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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.
600 digital panoramic radiographs of patients...
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... -Jankowski DS (5), in his classification. Hence we mo- dified Langlai's classification by adding a 4 th variant of elongation pattern. It mainly included styloid process si- milar to type "H to J" patterns (proposed by MacDonald -Jankowski DS ) of calcified stylohyoid chain which was not continuous with the base of skull. The elongation patterns (Fig. 2) were graded as type I (Uninterrupted integrity of styloid process (>30mm)), type II (Styloid process joined to the mineralized stylo- mandibular or stylohyoid ligament by a single pseu- ...Citations
... Adults and children High Okabe et al. [92] 2006 Asia X-ray 1318 Adults (only 80 years) Low Onbas et al. [93] 2005 Asia X-ray 566 Adults Low Oztas et al. [94] 2012 Asia X-ray 4000 Adults and children High Paraskevas et al. [95] 2022 Asia Osteological 127 Adults High Patil et al. [96] 2014 Europe Osteological 228 NR High Phulambrikar et al. [97] 2011 Asia X-ray 328 Adults and children High Ramadan et al. [98] 2007 Asia CT 200 Adults Low Rath and Anand [99] 1991 Asia Osteological 464 NR High Rathva et al. [100] 2013 Asia Osteological 300 NR High Reddy et al. [101] 2013 Asia X-ray 520 Adults and children High Ribeiro et al. [102] 2018 Europe X-ray 4750 Adults and children Low Rizzatti-Barbosa et al. [103] 2005 America X-ray 4504 Adults High Roopashri et al. [104] 2012 Asia X-ray 600 Adults and children High Ruprecht et al. [105] 1988 Asia X-ray 1042 Adults and children High Saati et al. [106] 2020 Asia X-ray 4054 Adults Low Safabakhsh et al. [107] 2018 Asia X-ray 10,000 Adults and children High Sahed et al. [108] 2011 Asia Osteological 1188 Adults High Sakhadari et al. [109] 2018 Asia X-ray 1000 Adults Low Saric et al. [110] 2023 Europe CT 1658 Adults Low Scaf et al. [111] 2003 America X-ray 332 NR High Shah et al. [112] 2012 Asia X-ray 1034 NR High Shahidi et al. [113] 2021 Asia CBCT 698 Adults and children Low Sharma et al. [114] 2019 Asia X-ray 2000 Adults and children High Shayganfar et al. [115] 2018 Table 2. A significant association was identified based on the study type. ...
Background: The temporal bone’s styloid process (SP) is an important structure that extends from the skull base to the parapharyngeal space. The stylohyoid ligament (SHL) attaches it to the hyoid bone. The SP and SHL are considered the stylohyoid chain (SHC) components. The SP’s close relationship with vital head and neck structures has important clinical implications. Specifically, SP and SHC variants are linked with clinical conditions. Therefore, adequate knowledge of these variations is of paramount importance. Methods: Using the latest guidelines, a systematic literature review was performed in four online databases (PubMed, Google Scholar, Scopus, and Web of Science) to identify studies referring to the SP’s typical anatomy and possible SHC morphological variants. The meta-analysis was conducted using R programming software to calculate the prevalence of typical anatomy and possible variants and the pooled mean length of the SP. Results: A total of 104 studies were included, with a total sample of 136,010 heminecks. The typical SP (under 30 mm) was estimated to have a pooled prevalence of 74.97%. SP elongation was observed in 25.03%. The subgroup analysis identified significant differences based on the study type, with computed tomography (CT) studies having the highest pooled prevalence. The SP length was calculated to have a pooled mean of 28.91 mm. For SHC ossification, the pseudo-articulated type was identified to have a pooled prevalence of 4.39%, and that of the segmented type was detected to be 3.89%. The geographical distribution and study type affected the estimated pooled prevalence. Conclusions: The current evidence-based systematic review with meta-analysis investigated the SHC’s typical anatomy and possible variants. The elongated SP pooled prevalence of 25.03% indicates that it is not a rare variant, and CT is the optimal method to investigate such a variant. These details demonstrated by the current meta-analysis could be of importance for clinicians.
