Styloid Process In Patients Research Articles

Evaluation of alterations in length and calcification of the styloid process in patients with end-stage renal failure

This study compared alterations in length and types of elongation and calcification of the styloid process (SP) between patients with end-stage renal failure (ESRF) who received renal transplantation, patients with ESRF undergoing dialysis, and a healthy control group. The SPs of 58 patients who had undergone renal transplants, 58 patients who received dialysis treatment, and 58 healthy individuals were examined with panoramic radiographs. Length measurements were made from the apex to the base of the SP. Elongation types were classified into 5 groups: normal, non-segmented, pseudo-segmented, segmented, and non-continuous. Calcification types were classified into 4 groups: external, partial, nodular, and complete. SP length was significantly greater in the renal transplantation and dialysis groups than in the control group (P < .001) and significantly longer in the renal transplantation group than in the dialysis group (P < .001). There was a significant difference between the groups regarding elongation types (P < .001), with the non-segmented type more frequent in the dialysis and renal transplant groups than in the control group. There was no significant difference in calcification types between groups (P=.225). Elongation and calcification types differed between sexes (P ≤ .008) CONCLUSIONS: Orofacial pain complaints in patients with ESRF should raise the suspicion of abnormal elongation and calcification of the SP, perhaps a manifestation of Eagle syndrome. It would be useful to evaluate the SPs of these patients clinically and radiographically.

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.

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.

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.

Cone-Beam Computed Tomographic Evaluation of Styloid Process in Patients With Temporomandibular Disorders and Asymptomatic Individuals.

Elongated styloid processes (ESP) may show clinical symptoms that are readily confused with symptoms associated with temporomandibular disorders (TMDs). The purpose of study was to compare the prevalance and characteristics of ESP in patients with TMD and asymptomatic individuals are examined by cone beam computed tomography. Angulations and length of the styloid process (SP) were evaluated in CBCT images of 100 patients with TMD symptoms and 100 control patients, retrospectively. Differences between the patient and control groups were assessed by analysis independent sample t test. Pearson correlation test was used to evaluate between length and angulation of SP relationship. The mean length of SP in the TMD group was 38.19 ± 8.6 mm for the right and 38.99 ± 8.1 mm for the right side. The mean length of SP in the control group was 36.80 ± 6.3 for the right side and 36.18 ± 6.5 mm for the left side. The mean anterior angulation of the SP in the TMD group was 22.08 ± 5.5 degree in the TMD group and 23.97 ± 4.1 degree in the control group. The mean medial angulation of the SP in the TMD group was 30.57 ± 4.9 degree and 29.89 ± 4.4 degree in the control group. There was no significant difference in length and angle between the groups (P > 0.05). No correlation was found in terms of length and angulations of SP between TMD and control groups.

Morphometric examination of the styloid process by 3D-CT in patients with Eagle syndrome

This study aimed to obtain the length, medial-anterior angulation and basis-apex coordinates of the styloid process in patients with Eagle syndrome by three-dimensional computed tomography. This study was performed on three-dimensional computed tomography images obtained from the hospital picture archiving and communication system (by obtaining 3D images by a RadiAnt DICOM viewer 4.6.9 version). In this study, the anterior and lateral lengths of the styloid process, its anterior and medial angulation, and the coordinate values on the x, y, and z-axes of 24 patients (14 males, 10 females) diagnosed with Eagle syndrome were examined. The mean anterior lengths were found to be 41.45mm on the right and 36.07mm on the left sides, while the mean lateral lengths were found to be 42.15mm on the right and 37.59mm on the left sides. The mean medial angulation was measured to be 62.91° on the right and 63.42° on the left, while mean anterior angulation was measured to be 28.01° on the right and 30.43° on the left. The styloid process basis coordinates were determined as (right: x = - 41.30, y = 0, z = 0, left: x = 40.79, y = 0, z = 0), and apex coordinates were determined as (right: x = - 22.61, y = - 36.86, z = - 19.52, left: x = 24.90, y = - 32.14, z = - 18.65). Knowing the styloid process basis and apex coordinates in addition to knowing the its length and angulation will be useful in diagnosing Eagle syndrome. We think that these results in relation to the coordinates of the styloid process will bring a new perspective to clinicians who investigate the length and angulation of the styloid process.

