CTA) of the supra-aortic trunks was ordered and showed two bilateral bony processes extending from the styloid process towards the lesser horn of the hyoid bone, indicating ossification of the stylohyoid ligament, which led to the diagnosis of Eagle syndrome.

SURGICAL TREATMENT OF EAGLE SYNDROME THROUGH INTRAORAL ACCESS

Eagle syndrome is a rare condition that can be associated with trauma and previous surgeries in the styloid process region and genetic and systemic conditions. The diagnosis is based on findings of clinical and imaging exams. The treatment can vary from pharmacologic or surgical depending on the patient and surgeon. In the present case, a 43-year-old female patient reported mandibular pain during mouth opening and chewing associated with throat pain for 3 years. Clinically, the patient presented no pain during cervical mobilization and had a rigid structure in the peritonsillar region and oral floor, bilaterally, with more severe pain on the right side. Resection of the elongated styloid process was performed through an intraoral approach. The patient had complete resolution of the condition, without lesions of the lingual and hypoglossal nerves. The choice for surgical treatment through intraoral access is a safe, fast approach and presents good aesthetic results to treat patients with Eagle syndrome.

Prevalence of styloid process elongation on digital panoramic radiography in South India population from Chengalpet district

The styloid process (SP) arises from the temporal bone in front of the stylomastoid foramen. Many nerves and vessels are adjacent to the SP. The length of the SP is usually 2-3 cm; if it is longer than 3 cm, it is considered elongated. The elongated SP may compress adjacent neurovascular structures, and cause neck and cervicofacial pain. This study aims to determine the prevalence of SP elongation detected on digital panoramic radiographs in the south Indian population from the Chengalpet region and its relation to gender, age, sides and types. Digital panoramic radiographs of 1000 patients with an age ranging from 10 to 80 years were retrospectively obtained from a private dental college. The subjects were divided into six age subgroups: 10-19, 20-29, 30-39, 40-49, 50-59, and 60 years and older. The apparent length of the SP was measured from the point where it left the temporal bone to its tip. SP measuring more than 3 cm were considered to be elongated. The data were analyzed by using Student’s t-test and Chi-square test with a P value less than 0.05. The study findings reported that SP elongation was present in sixty-two (6.2%) patients. The prevalence of SP elongation in males was slightly higher than in females. In males, there was a statistically significant difference found between age groups. The prevalence of SP elongation was increased as the age increased. The most frequently observed type of elongation was the type I elongation. The digital panoramic radiographs are an economical, easily accessible and useful diagnostic tool for early detection of SP elongation. It was found that the elongated SP is an anatomical variation, which must be taken into account by practitioners while treating the patients with head and neck pain.

Styloid Process Length Variations: An Osteological Study.

The objective of this study was to study the morphometry of the styloid process of the temporal bone and the prevalence of an elongated styloid process in relation to side and gender. The present study included 200 human skulls which were procured from the rich osteological collections of the Department of Anatomy, Faculty of Medicine, University of Sarajevo. The styloid process was observed macroscopically on both sides of all the skulls and elongations, if any, were noted. The lengths of the styloid processes were measured using digital vernier calipers. The measurements were taken from the point of emergence of the process (base) up to the tip. Out of 200 specimens, only 14 cases (7%) exhibited an elongated styloid process. The mean length of the styloid process was 25.8±4.68 mm and 24.2±4.54 mm for the right and left sides, respectively. The size of the styloid process did not different significantly between the two sides (P=0.724). The mean length of the styloid process was 24.05±3.54 mm in females and 25.95±5.68 mm in males, and the difference was statistically significant (P=0.023). The study and knowledge of the anatomical variations of the styloid process in the Bosnian population may help clinicians to diagnose Eagle's syndrome. Knowledge of this disorder can prevent the worsening of the painful symptoms related to an elongated styloid process.

Does the orientation of the styloid process cause Eagle Syndrome? An anatomical study of the styloid process in 72 Greek skulls.

<b>Introduction:</b> Patients often suffer from an elongated styloid process. This clinical entity is well known and is described as Eagle syndrome. The presence of this anatomical variation is not always associated with symptoms. However, there is a strong correlation between the elongated styloid process and Eagle syndrome </br></br> <b>Aim:</b> This study aims to calculate the incidence of elongated styloid processes in the Greek population, to analyze the morphometric characteristics of styloid processes, and to compare these among sexes. </br></br> <b>Material and methods:</b> This is a single-center retrospective study. All skulls were donated to the Department of Anatomy, the Ari-stotle University of Thessaloniki from January 2013 to May 2019 for research purposes. A styloid process longer than 30 mm was considered elongated. We used Welch's t-test for the statistical analysis of the data. </br></br> <b>Results:</b> The prevalence of elongated styloid processes was 35%. The average diameter was 3.32 mm and the average total length was 25.02 mm. There was no statistically significant difference between male and female skulls, though the female styloid processes were slightly longer and the male ones were slightly wider. Symmetry was recorded in 31% of skulls. Average axial angle was 650 but in 4% of cases it was less than 20<sup>0</sup>. </br></br> <b>Conclusions:</b> The elongated styloid process is not a rare entity. Eagle syndrome should always be considered in the differential diagnosis when patients report chronic sore throat. Our anatomical findings add a new dimension to the etiopathogenesis of Eagle syndrome.

