Extraoral Surgical Treatment for Styloid Process Syndrome: a Case Report

This report describes a case of styloid process syndrome (Eagle's syndrome) with ossification of the stylohyoid ligament. A 58-year-old woman was referred to our department because of right submandibular pain in December 2009. She presented with a 2-month history of spreading pain of the right submandibular region. She had spontaneous pain of the submandibular region, which spread to the right side of the face. On examination, the patient reported some discomfort when she turned her head right. She could open her mouth, but complained of painful limitation of mandibular opening at 39 mm. Bernfeld's digital examination elicited pain of the right posterior region of the ramus of the mandible. She had no throat pain on swallowing. On oral examination, there was no abnormality; however, palpation detected a bony structure and elicited pain of the right tonsillar fossa. A right elongated styloid process was demonstrated on a panoramic radiography and 3D-CT. These radiographic findings showed a mineralized stylohyoid ligament, approximately 70 mm in length, posterior to the right ramus of the mandible. Although glossopharyngeal neuralgia should be included in the differential diagnosis, a clinical diagnosis of styloid process syndrome was made on the basis of radiographic findings, the nature of the patient's symptoms, and positive results of the digital examination. The patient was given NSAIDs for 1 month, but the symptoms did not resolve. In April 2010, the patient underwent a styloid process resection by a transcervical approach under general anesthesia. The right elongated process was removed and measured 45 mm in length. The postoperative course was uneventful. The patient has been free of symptoms since the operation. Histologic examination of the mineralized tissue showed normal mature bone with a central cavity, containing viable marrow and cartilage. Our findings support the concept that the transcervical resection of an elongated styloid process is safe and effective, especially in patients with complete ossification of the stylohyoid ligament.