Clinical and Radiological Evaluation of Elongated Styloid Process in Patients with Temporomandibular Joint Disorder

Objectives: Clinical findings of elongated styloid process (SP) can easily be confused with clinical symptoms associated with temporomandibular joint disorders (TMD). This study aims to investigate the presence of elongated SP in patients with TMD.Materials and Methods: This retrospective study was performed on the digital panoramic radiographs of 300 patients between 14-68 years of age, where the study group consisted of 150 (300 SP) patients diagnosed with TMD and the control group consisted of 150 (300 SP) individuals without TMD. 224 of the patients were female and 76 were male. SP measurement was performed by a physician with radiography experience. The measurement values higher than 30 mm were accepted as elongated SP.Results: There was a significant difference between the TMD group and the control group in terms of SP length (p&amp;lt;0.05). While 62% of the patients with TMD had elongated SP, this rate was 38% in the control group.Conclusions: Elongated SP rate was higher in patients with TMD. Since TMD and Eagle syndrome have similar clinical findings, physicians should consider the differential diagnosis of patients with TMD compared to Eagle's syndrome.

The incidence of elongated styloid process in chronic tonsillitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The styloid process is a conical projection of the temporal bone lateral to the jugular foramen, and is of variable length. The objective of this study is to know the incidence of elongated styloid process in patients presenting with chronic tonsillitis, and whether x-ray Towne’s view should be part of preoperative evaluation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study was conducted on 160 patients who attended ENT OPD with symptoms of chronic tonsillitis. Towne’s view x-rays were taken and elongated styloid process looked for. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 73.4% of patients with chronic tonsillitis have associated elongated styloid process.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; X-ray Towne’s view should be considered as part of routine preoperative evaluation in patients with chronic tonsillitis. &lt;/p&gt;

Elongated styloid process in patients with temporomandibular disorders — Is there a link?

BackgroundElongated styloid processes may display clinical signs that can easily be confused with symptoms associated with temporomandibular disorders (TMD). Thus, the present study aimed to investigate alterations of the styloid process in patients with TMD. MethodsTemporomandibular joint (TMJ) X-ray images of 192 patients with RDC/TMD diagnoses were examined retrospectively. On each side, the styloid process and mandibular ramus were evaluated regarding length as well as sagittal angulation. Data were statistically analyzed using two-way ANOVA, Pearson’s r and Kruskal–Wallis test. In order to confirm the accuracy of the obtained X-ray measurements, the available cone-beam-computed tomographies (CBCT) of the subjects were also examined as reference standard and compared with the X-ray TMJ data by using Bland–Altman analysis. ResultsIn a group of TMD patients we assessed a mean styloid length of 40.8mm over both genders. In female subjects the means of length and angulation of the styloid process were 40.4mm and 54.9°, male subjects showed means of 42.1mm and 63.4°. The mean height of the mandibular ramus in males was significantly higher than the same measurement in females (66.8mm vs 59.7mm). Styloid length in relation to ramus height (relative styloid length) was significantly larger in females. No significant correlations between RDC/TMD diagnoses and process length as well as process angle were found. A Bland–Altman analysis revealed conformity of CBCT and digital X-ray results. ConclusionThe mean styloid length measured in a group of TMD patients is referred to as elongated, whereas females showed longer styloid in relation to body height. However, it appears that alterations of the styloid are not related to TMD diagnoses.

Styloid Process Fracture Associated With Maxillofacial Trauma: Incidence, Distribution, and Management

Fracture of the styloid process of the temporal bone has been infrequently reported. The present study evaluated the incidence, causes, distribution, and management of styloid process fracture in association with other maxillofacial fractures. A prospective evaluation of patients with maxillofacial trauma over a period of 1year was carried out and patients' characteristics, mode and distribution of injury, and length of styloid process were recorded. Patients were divided into 5 groups based on the site of maxillofacial fracture and into 2 groups based on styloid process length to evaluate their association with styloid process fracture. The authors' unit protocol was carried out for management of styloid process fracture. Of 84 patients with maxillofacial trauma, 27 patients (14 men, 13 women; mean age, 25.7±8.92yr) had styloid process fracture. The most common cause of injury was road traffic accidents. Mandibular and multiple facial fractures accounted for most concomitant styloid process fractures. The mean length of the styloid process in patients with fracture was 2.46±0.89cm and no relevant association was present between the length and fracture of the styloid process. All patients responded well to initial conservative management. Styloid process fractures are relatively common injuries in developing countries and a meticulous examination is essential for prompt diagnosis and adequate care.

