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

Eagle and Ernest syndromes: a scoping review

INTRODUCTION

Ossification disorders can affect the stylohyoid ligament as well the stylomandibular ligament. The symptomathology between those syndromes and other pathologies it has been a problem because there is not a guideline.

EVIDENCE ACQUISITION

With the aim to establish prevalence, diagnosis and etiopathogenesis of Eagle and Ernest syndromes, a scoping review was performed base on PRISMA criteria.

EVIDENCE SYNTHESIS

To review stylohyoid ligament and Eagle Syndrome 93 articles were selected. Three articles regarding the stylomandibular ligament and Ernest Syndrome were founded and selected.

CONCLUSIONS

Both syndromes should be clinically diagnosed and corroborate with imaging (2D or 3D), although imaging in Ernest Syndrome is not clear as well in Eagle Syndrome. A decisional algorithm for diagnosis of Eagle Syndrome and Ernest Syndrome is presented.

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

OBJECTIVE

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.

STUDY DESIGN

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.

RESULTS

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.

A Case of Eagle Syndrome in a Chiropractic Patient

Eagle syndrome is a rare condition that is characterized by, among other things, pain in the face and neck, with the majority of cases being unilateral and isolated to the lower jaw. It is not uncommon for the pain to radiate to the ear. Symptoms can be constant or intermittent and may increase with yawning or rotation of the head, causing Eagle syndrome to be frequently misdiagnosed. The objective of this report is to summarize the symptoms, diagnostic workup, necessary imaging, and management of Eagle syndrome.

Prevalence and Pattern of Stylohyoid Chain Complex on Panoramic Radiographs: A Retrospective Study

Objective: The elongated styloid process (SP) and calcified stylohyoid ligament can be evaluated radiologically and are associated with some symptoms and syndromes. This study aimed to define the incidence of different stylohyoid chain patterns and classify them. Methods: Digital panoramic radiographs of 1217 patients were included in the study. The styloid chain patterns were analyzed according to MacDonald-Jankowski’s study. Data analysis was performed using the IBM SPSS Statistics 21.0 (Statistical Package for Social Sciences) program. Descriptive values were analyzed by using descriptive statistics. The data were assessed by using Chi-squared tests. A probability level of less than .05 (p ˂ .05) was considered significant. Results: The prevalence of the stylohyoid chain complex patterns was higher for normal SP (86.5%), followed by elongated SP (7.1%), calcified stylohyoid ligament (2.2%), and absent stylohyoid chain (2.8%). Unclassified SP was detected in twenty individuals on the left (1.6%) and fourteen on the right (1.2%). In view of symmetry of the stylohyoid chain complex, 979 (80.4%) were symmetric, 238 (19.6%) were asymmetric and 14 (1.15%) of the asymmetrical ones were unilateral. There was no significant difference in gender for the type of stylohyoid chain complex pattern (p > .05). There was statistically significant difference between the stylohyoid complex pattern and age groups for the right and left sides (p < .05). Conclusion: The authors believe that this study provides additional information about the frequency of the elongated styloid process and provides valuable knowledge of the anatomical variations of the SP. Current findings should be correlated with clinical symptoms in future studies

The effect of styloid process medial angulation on Eagle's syndrome's self-reported symptoms: A preliminary cross-sectional study

OBJECTIVE

The aim of this study was to investigate whether the medial angulation of the styloid process (SP), regardless of its length, has an association with self-reported symptoms of Eagle's syndrome.

STUDY DESIGN

In this cross-sectional study, we measured the length and medial angulation of the SP, including ossification of the stylohyoid ligaments, in archived cone beam computed tomography scans. Patients with valid contact details were interviewed by telephone and asked about the clinical symptoms related to Eagle's syndrome.

