The clinical significance of the elongated styloid process

doi:10.1016/0030-4220(86)90426-3

Oral Surgery, Oral Medicine, Oral Pathology

Volume 61, Issue 4, April 1986, Pages 399-404

Oral Surgery, Oral M...

https://doi.org/10.1016/0030-4220(86)90426-3 Get rights and content

Abstract

A group of 1135 edentulous patients was investigated radiographically and clinically to determine the relation between elongated styloid processes and four symptoms frequently encountered in patients suffering from Eagle's syndrome. The radiologic finding of elongated styloid processes and/or ossification of the stylomandibular or stylohyoid ligaments occurred in about 30% of the patients. In female patients, facial pain and pain on turning the head appear to be related to the radiologic finding.

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Cited by (149)

An evaluation of the prevalence of elongated styloid process in Taiwanese population using digital panoramic radiographs
2022, Journal of Dental Sciences
Styloid process (SP) was an anatomical structure located in front of the stylomastoid foramen and the occurrence of styloid process elongation was uncertainly reported. The purpose of this study was to survey, using digital panoramic radiography, the lengths of styloid process (SP) and the prevalence of elongated SP in the Taiwanese population. Their relationships with age, gender and laterality were also determined.
A total of 539 patients (including 53 that were referred from the Department of Otorhinolarygngology with clinical symptoms) were studies retrospectively. Panoramic radiographic examinations were performed on all these patients at the Outpatient clinics of the Department of Stomatology, Taichung Veterans General Hospital between January 2019 and December 2019. Patients were divided into groups according to their age and gender. The length of SP from the base of temporal bone junction to the tip of the process was measured using the Sirona software. Data were analyzed using SPSS version 22.0 based on tests of Chi-square, Mann–Whitney U and Kruskal Wallis tests. Statistical significance was set at p < 0.05.
A total of 539 (240 males and 299 females) digital panoramic radiographs were measured and evaluated in this study. The mean length of SP was 30 ± 0.7 mm on the right side and 29 ± 0.7 mm on the left side. The average length of SP on both sides was 29.5 ± 0.7 mm. In those cases with symptomatic Eagle syndrome, the mean length of SP was 32 ± 0.8 mm on the right side and 33 ± 0.8 mm on the left side (average 32.5 ± 0.8 mm). These lengths were statistically different between the general population and the symptomatic patients. Furthermore, the mean length of SP was 29 ± 0.7 mm in females and 30 ± 0.7 mm in males. The length of the SP grew progressively with age, and was more clearly seen within subjects from 41 to >60 years of age (p < 0.005). Meanwhile, the prevalence of elongated SP in our study was 41.5% on the right side and 36.2% on the left side, with female predominance.
The mean length of SP was 30 ± 0.7 mm (right side) and 29 ± 0.7 mm (left side). The prevalence of elongated SP was 41.5% on the right side, and 36.2% on the left side. Our findings were consistent with some previous studies that were differences related with age, and were more prominent in those patients with symptoms.
Retrospective study of the styloid process in a Taiwanese population using cone beam computed tomography
2022, Journal of Dental Sciences
Citation Excerpt :
The mean SP transverse angle was 66.90°, and the mean SP sagittal angle was 26.67°. A number of studies have reported an increased SP length with respect to increasing age.9–14 Gokce et al.15 suggested that age may be associated with elongation of the SP.
Review of literature, evaluation of the styloid process (SP) using cone beam computed tomography (CBCT) has not been performed in a Taiwanese population. Our study aimed to evaluate the different characteristics of SP using CBCT in a Taiwanese population.
CBCT scans of 121 patients (55 males, 66 females; mean age, 27 ± 9.09 years) were evaluated to assess the length, morphological type, calcification pattern, and angulation of the SP. A SP length greater than or equal to 30.00 mm is considered to indicate an elongated SP (ESP). ESP was classified in terms of morphology as Type I: uninterrupted; Type II: pseudo-articulated; or Type III: segmented. The calcification pattern of SP was categorized as Type A: calcified outline; Type B: partially calcified; Type C: nodular; or Type D: completely calcified. The transverse and sagittal angles between the bilateral SP were also measured.
One-hundred and nine patients had a bilateral SP and 12 patients had a unilateral SP. The mean SP length was 26.34 ± 7.44 mm. Forty-two (34.71%) patients had an ESP. The most common ESP morphology was Type 1, followed by Type II, then Type III, while the calcification pattern prevalence was of the descending order Type B, Type A, Type C, and Type D. The mean transverse and sagittal angles were 66.90 ± 5.41° and 26.67° ± 6.50°, respectively.
The present study was the first to evaluate the characteristics of SP in a Taiwanese population using CBCT. The data contribute a useful basis for clinical investigation of the SP in future.
Eagle's syndrome, elongated styloid process and new evidence for pre-manipulative precautions for potential cervical arterial dysfunction
2020, Musculoskeletal Science and Practice
Safety 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.
This 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.
Including 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.
A proposed extension to the elongated styloid process definition: A morphological study with high-resolution tomography computer
2020, Morphologie
The objective of the present study was to evaluate the morphology and angulation of the styloid process (SP), analyzing results stratified by gender, side and age on asymptomatic patients. We retrospectively analyzed 99 high-resolution computed tomography study images from asymptomatic patients. The images were assessed intra-observatory by a head and neck expert radiologist. Data for length, morphology, and angulation in a coronal and sagittal plane were recorded and stratified by age and gender. Morphology was classified according to the Langlais modified by Guimares classification. The mean lengths were 31.67 ± 0.97 mm and 31.64 ± 0.90 mm for the right and left sides respectively. Using the Langlais modified by Guimares classification, the normal type was the most prevalent and without a statistically significant difference when comparing between genders. A total of 27.6% presented a morphologically elongated SP (>25 mm of continuous process), 49.5% presented a radiologically elongated SP (>30 mm), and a total of 9.59% had a longer length than the proposed ≤ 45 mm. The right transverse angle was greater in men than women, and a statistically significant difference was found (P = 0.010). We show the morphological variability of the SP. Although our results are reported with the traditional definition, the high prevalence supports the need for a new definition of elongated SP and a normal angulation ranges.