A clinical study of the patients with elongated styloid process

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The elongation of styloid process is considered an anomaly which can cause throat pain and cervico-facial pain and trigger a series of symptoms such as dysphagia, odynophagia, facial pain, ear pain, headache, tinnitus and trismus. The present study was undertaken find out the length of styloid process in patients with throat pain.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study was conducted among 150 patients. A detailed ENT and general examination was done apart from palpation of the styloid along the posterior tonsillar pillar, a routine Hematological tests with estimation of serum calcium levels, and X-ray towne view was done. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The female to male ratio was found to be 1.6:1. Of the 150 cases 92 were middle aged females, the severity of symptoms were directly proportional to the length and the thickness of the styloid. The symptoms ranged from foreign body sensation in the throat to cervicofacial pain and otalgia. Serum Calcium levels were elevated in 60% of the cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Elongation of the styloid being multi-factorial in origin. A strong suspicion is required on the part of the surgeon to rule out this particular entity. A simple palpitation and an x- ray Towne view can establish the diagnosis of elongated styloid process.&lt;/p&gt;

Morphometric Study of Styloid Process and its Clinical Importance on Eagle's Syndrome

Background: The styloid process is a slender bony process that projects downwards from the inferior surface of the temporal bone and gives attachment to muscles and ligaments. The aim of the present study is to determine the anatomical morphometry of the styloid process and to study about the elongated styloid process (Eagle’s syndrome). Materials and Method: An observational study was carried out on 60 dry adult human skulls which were used from the Department of Anatomy, Saveetha Dental College, Chennai, India, to study the morphometry of styloid process and its elongation. Length more than 30mm was considered as an elongated styloid process. A Vernier calliper was used for the measurement. Result: The average length of the styloid process was 9.3mm (right) and 8.9mm (left) and the average of dry human skulls having an elongated styloid process was 3.3%. Conclusion: Anatomical knowledge of the styloid process and elongated styloid process is clinically important because of its close relation to important neurovascular structures. The present study highlights the importance of styloid process in patients with symptoms of Eagle’s Syndrome as it is useful for physicians, radiologists and neurosurgeons.

Evaluation of styloid process in Bareilly population on digital panoramic radiographs

Introduction: The styloid process is a long slender and pointed bony process projecting downwards, forwards and slightly medially from the temporal bone. Elongated styloid process is being more often seen in panoramic radiographs which are commonly used in dental practice. Aim: To assess the styloid process on digital panoramic radiographs. Materials and Methods: It is a cross-sectional study based on the panoramic radiographs of 2000 patients who reported to the department. The panoramic radiographs were available in the archives of our department as soft copies. These panoramic radiographs were obtained using Orthoralix DDE (GENDEX, USA) digital panoramic system. The length of the styloid process was measured radiographically on both sides of the maxillofacial region using the measurement toolbars on the accompanying analysis software. For statistical analysis, we used the unpaired t-test, Chi-square test, and one-way analysis of variance test, as necessary. Results: The average length of the right and left styloid process in males was 26.96 ± 8.748 and 26.76 ± 8.33 in females; right and left average length were 26.02 ± 5.86 and 26.59 ± 7.00 in males and females, respectively. The length of the styloid process on both sides increased with age; males had longer styloid process than females. Elongated styloid process was present in 26.5% of the patients. Langlais type I elongated styloids and type D calcification pattern were more common than others. Conclusion: Panoramic radiography is useful for the detection of an elongated styloid process in patients with or without symptoms, and helps avoid misdiagnosis of tonsillar pain or pain of dental, pharyngeal, or muscular origin.

Morphometric study of the styloid process of temporal bone.

Styloid process of temporal bone is clinically important, because variations in length, as well as the angulations of styloid process are associated with the symptoms of stylalgia (Eagle's syndrome) and the surgical excision of the process could alleviate neck and cervicofacial pain in patients. This study was aimed to evaluate the length, angulation and distance between bases and tips of the styloid process. We studied 114 dry skull bones with intact styloid processes. The length of styloid process and distance between bases and tips of the styloid process were measured with the help of vernier calipers. The angulation (anterior and medial angles) of the styloid process was measured directly from the digital images by the image analysis using Adobe Photoshop 7.0 and Image Tool 3.0 Program. A styloid process longer than 3 cm was identified as an elongated styloid process. The means of length of styloid process, distance between bases and tips of styloid process were 2.58 cm, 6.80 cm and 4.65 cm respectively, while means of anterior and medial angles were 62.45(o) and 74.15(o), respectively. Significant statistical difference was seen in anterior angles between groups with normal and elongated styloid processes (p>0.001). Anterior angulation and distance between bases and tips decreased in elongated styloid processes while medial angulation showed no significant change. Our findings highlight the importance of the examination of styloid process in patients with symptoms of stylalgia.