... The PR allows initial insights into the length and anatomical structure of the SP as well as possible calcification patterns (12,13). Furthermore, certain tilts/rotations, and/or segmentations of the SP in the context of the Langlais classification can be identified (13,14). Furthermore, an ESP is often detected as an additional finding in routine PR (e.g., pre-/postoperative PR in general dental treatment). ...
Background/aim:
The styloid process (SP) becomes clinically relevant when it shows enlargement (>30 mm) in the sense of an elongated SP (ESP) and/or increasing calcification leading to Eagle Syndrome (ES). Panoramic radiograph (PR) or computed tomography (CT) are part of the routine diagnostics in ES. Currently, CT is considered the gold standard. The aim of this study was to investigate the accuracy in the diagnostics/measurements of SP/ESP throughout a comparative study between PR and CT. Furthermore, in addition to measuring established parameters, this study aimed to determine the currently unexamined width in the base and tip of the SP.
Patients and methods:
The present study examined the radiological findings of bilateral SP in 100 patients who received both PR and CT on the same day. Measurements of the length of the SP and width at the basis and tip were performed. Furthermore, calcification patterns, Langlais classification and the prevalence of ESP were analyzed.
Results:
There was a highly significant correlation between PR and CT measuring SP for every parameter. Males showed significantly longer SP than females among the age group between 18-75 years. The results of the length measurements of the SP (male: right SP=32.98 mm; left SP=35.21 mm; female: right SP=30.31 mm; left SP=30.92 mm) significantly exceeded the values of comparable studies.
Conclusion:
Consequently, it can be concluded that PR provides accurate measurements when compared to CT for measuring and diagnosing SP/ESP/Eagle syndrome. This study was one of the first to examine the width of the SP in the base and tip, thus these measurements can serve as a baseline for further studies. Since the mean lengths of SP exceeded 30.0 mm in the present study, these findings raise the question of whether the cut-off of 30.0 mm is adequate for the diagnosis of ESP.
... It seems that the demographic variables of ESP are not consistent. Some studies indicated ESP is proportional to the aging process [29,70]. Concerning gender, Hamedani et al. [71] indicated that females with low bone density show an ESP as twice as normal ones. ...
Background:
Styloid process (SP) is a cylindrical bony projection that originates from the inferior part of the petrous temporal bone just anteriorly to the stylomastoid foramen. Several nerves, muscles, and ligaments are related closely to the (SP). It is considered elongated when the measurement exceeds 30 mm. The overall prevalence of the styloid process is between 3.3% to 84.4%. The elongation of the styloid process (ESP) is associated with the manifestation of Eagle's Syndrome (ES) which is characterized by various types of pain in the head and neck region such as headache, tinnitus, otalgia, and trigeminal neuralgia. Eagle's syndrome occurs in 4-10.3% of individuals with an elongated styloid process (ESP). The objective of the study is to determine the prevalence of (ESP) in the patients who were treated in the Dental Hospital University of Barcelona (HOUB), to review the literature to spot the light on the different demographic data worldwide.
Methods:
The archived panoramic image in the University of Barcelona dental Hospital were consecutively retrieved to investigate the prevalence of (ESP). Of all digital panoramic radiographs (OPG), 400 met the inclusion criteria and were furtherly analyzed. The results are correlated with the participant's gender, age, and occurrence. Age is subcategorized into three groups. A chi-square test is used to measure the significant differences and the P-value is set at < 0.05 for the level of significance.
Results:
Among the included 400, we found 291 demonstrating (ESP). The prevalence of (ESP) which exceeds 30 mm is 72.75%. It is found that the most common morphological type is type 1 which is regarded as the uninterrupted (ESP) regardless of gender and age group. Concerning the calcification pattern, the most prevalent is the partial calcified (ESP) despite genders and age groups.
Conclusion:
(OPG) is a sufficient tool for the screening of the elongated styloid process. Regarding the prevalence, our results are considered higher than previously reported prevalence in different populations using (OPG) radiography tool. A study on a wider spectrum of the Spanish population is recommended to further investigate the correlation between the elongated styloid process and the occurrence of Eagle's syndrome.