RESULTS

Eighty-eight patients participated in this study. Their median age was 39.0 years and ranged from 18 to 75 years. Thirty-one (35.2%) of the participants reported cervicalgia with at least one other symptom related to Eagle's syndrome. The mean length and angulation of the right SP were 37.2 mm and 36.3°, respectively, with both readings showing positive correlation with the left SP (r = 0.746 and r = 0.670, respectively; P < .001). Medial angulation of the SP was a predictor of Eagle's syndrome self-reported symptoms (odds ratio, 1.082; 95% confidence interval, 1.003-1.167; P = .042), adjusted for SP length and the patient's age.

CONCLUSIONS

Self-reported clinical symptoms of Eagle's syndrome appear to be more associated with the medial angulation of the SP than with its length. Further research on larger samples is needed to establish the medial angulation cutoff angle and the specific symptoms that are attributed to that angulation.

Prevalence of morphological and structural changes in the stylohyoid chain

Background

Total or partial calcification of the stylohyoid chain, elongation of the stylohyoid process of the temporal bone and/or calcification of the stylohyoid ligament are usually incidental radiographic findings. The purpose of this study was to evaluate the prevalence of morphological and structural changes within the stylohyoid chain in 4413 digital panoramic radiographs.

Material and Methods

The images were evaluated for the presence or absence of changes in the stylohyoid chain by a specialist in dentofacial radiology and the information collected comprised gender, age, side, right and left measurements and classification of the chain side elongated or calcified stylohyoid process, as well as type and pattern of right or left calcification.

Results

275 (6.2%) subjects presented alterations, mostly bilateral, in the stylohyoid chain, being 186 females (67.6%) and 89 males (32.4%), with a higher proportion elongation. Partial calcification was more prevalent than total calcification. The right side was most affected and the frequency of events increased with age.

Conclusions

The findings of the present study demonstrate that the commonest alterations in the stylohyoid chain are bilateral, mainly elongation, with a clear trend to increased prevalence with increasing age, presenting a low incidence. Noneless, the clinicians must be aware of these alterations in the routinely radiographic examination.

Key words:Stylohyoid process, Stylohyoid ligament calcification, Stylohyoid chain, Eagle’s syndrome.

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

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

Evaluation of styloid chain calcification related to temporomandibular joint disc displacement: a retrospective cohort study

OBJECTIVES

The present study aimed to evaluate any relationship between elongated styloid process (ESP) and temporomandibular joint disc displacement (TMJD).

STUDY DESIGN

A retrospective cohort study.

SETTING

Dentomaxillofacial Radiology division of Erciyes University Dental Hospital.

PARTICIPANTS

Ninety-four temporomandibular joints (TMJs) of 47 patients were allocated in this study. Intervention-disease: Two experienced dentomaxillofacial radiologists have interpreted all CBCT and MR images. Patients who referred with TMJ disorders were classified according to temporomandibular joint's disc status as normal disc position (ND), displacement with reduction (DWR) and displacement without reduction (DWoR).

METHODS

Main outcome measures: Interpretation of styloid chain calcification pattern and styloid processes length measured linearly on reconstructed sagittal slices of CBCT. Randomization: Cone beam computed tomography (CBCT) and magnetic resonance (MR) images of 154 patients who were admitted between September 1, 2012 and September 1, 2019. Only 47 of them fulfilled the study requirements. Blinding: Single blind of the outcome measurements and interpretations of MR images.

RESULTS

Total 94 TMJs of 47 patients disc status groups were analyzed and defined as DWoR (n = 25), DWR (n = 32), and ND (n = 37). On multivariate analysis, no statistical significant differences were found between groups in terms of styloid process lengths. Mean SP length and standard deviation of disc status groups (DWoR, DWR, and ND) are 35.5 (± 9.8) mm, 34.6 (± 9.2) mm, and 38.3 (± 8.9) mm, respectively. When patients were grouped individually according to their post-MRI diagnosis, the mean styloid process length in the non-temporomandibular joint disc displacement (non-TMJD) patients (47.9 ± 10.8) was significantly higher than the TMJD patients (36.1 ± 9.3). In this study, there is no intervention to cause any harm or side effects.