Evaluation of Elongated Styloid Process in Patients with Oral Submucous Fibrosis Using Panoramic Radiographs.

Oral submucous fibrosis (OSF) is an insidious disease affecting the oral cavity, pharynx, and upper digestive tract. It is characterized by a juxtaepithelial inflammatory reaction followed by fibroelastic change in the lamina propria and associated epithelial atrophy. Higher levels of TGF-β present in patients with OSF could be responsible for impetus to remnants of Reichert's cartilage present in styloid complex leading to partial or complete ossification of associated ligaments. So, a study was conducted to evaluate the elongation of the styloid process in patients with OSF by using panoramic radiographs. Panoramic radiographs of patients with OSF were studied from 2007-2011. The apparent lengths of styloid process were measured with the help of divider and steel metric ruler. The length of the styloid process and/or ossification of stylomandibular ligaments which were longer than 30 mm were considered. Out of 47 patients, 35 patients (34 males & 1 female) met the inclusion criteria. Eleven patients (31.4%) were found to have elongated styloid processes which included 10 male patients and 1 female patient. It had been estimated that between 2 % and 4% of the general population presents radiographic evidence of an ossified portion of the styloid complex. The high incidence of elongation of styloid process (31.4 %) in patients with oral submucous fibrosis highlights that progressive OSF might have some influence on elongation of styloid process.

Prevalence of elongation and calcification patterns of elongated styloid process in south India.

Objective: Very few studies have been reported in the literature classifying the elongation and calcification patterns of styloid process. The present study was done to investigate the prevalence of elongation and calcification patterns of styloid process in patients attending a dental institution in south India. Study design: 600 digital panoramic radiographs of patients with dental problems were obtained from the outpatient department of the Dental institution. The apparent length of the styloid process was measured by a single experienced oral radiologist, with the help of the measuring tools on the accompanying software. The type of elongation and calcification patterns of each elongated styloid process was classified as per Langlai’s classification with few modifications. Finally the data was subjected to statistical analysis. Results: Out of 520 measurable styloid processes (260 panoramic radiographs), 154 styloid processes had length greater than 3cm. The mean average length of elongated styloid process was 3.67±0.62 cm. No significant association was obtained between age and length of styloid process. In present study, the type of elongation pattern has no effect on the calcification pattern. Our results suggested that Type I elongated styloid processes were most likely to be completely calcified (type D), but statistically not significant. Conclusion: Type I pattern of elongation was found to be more prevalent in elder age group and was completely calcified in most of the cases. Interestingly, only three patients (out of 260) showed symptomatic elongation of styloid process. A relatively high prevalence of type IV elongation pattern (9 /154) was obtained in the present study, when compared to type III styloid process. Further large scale imaging studies are required to evaluate the presence of type IV elongation pattern in various population groups. Key words:Eagle’s syndrome, Elongated styloid process, Stylopharyngeous muscle, Tonsillectomy.

Styloid process elongation and calcification in subjects with tmd: clinical and radiographic aspects

Knowledge of the Eagle's syndrome shows that its symptoms can be very easily confused with other types of craniomandibular disorders, especially temporomandibular disorders (TMD). The aim of this study was to find a possible correlation between the presence of TMD and elongation of the styloid process as well relate to presence of calcification of the stilohyoid chain. Fifty patients with TMD, confirmed from the RDC/TMD, were examined clinically and radiographically. Radiographic documentation consisted of digital panoramic radiograph and digital lateral cephalometric radiograph. Radiocef software (Radiomemory) was used for the analysis of radiographs by means of specific cephalometric tracing and linear measurements of the styloid process. Each radiograph was traced and measured three times with intervals of 1 month to spread the error. Statistical analysis was performed by Pearson's test (p=0.001) using Biostat 4.0 statistical software. Result showed an incidence of 76% elongation of the styloid process in the sample. There was a correlation between the bilateral measures taken in panoramic radiographs (?<0.001) and also for measures of styloid process length carried out in different panoramic radiographs and lateral cephalometric radiographs (?<0.001). It was concluded that there is prevalence of elongated styloid process in patients with TMD. However, no relationship was found between measurements on the stylohyoid chain and symptoms of headache, orofacial pain, tinnitus and vertigo.