... Other studies reported widely varied rates [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Prevalence of styloid process elongation in different countries ranged from 0.4% to 81% ( Table 4). ...
Objectives
Elongation of the styloid process causes different symptoms with varying degrees of severity in some people. This elongation can be detected haply during routine reading of panoramic X-ray. The aim of this study is to determine the prevalence rate of Eagle’s syndrome among a population from Damascus, Syria, and to evaluate the accompanying clinical symptoms.
Methods
This is a descriptive epidemiological study including 3,962 patients who attended one of the many dental clinics of educational and/or healthcare institutions in Damascus. All digital panoramic radiographs were reviewed, and the styloid processes were measured and assessed for elongation. Patients with styloid process of more than 3 cm in length were contacted and their consents were obtained to participate in the study to assess the presence of clinical symptoms.
Results
Radiographic elongation of the styloid process was found in 179 out of the 3,962 assessed dental records (prevalence rate was 4.5%). Length ranged from 30 to 90 mm, with an average of 55.9 mm. Of the patients with elongated styloid process, 10.2% had undergone tonsillectomy. All patients who underwent tonsil surgeries were symptomatic with at least three of the studied symptoms. Symptoms included peri-orbital pain (40.9%), orbital pain (35.2%), neck and shoulders pain (52.3%), ipsilateral headache (58%), earache (30.7%), tinnitus (37.5%), articular clicking (29.5%), throat pain (31.8%), globus sensation (22.7%), and dysphagia (21.6%).
Conclusions
The prevalence of Eagle’s syndrome according to this study was 4.5%. Patients who had undergone tonsillectomy were more likely to be more symptomatic. The most common symptom was severe headache (migraine) on the same side of styloid elongation. Panoramic radiography is a low-cost means that can be helpful in the diagnosis of vague pain and symptoms caused by Eagle’s syndrome in the head and neck regions.
... On estime que 2 à 4 % de la population générale présente des signes radiographiques d'une portion ossifiée du CSH. La majorité de ces patients (96%) sont asymptomatiques [9,10]. La longueur du PS de l'os temporal varie d'une population à l'autre et donc d'une étude à une autre [11]. ...
Introduction : Les modifications morphologiques (longueur, angulations, épaisseur) du
processus styloïde (PS) peuvent irriter les structures neurovasculaires adjacentes et entrainer
des symptômes connus sous le nom de syndrome de Eagle (SE). Cette morphologie varierait
d’un individu à un autre et d’une population à une autre. L’objectif général de ce travail était
d’étudier la morphologie du PS au scanner dans la ville de Parakou (Bénin).
Matériels et Méthodes : Il s’agissait d’une étude rétrospective descriptive et analytique avec
inclusion des scanners réalisés sur la période de novembre 2019 à juillet 2020. Les images
tomodensitométriques de 218 patients ont été étudiées. La morphométrie du PS a été mesurée
sur des reconstructions multiplanaires à l’aide des paramètres de mesure du logiciel Radiant.
Le type d’élongation et le modèle de calcification des PS ont été classés selon la classification
de Langlais.
Résultats : La prévalence du processus styloïde allongé (PSA) était de 31,54% (n=131) et le
type I d’élongation était la plus fréquente (57,25%, n=75). La longueur moyenne du PS était
de 30,52 mm et l’épaisseur maximale moyenne de 3,56 mm. L’angle médio-latéral moyenne
était de 72,24 degré, l’angle antéro-postérieur moyenne de 70,81 degré, la forme linéaire
(77,77%, n=322), et la calcification complète (77,39%, n=104) étaient les variantes
morphologiques les plus fréquentes. En dehors de l’épaisseur et de la distance minimale entre
le complexe stylo-hyoïdien et la fosse tonsilaire aucune variable n’était statistiquement
associée à l’allongement du PS. Plus le PS était long, plus il était épais et plus proche était-il
de la fosse tonsilaire. L’épaisseur maximale du PS quant à elle augmentait avec l’âge
(p=0,0003).