CONCLUSION

Our results indicate that styloid-stylohyoid syndrome may be misdiagnosed with temporomandibular joint disorder (TMD).

TRIAL REGISTRATION

Clinical Trials NCT04280107.

Evaluation of stylohyoid complex in subjects with different types of malocclusions using cone-beam computed tomography: a retrospective study in a Turkish subpopulation

PURPOSE

According to the functional matrix theory, the development of maxillomandibular complex may be affected by the surrounding tissues. The aim of this study was to evaluate the length and angulation of the styloid process in different types of malocclusions using cone-beam computed tomography (CBCT).

METHODS

Angulations and length of the styloid process were evaluated in CBCT images of 97 individuals retrospectively. The patients were classified as class I, II, and III groups according to sagittal skeletal classes. The mean length, anterior angulation, and medial angulation of the styloid process were analyzed. Statistical significance was evaluated at p < 0.05.

RESULTS

The mean styloid process length in group class III was found to be significantly longer than class I (p: 0.035). Anterior angle was significantly higher in class III group than in other groups (p < 0.05). No statistically significant difference was found in medial angle between the groups (p: 0.506).

CONCLUSION

According to present findings, class III malocclusion is associated with the stylohyoid complex morphology due to longer styloid process lengths and higher anterior angle values.

Relationship between the prevalence of soft tissue radiopacities on panoramic radiographs and medical conditions

BACKGROUND

This study aimed to describe radiographic characteristics and the prevalence of selected anatomical structures and soft tissue radiopacities on panoramic radiographs and their relationship to medical conditions.

METHODS

A retrospective cross-sectional study was conducted with 814 consecutive patients aged 35-88 years and their panoramic radiographs. Soft tissue calcifications found in the mandibular angle area were recorded according to gender, age, and bilaterally. Patient medical records were reviewed for atherogenic risk factors including hypertension, diabetes, dyslipidemia, chronic renal disease, menopause, drug usage and any other systemic condition. Data were analyzed with the χ² test and Fisher's Exact test; P<0.05 was considered statistically significant.

RESULTS

Among the 814 patients, a total of 74 (9.1%) calcified carotid artery atheromas (CCAA) were identified, of which 34 (4.17%), 40 (3.19%), and 14 (1.7%) were right, left, and bilateral, respectively. Orthopantomographic examination revealed triticeous cartilage (7.3%) in the cervical bifurcation region, asymptomatic styloid process elongation 192 (23.5%), tonsilloliths 27 (3.3%), sialoliths 37 (4.5%), calcified lymph nodes 46 (5.7%), impacted roots 109 (13.4%), and foreign radiopaque materials 23 (%2.8). There was a significant age and gender difference between type II diabetes and CCAA. A positive correlation was found between styloid process elongation and temporomandibular joint disorders and antidepressant use.

CONCLUSIONS

Soft tissue radiopacities can be a validated risk indicator of cardiovascular events or misdiagnosed pain. Dental practitioners must be aware of these atypical findings as they may be related to serious disease states and may require referral for further investigation.

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

OBJECTIVES

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.

METHODS

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.

RESULTS

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).

CONCLUSION

No correlation was found in terms of length and angulations of SP between TMD and control groups.

Cone beam computed tomographic evaluation of styloid process: A retrospective study of 1000 patients

Objective:

The styloid process (SP) is a bony projection, located just anterior to the stylomastoid foramen, the normal length of which is approximately 20–30 mm. The length of SP when exceeds 30 mm it is said to “elongated.” The purpose of this retrospective study was to assess the prevalence of elongated SP (ESP) by cone beam computed tomography (CBCT) examination in Turkish subpopulation and its relation to gender and age.