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

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. Twenty-seven sides (right and left of bodies) in males and 51 sides in females were analysed. 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 analyse the female-to-male elongation ratio. A p-value < 0.05 was considered statistically significant. Styloid process 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). 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.

Chronic oropharyngeal pain and medical nomadism in an Eagle’s syndrome patient: a case report

BackgroundElongation of the styloid process associated with oropharyngeal pain and dysphagia is known as Eagle’s syndrome, a condition whose pathophysiology is still a matter of debate. Given its low prevalence and complex symptomatology, this syndrome is often misdiagnosed, leading to chronic pain and medical nomadism.Case summaryA 51-year-old woman of African origin with 3-year history of left-side oropharyngeal pain and worsening dysphagia consulted several health professionals. Medical and surgical treatments, including a sinus surgery and the extraction of three healthy teeth, did not improve her symptoms. Evaluation in an orofacial pain clinic revealed an asymmetrically elongated styloid process. Surgical shortening of the elongated styloid process provided complete pain relief and recovery of normal swallowing function.ConclusionBased on this case report, the pathophysiology of Eagle’s syndrome is discussed, and the need for specific follow-up in a subpopulation of patients with asymptomatic styloid process elongation is highlighted.

MORPHOMETRIC STUDY OF THE STYLOID PROCESS AND ITS CLINICAL IMPLICATIONS

Background: Styloid process is a slender, cylindrical spur of bone fused with the inferior aspect of the temporal bone in front of the stylomastoid foramen. Present study aimed to evaluate the length, angulation, interstyloid distance and styloid ratio to highlight their possible etiological importance in clinical and surgical conditions. Interstyloid distance is used for sexual dimorphism. Excessive length and angulation of styloid process is clinically important, as it may cause Eagle's syndrome. Material And Methods: The study was done on both sides of 52 dry human skulls of unknown age and sex without any obvious deformity. Each skull was carefully examined for the presence of elongated styloid process (length&gt;30 mm). The length was measured using Vernier caliper and interstyloid distance was measured using divider. Angle of styloid process with the Reid's baseline and styloid ratio was also calculated. Results: Out of 52 skulls, elongated styloid process was observed in thirteen skulls, amongst them eight skulls (15.38%) with unilateral and ve (9.62%) with bilateral elongation. Rest of the skulls (n=39) had lengths varying from 20-30 mm. Mean angle between styloid process and Reid's baseline was 51.13°. Average interstyloid distance was 75.42 mm while 70-80 mm was the most common range. Styloid ratio varied from 3-4. Conclusions: Unilateral elongated styloid process was found more frequently as compared to bilateral. The results can be used as a baseline data for identication of male and female skull by calculating the interstyloid distance. The ndings of the present study may be of utmost importance in the examination of styloid process in patients with symptoms of stylalgia.

Elongated styloid process: literature review and morphometric data on a collection of dried skulls

The styloid process is a subtle process of variable length that originates from the petrous part of temporal bone . From the process originate three muscles: the stylopharyngeus,the styloglossus, the stylohyoideus and two ligaments :stylohyoid and stylomandibular . The styled process of the temporal bone has a variable length as demonstrated for studies conducted in three-dimensional computed tomography or dental panoramic three-dimensional scanning,and in dried skulls The normal length of the styloid process is particularly important to establish for the relations of closeness with vascular and nervous structures and their possible compression by an elongated styloid process.Several studies have focused on the effects of changes in length and course of the styloid process, highlighting the relations of the carotid artery and the glossopharyngeal nerve to explain cerebrovascular symptoms or Eagle’s syndrome characterized by neck pain and dysphagia .However the association for the abnormal length of styloid process and Eagle’s syndrome is not always present and many cases are asymptomatic. In the present study we propose a review of the studies performed with different in vivo radiological techniques and on dried skull collections on the normal and pathological length of the stiloyd process and on its association with the Eagle’s syndrome. We also present a morphometric study carried out in dried skulls of our museum collection.The results are discussed in light of the possible variations in the muscular and ligamentous structures consequent to the elongation of the styloid process.

Stylalgia and Styloidectomy: A Review.