Conclusion : 31,54% des sujets de cette étude présentaient un PS long de plus de 30 mm. Il
serait donc intéressant de faire une étude radioclinique afin de déterminer la valeur normale
du PS chez le sujet noir africain et la prévalence du SE
... On estime que 2 à 4 % de la population générale présente des signes radiographiques d'une portion ossifiée du CSH. La majorité de ces patients (96%) sont asymptomatiques [9,10]. La longueur du PS de l'os temporal varie d'une population à l'autre et donc d'une étude à une autre [11]. ...
Introduction: Morphological changes (length, angulations, and thickness) of the styloid process (SP) can cause friction with adjacent neurovascular structures and lead to symptoms known as Eagle syndrome (ES). This morphology would vary from individual to individual and from population to population. The aim was to study the morphology of the PS on the CT scan in Parakou (Benin). Materials and Methods: This was a retrospective descriptive and analytical study with inclusion of CT scans performed over the period from November 2019 to July 2020. CT images of 218 patients were studied. PS morphometry was measured on multiplanar reconstructions using Radiant software measurement parameters. The type of elongation and calcification pattern of the PS was classified according to the Langlais classification. Results: The prevalence of elongated styloid process (ESP) was 31.54% (n=131) and type I elongation was the most frequent (57.25%, n=75). The mean length of the PS was 30.52 mm and the mean maximum thickness was 3.56 mm. The mean medio-lateral angle was 72.24 degrees, the mean antero-posterior angle was 70.81 degrees, linear shape (77.77%, n=322), and complete calcification (77.39%, n=104) were the most common morphological variants. Apart from the thickness and the minimum distance between the stylohyoid complex and the tonsil fossa, no other variable was statistically associated with the lengthening of the PS. The longer the SP, the thicker it was and the closer it was to the tonsil fossa. The maximum thickness of the PS increased with age (p=0.0003). Conclusion: 31.54% of the subjects in this study had a long PS of more than 30 mm. It would be interesting to carry out a radio-clinical study to determine the normal value of PS in black African subjects and the prevalence of SE. RESUME Introduction : Les modifications morphologiques (longueur, angulations, épaisseur) du processus styloïde (PS) peuvent irriter les structures neurovasculaires adjacentes et entrainer des symptômes connus sous le nom de syndrome de Eagle (SE). Cette morphologie varierait d’un individu à un autre et d’une population à une autre. L’objectif général de ce travail était d’étudier la morphologie du PS au scanner dans la ville de Parakou (Bénin). Matériels et Méthodes : Il s’agissait d’une étude rétrospective descriptive et analytique avec inclusion des scanners réalisés sur la période de novembre 2019 à juillet 2020. Les images tomodensitométriques de 218 patients ont été étudiées. La morphométrie du PS a été mesurée sur des reconstructions multiplanaires à l’aide des paramètres de mesure du logiciel Radiant. Le type d’élongation et le modèle de calcification des PS ont été classés selon la classification de Langlais. Résultats : La prévalence du processus styloïde allongé (PSA) était de 31,54% (n=131) et le type I d’élongation était la plus fréquente (57,25%, n=75). La longueur moyenne du PS était de 30,52 mm et l’épaisseur maximale moyenne de 3,56 mm. L’angle médio-latéral moyenne était de 72,24 degré, l’angle antéro-postérieur moyenne de 70,81 degré, la forme linéaire (77,77%, n=322), et la calcification complète (77,39%, n=104) étaient les variantes morphologiques les plus fréquentes. En dehors de l’épaisseur et de la distance minimale entre le complexe stylo-hyoïdien et la fosse tonsilaire aucune variable n’était statistiquement associée à l’allongement du PS. Plus le PS était long, plus il était épais et plus proche était-il de la fosse tonsilaire. L’épaisseur maximale du PS quant à elle augmentait avec l’âge (p=0,0003). Conclusion : 31,54% des sujets de cette étude présentaient un PS long de plus de 30 mm. Il serait donc intéressant de faire une étude radioclinique afin de déterminer la valeur normale du PS chez le sujet noir africain et la prévalence du SE.