Materials and Methods:

This study analyzed CBCT of 1000 patients who were randomly selected to participate and were aged from 14 to 78 years. Any radiograph with questionable SP was excluded from the study. The apparent length and thickness of the SP were measured by two dental and maxillofacial radiologists. The ESP was classified with radiographic appearance-based morphology of elongation. The data were analyzed with the IBM SPSS Statistics 20.0.

Results:

The mean age of patients was 42.49 ± 14.83 years. The length of SP was measured over 30 mm in 151 patients (15.1%). A total of 151 CBCT showed ESP, of which 87 (57.6%) were noticed in males and 64 (42.4%) in female patients. The length of right-sided SP ranged from 30.05 to 85.49 mm and left-sided SP from 30.14 to 83.72 mm.

Conclusion:

CBCT is a valuable diagnostic imaging tool which makes accurate length measurements. It is important for the clinicians to be aware of natural variations of the SP whose clinical importance is not well understood.

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

PURPOSE

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.

METHODS

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.

RESULTS

The mean anterior lengths were found to be 41.45 mm on the right and 36.07 mm on the left sides, while the mean lateral lengths were found to be 42.15 mm on the right and 37.59 mm 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).

CONCLUSION

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.

Evaluation of Styloid Process and Its Anatomical Variations: A Digital Panoramic Study with Systematic Review

Aims and Objectives:

To evaluate the styloid process (SP) and its anatomical variations on digital panoramic radiographs from the database and also to synthesize the current evidence of literature on SP and anatomical variations along with the systematic review of the relevant studies after making the necessary exclusions.

Materials and Methods:

A total of 500 panoramic radiographs from the database were examined and evaluated for the length of SP using OmniVue software and for the calcification patterns which were categorized into three types as described by Langlais. The obtained values were analyzed using t-test and Chi-square tests with a significance level of 0.005 and SPSS version 20.0 software.

Results and Conclusion:

The mean length of the SP in females was found to be 3.7 cm on the right side and 3.8 cm on the left side. The mean length of the SP in males was found to be 3.4 cm on the right side and 3.3 cm on the left side with significant difference between the genders with the P values of 0.0002 and 0.0001, respectively. The length of the SP was significantly longer in females than in males. Type I was the most common SP and was more prevalent in females. The results of the present study along with the wide range of reported incidence of anatomical variations in the form of elongation from the literature extracted through the systematic review suggests the need to reevaluate the range of the normal length of the SP.

Length of the ossified stylohyoid complex and Eagle syndrome

PURPOSE

To assess radiographically the presence of an ossified stylohyoid complex (OSHC) with signs and symptoms of Eagle syndrome or other oro-facial painful diseases in patients attending our institution and to confirm that the important issue for study is to know the length of the ossificated portion of the stylohyoid complex only.

METHODS

We separated 1000 consecutive files, and after selection, 922 panoramic radiographs were evaluated. Assessed parameters were gender and age of the patients, size, and location of the analyzed OSHCs. In addition, the length parameters of the studied OSHCs were also determined in 100 extra radiographs.

RESULTS

Normal length of OSHCs was between 2.83 and 4.16 cm and OSHCs measuring more than 4.17 cm long comprising 23.2% of the sample. Any of the patients with OSHC presented signs or symptoms of the Eagle syndrome or any other orofacial painful disease.

CONCLUSIONS

This is the first study on OSHCs using the mandatory parameters of normal, short and elongated length in the studied population. Our results suggest that the presence of an OSHC is not an important feature for pain detection in the Eagle syndrome and is not an important risk factor for development of throat pain in this and other painful orofacial diseases. Our results are different from those previously published in other populations and suggest that the widely used lengths of 2 to 4 cm for measuring the OSHCs are not adequate parameter. It is desirable to define first the short, normal and abnormal parameters of OSHCs in each studied population.