Stylalgia also referred to as Eagle's or stylohyoid syndrome (first described by Watt Eagle) is a constellation of signs secondary to an elongated styloid process or due to mineralization of the stylohyoid or stylomandibular ligament or the posterior belly of the digastric muscle (Malik et al. in Iran J Otorhinolaryngol 30(6): 101, 2018). The Eagle's syndrome includes symptoms ranging from stylalgia (i.e., pain in the tonsillar fossa, pharyngeal or hyoid region) to foreign-body sensation in the throat, cervicofacial pain, otalgia or even increased salivation or giddiness. Diagnosis is primarily based on symptomatology, physical examination and radiographic investigations and should not be missed. However, palpation of tonsillar fossa with radiological demonstration of the elongated styloid process confirms the diagnosis. Surgical treatment by tonsillo-styloidectomy produces satisfactory results in stylalgia. (Malik et al. in Iran J Otorhinolaryngol 30(6):101, 2018).

ORAL PRESENTATION: Eagle Syndrome: The Forgotten Entity

Elongated styloid process or Eagle syndrome is a rare condition presenting with a wide range of symptoms including throat pain, foreign body sensation, neck pain and ear pain. Establishing a diagnosis requires a high index of suspicion and understanding of this entity by the physician. Computed tomography (CT) is the gold standard to diagnose Eagle syndrome. Conservative medical treatment with analgesics, oral steroids and anticonvulsants are offered in patients who refused surgery. The mainstay of treatment is surgical resection via intraoral or cervical approaches. We describe a rare case of bilateral Eagle syndrome in a 46-year-old female who was presented with chronic foreign body sensation in the throat but aggravated following fish bone ingestion. Flexible nasopharyngolaryngoscopy (FNPLS) and cervical x-ray did not reveal any foreign body and the patient was treated conservatively. Incidentally, a cervical x-ray also revealed an elongated styloid process bilaterally. Upon follow-up, the patient was still symptomatic. Thus, a CT scan with contrast of the neck was requested, which reported no foreign body, but the presence of bilateral elongated styloid process suggesting Eagle Syndrome. The patient was subjected to transoral endoscopic assisted bilateral styloidectomy following tonsillectomy. There was a complete resolution of the symptoms postoperatively. This approach is recommended to avoid external scarring and minimize postoperative pain. Eagle syndrome is diagnosed based on a combination of physical examination and radiological findings. The treatment options may vary based on the severity of symptoms.International Journal of Human and Health Sciences Supplementary Issue: 2022 Page: S14

Evaluating the relation between the elongated styloid process and the ponticulus posticus using cone-beam computed tomography.

Ponticlus posticus (PP) as a one of the cervical vertebra variations brings about symptoms similar to Eagle syndrome. This study aimed to determine the relationship between elongated styloid process (ESP) and PP in a group of Iranian patients using cone-beam computed tomography (CBCT) images. The CBCT images of 349 patients (118 males and 231 females; mean age: 32.53 ± 14.143) were involved in this study. The atlas vertebra was investigated for the presence and classification of PP (partial or complete) in sagittal views. Also, the styloid process was evaluated for the presence of ESP in reconstructed panoramic and three-dimensional images. Data were analysed using Mann-Whitney test, Fisher's exact test, and Chi-square test to assess the relationship between the presence of PP and ESP with regard to age and gender. Ponticulus posticus was observed in 24.5% of patients with ESP and 31.98% of patients without ESP. There was no significant relationship between the presence of PP and ESP (p = 0.198). Twenty-five patients with ESP showed PP; cases of ESP with either side and opposite side PP were 7.84% and 1.96%, respectively. Cases of bilateral ESP and PP were predominant (14.70%). The mean age of patients with bilateral ESP and PP was higher than others. There was no significant difference between males and females (p = 0.456). Considering the prevalence and characteristics of PP in the case and control groups, there was no significant relationship between PP and ESP.

Styloid process elongation and temporomandibular disorders: a pilot study in the Albanian population.

Patients with an elongated styloid process (SP) presented related symptoms as deep neck pain, foreign body sensation in the throat, pain on turning the head, and odynophagia. These symptoms are the source of misdiagnosis of this syndrome since these clinical manifestations are like those of temporomandibular disorders (TMD). This study aimed to investigate a possible correlation between the TMD and elongation of the SP. The case-control study included 60 participants between 25-60 years of age and was carried out at University Dental Clinic, Department of Maxillo-Facial Surgery, Tirana, Albania during the period November 2020 - March 2021. The study group consisted of 30 patients diagnosed with TMD (21 females and 9 males) and the control group consisted of 30 individuals without TMD (18 females and 12 males). The diagnosis of TMD was performed according to Research Diagnostic Criteria for Temporomandibular Disorders axis I and the SP measurement was performed by a single experienced examiner. The normal range of SP length was considered 20-30 mm. SP >30mm was found in 86.67% of patients with TMD group and 43.33% of individuals of the control group. There was a significant difference between the TMD group and the control group in regards to SP length (p <0.001). There is a significant association between the elongation of the SP and TMD. Dental clinicians should recognize the morphological changes in the length of SP on the panoramic radiographs, which could be a hint in the proper diagnosis of TMD.