L’objectif de la présente étude était d’évaluer la morphologie et l’angulation du processus styloïde (SP), en analysant les résultats stratifiés par sexe, côté et âge sur des patients asymptomatiques. Nous avons analysé rétrospectivement 99 images d’étude de tomodensitométrie à haute résolution de patients asymptomatiques. Les images ont été évaluées en intra-observateur par un radiologue expert de la tête et du cou. Les données de longueur, de morphologie et d’angulation dans un plan coronal et sagittal ont été enregistrées et stratifiées par âge et sexe. La morphologie a été classée selon Langlais modifié par la classification de Guimares. Les longueurs moyennes étaient respectivement de 31,67 ± 0,97 mm et 31,64 ± 0,90 mm pour les côtés droit et gauche. En utilisant la classification de Langlais modifiée par Guimares, le type normal était le plus répandu et sans différence statistiquement significative lors de la comparaison entre les sexes. Un total de 27,6 % présentait un SP allongé morphologiquement (>25 mm de processus continu), 49,5 % présentait un SP allongé radiologiquement (>30 mm), et un total de 9,59 % avait une longueur plus longue que les ≤ 45 mm proposé. L’angle transversal droit était plus important chez les hommes que chez les femmes, et une différence statistiquement significative a été trouvée (n = 0,010). Nous montrons la variabilité morphologique du SP. Bien que nos résultats soient rapportés en utilisant la définition traditionnelle, la prévalence élevée confirme la nécessité d’une nouvelle définition de la SP longue et d’une plage d’angulation normale.
Surgical management of Eagle syndrome: A 17-year experience with open and transoral robotic styloidectomy
2020, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Eagle Syndrome (ES) is a rare disorder that can present with symptoms ranging from globus sensation to otalgia that is attributed to an elongated styloid process and/or calcified stylohyoid ligament. No standardized treatment algorithm exists, and although various surgical approaches have been described, data on the use of transoral robotic surgery (TORS) in this population is limited. To investigate the utility of TORS in the treatment of ES, a retrospective review in 19 ES patients was carried out at a single academic, tertiary medical center between 2000 and 2017. Nineteen patients underwent twenty-one styloid resections: 6 performed via TORS and 15 via transcervical approach. Across all patients, 90% reported some degree of lasting improvement in symptoms while 55% reported significant improvement. When TORS was compared to transcervical resection, there was no difference in the subjective rate of “meaningful” (83 vs. 57%) versus rate of “non-meaningful” symptom improvement (17 vs. 43%) (p = 0.35). There was a trend towards less estimated blood loss (EBL), operative time, and post-operative length of stay (LOS) with TORS versus transcervical cases (9.2 mL vs. 30.0 mL, 98 vs. 156 min, and 0.7 vs. 1.2 days); however, these did not reach statistical significance (p = .11, 0.13, and 0.42, respectively). Three patients experienced complications associated with an open approach, as compared to none with TORS. In select patients, TORS styloidectomy is a reasonable surgical alternative to traditional transoral and transcervical techniques as it provides similar symptom improvement, and reduced length of stay, blood loss, and operative time.
Evaluation of the styloid process in a Sri Lankan population using digital panoramic radiographs
2019, Journal of Oral Biology and Craniofacial Research
Citation Excerpt :
The incidences determined in these studies agree with the findings of Eagle. However, in contrast to these findings a considerable difference was demonstrated with the findings of Correll et al.22 Kauffman et al.18 and Keur et al.23 where the incidence reported was as 18.2%, 28% and 30%, respectively. The incidence of elongated styloid process estimated as 26% in males and 20% in females in the present study which is comparable with the findings of Kaufmann et al.18 and Keur et al.23 Higher incidences have been reported in a North Italian (33%)12 and a central Brazilian (43.89%) population.11
The objectives of this study were to evaluate the normal radiographic length of the styloid process (SP), prevalence and type of elongation, and angulation of the styloid process in relation to sex and side on digital panoramic radiographs in a Sri Lankan population.
A total of 100 digital panoramic images selected from the database at the Division of Oral Medicine and Radiology, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka were evaluated for the radiological features of the styloid process. Lengths greater than 30 mm were consider as elongated. Elongated styloid processes were also classified into three types based on Langlais classification (elongated, pseudo articulated; and segmented).
The mean radiological length of the SP on the right and left side was 25.8 mm ± 7.5 mm and 23.2 mm ± 9.0 mm respectively. The prevalence of elongated styloid process in males and female were 34.9% and 24.6%. The maximum length observed on right and left sides were 43.2 mm and 41 mm respectively. However, the differences between the genders and the sides were statistically not significant (P = 0.199). The most frequently observed type of elongation was type I (elongated) according to the Langlais classification.
This study provides valuable knowledge of the anatomical variations of the SP which may help clinicians from various specialties to diagnose the Eagle syndrome.

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The clinical significance of the elongated styloid process

Abstract

J Prosthet Dent

Oral Surg Oral MED Oral Pathol

Oral Surg Oral MED Oral Pathol

J Prosthet Dent

Oral Surg Oral MED Oral Pathol

Oral Surg Oral MED Oral Pathol

Oral Surg Oral MED Oral Pathol