Prevalence of calcifications in soft tissues visible on a dental pantomogram: A retrospective analysis

OBJECTIVES

To determine the frequency and spectrum of soft tissues calcifications identified on Dental Pantomograms (DPT) at a University Dental Clinic in the northern region of Portugal and to compare the data obtained with those published in the literature.

METHODS

We conducted a 3-year descriptive analysis (2012-2014) of DPT calcifications within soft tissues at the University Clinic (CESPU), in Oporto, Portugal. Information on gender, age, location of the lesions and the radiographic diagnosis were analysed. DPTs were interpreted by two examiners (Kappa test 0.8). Data were entered into a database and analysed with Chi-square and Fisher exact tests. Statistical analysis was performed using the Kolmogorov-Smirnov and Shapiro-Wilk test.

RESULTS

2375 DPTs were analysed, with 468 calcifications observed in the radiographs of 420 individuals. Calcifications of the stylohyoid and stylomandibular ligament were most common, with atheroma, sialoliths, tonsilloliths rhinoliths and antroliths also identified. A statistically significant relationship was observed between the presence of calcifications of the stylohyoid and stylomandibular ligaments, atheromatous calcifications in the carotid artery and tonsilloliths in individuals older than 40.

CONCLUSIONS

This is the largest sample analysis ever done in Portugal, providing useful information about the incidence and distribution of soft tissue calcifications identifiable on DPTs, allowing valuable comparison with other countries.

ADVANCES IN KNOWLEDGE

Despite mostly being incidental findings, panoramic radiography can be the first relevant test that aids dental practitioners in the process of requesting other imaging techniques or forwarding to the correct specialty.

Elongated styloid process: An epidemiological study on digital panoramic radiographs

Background

The styloid process is a projecton of the temporal bone, its lenght is between 20 to 30 mm, when it is longer than 30 mm it is defined elongated styloid process. The aim of this study is an epidemiological evaluation of 1003 digital panoramic radiographs in an Italian population between 5 and 90 years old.

Material and Methods

This is a retrospective analysis and the radiographs were selected from the Complex Operating Unit of Dentistry of Padua University Hospital database. The radiographs were performed using a Sirona Ortophos XG and the styloid process length was measured using the measuring tool of Sidexis Software. It was measured from the point where it left the temporal bone plate to its tip. Styloid processes measuring more than 30 mm were considered elongated. Chi-squared test, Fligner-Killeen test, Shapiro-Wilk test and t-test with Welch correction were performed.

Results

In the study 33.40% of the patients showed an elongated styloid process.

Conclusions

The number of patients with elongated styloid process and the mean length of the process increase with the age confirming the chronic development of the calcification described in literature. No statistically significant correlation is found between the presence of elongated styloid process and the gender and affected side (bilateral or unilateral).

Key words:Elongated styloid process, panoramic radiograph, epidemiological study, Eagle’s syndrome.

Elongated styloid process evaluation on digital panoramic radiograph in a North Italian population

Background

The aim of this study is to evaluate the prevalence of elongated styloid process in digital panoramic radiographs in a North Italian population in relation to age, gender and side.

Material and Methods

This study was performed as a retrospective analysis on digital panoramic radiographs of 600 (271 males and 329 females) Italian patients between 6 and 87 years old. The styloid process length were measured using the measuring tool of Sidexis Software. It was measured from the point where it left the temporal bone plate to its tip. Styloid processes measuring more than 30 mm were considered elongated. Chi-squared and Fisher tests were used and the test is considered significant if the p-value is lower or equal to 0.05.

Results

Thirty-three per cent of the patients showed an elongated styloid process. Seventeen per cent were elongated on both right and left side, fifteen point nine per cent were elongated only in one side.

Conclusions

The prevalence of elongated styloid process was high and a progressive increase of the elongation prevalence was found in older groups.

Key words:Elongated styloid process, Eagle’s syndrome, panoramic radiograph.

Does the state of dentition effect the type of stylohyoid chain calcification pattern?

INTRODUCTION

The human stylohyoid chain calcification patterns (SCP) present considerable anatomic variability. This study was performed to investigate the calcification on SCP in the dentate and total edentulous population and its relation to mandibular protrusive movement.

MATERIALS AND METHODS

The study analyzed 1.234 SCP in digital panoramic radiographs of 617 subjects. The SCP were classified according to Mac Donald-Jankowski. The amount of mandibular protrusion movement limitation was evaluated for each subject. The data were analyzed using one-way Anova, Kruskall Wallis, Mann-Whitney U, and Chi-squared tests with significance set at p = 0.05.

RESULTS

Among the 617 subjects evaluated there was symmetry of the SCP between the left and right sides in 87.3 % of the cases. In the study population 501 subjects were dentate (Class I, Class II, Class III molar relationship) and 116 subjects were total edentulous. There were significant differences among dentate and total edentulous patients for the distribution of SCP (p < 0.05). Elongated group was more prevalent in total edentulous subjects while in subjects with Class I occlusion normal SCP was observed. Although mandibular protrusive movement range was within normal limits for all the groups, calcified and elongated groups have numerically less protrusive movement compared to normal groups (p < 0.05).

CONCLUSION

Among dentate and total edentulous subjects, similarity in SCP for right and left side was observed. The elongation of SCP was more common in the total edentulous group. Further studies conducted on larger populations are necessary to establish the effect of the state of dentition on the SCP.

Prevalence of Elongated Styloid Process in a Central Brazilian Population

BACKGROUND

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.

AIM

To investigate the prevalence of the elongated styloid process in a Central Brazilian population and its relation to gender, age and side.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSION

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 non-perceived differential diagnosis of temporomandibular disorder

•

We investigated Eagle’s syndrome as a common origin of head and neck pain and differential diagnosis of temporomandibular joint disorders.

•

Styloid syndrome is a cause of head and neck pain, resulting from the presence of an elongated styloid process above 25 mm as Eagle believed.

•

Eagle’s Syndrome can be diagnosed easily upon panoramic imaging and an analysis of reported symptoms in a routine check by a dentist.

•

Using CT-navigation combined with endoscopy in an external surgical approach should be the treatment of choice when a patient is faced with long term pain of head and neck region.

Introduction

This article unveils a case of the classic styloid syndrome and states that panoramic imaging and ultrasound can be an alternative to computed tomography. In addition, the endoscope-assisted extraoral approach using CT-based navigation is useful. Eagle’s Syndrome is an aggregate of symptoms described by Eagle in 1937. He described different forms: the classic styloid syndrome consisting of elongation of the styloid process which causes pain. Second, the stylo-carotid-artery syndrome which is responsible for transient ischemic attack or stroke.

Presentation of case

Using the example of a 66 years old male patient suffering from long term pain, we explain our diagnostic and surgical approach. After dissecting the styloid process of the right side using an extraoral approach, the pain ceased and the patient could be discharged without any recurrence of the pain up to this point.

Discussion

Eagle’s syndrome, with its similar symptoms, is rather difficult to differentiate from temporomandibular joint disorders (TMD), but can be easily excluded from possible differential diagnoses of TMD using panoramic radiographs and ultrasound.

Conclusion

Making use of low cost and easily accessible diagnostic workup techniques can reveal this particular cause for chronic pain restricting quality of life. Thereby differentiation from the TMD symptomatic complex is possible.

Nonsurgical treatment of stylohyoid (Eagle) syndrome: a case report

Eagle syndrome is a rare condition caused by elongation of the styloid process or calcification of the stylohyoid ligament. Patients with Eagle syndrome typically present with dysphagia, dysphonia, cough, voice changes, otalgia, sore throat, facial pain, foreign body sensation, headache, vertigo, and neck pain. Here we report a case in which the patient initially presented with sore throat, left-sided facial pain, and cough. This case report provides a brief review of the diagnosis and nonsurgical management of this rare syndrome.