... The styloid process is considered to be elongated if more than this. The elongated SP is associated with Eagle syndrome [3][4][5][6]. In an adult individual, the styloid ligament, which is usually formed by dense fibrous connective tissue, may retain some of its embryonic cartilage and thus has the potential of becoming partially or completely ossified. ...
... All of these variations may be associated with some clinical symptoms, such as sore throat, foreign body sensation, pain during swallowing, facial neuralgia, headache, and temporomandibular joint disorders. These symptoms are present in Eagle syndrome and the main cause of it is due to the compression of various nervous and vascular structures around it [3][4][5][6]. Computed tomography (CT) provides a three dimensional visualization of styloid process and thus aids on an accurate diagnosis. ...
Objective: This study aimed to assess the anatomical variation of the styloid process of Nepalese individuals by using multi-detector computed tomography scans. It was carried out to establish the baseline for the normal length of the styloid process and to compare the variability of styloid process measurement between different age group and gender. Materials and methods: This quantitative, cross-sectional was performed in the Department of Radiology and Imaging, Tribhuvan University Teaching Hospital. Imaging data were collected over the period of January to April 2021 with the total number of 153 individuals. The age and gender of the individuals were noted. The measurement was done in the Multiplanar Reconstruction (MPR) coronal sections of Head and Neck, Results: The measurement of the length of SP was found to be 3.06±0.72 cm (ranged 1.80-5.54 cm) in right SP while that of left SP was 3.08±0.72 cm (ranged 1.45-5.69 cm). The gap between the SP and the calcification pattern was found to be 0.51±0.30 cm (ranged 0.08-1.20 cm) in right SP while that of left SP was 0.63±0.43 cm (ranged 0.08-1.97cm). Similarly, there was a statistical significant difference between the RLSP-RGSP and LLSP-LGSP. The length of styloid process was found to be higher among male than in female. But there was no statistical significant difference between male and female in the SP measurement. The series of elongation patterns were found to be normal SP, followed by elongated, distant elongated, pseudoar-ticulated, and segmented SP. The series of calcification patterns were found to be calcified SP, followed by nodular, partial, and outlined SP. Conclusion: In this study, the valuable information regarding anatomical length and variation of styloid process with respect to age and gender among the Nepalese individuals was found. 3D CT reconstruction is a gold standard investigation that helps in studying the relation of the SP with surrounding structures.
... (38) assessed the SP as elongated when the SP's tip extends below the mandibular foramen. Consistent with previous studies, we refrained from measuring the lengths of SPs due to technical (panoramic radiography machine differences, magnifications, manual versus digital measurement and calibration) and epidemiological (ethnic and genetic variety) circumstances (36)(37)(38)(39). Therefore, the types of SP were compared according to MacDonald-Jankowski's study (20). ...
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
... Prevalence of eagle Syndrome had an average of 1.84% (table iV). 21,33,[42][43][44][45][46][47][48] ...
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 guideliness.
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:
93 articles were selected to review stylohyoid ligament and Eagle syndrome. 3 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.
... Our study centered mainly on variation of morphological patterns in accordance with age and gender, unlike R Sudhakaran et al study, 14 Type 1 pattern is more frequent type in females and Type IV pattern is predominant among age group upto 20 years (37%) next to elongated variant (47%). In comparison with the study conducted by Mun Bhawni Bagga et al, it shows male predilection for the elongated variant. ...
Orthopantomograms of different individuals were studied to understand the prevalence of morphological variants in styloid process. New types of styloid processes were identified other than that found in the existing classification while proceeding with the study. Thus, a deeper examination of this topic felt interesting.
To identify the anatomical variations of styloid process and its distribution according to age and gender on digital panoramic radiographs.
A total of 1000 panoramic radiographs from the database were analyzed for the types and distribution. Langlais classification with modification is used for the study.
The tapered and wavy forms were identified apart from Langlais classification of styloid process, in elongated category. Among total population under study elongated category were predominant compared to other types and gender wise distribution manifested the predilection of elongated category among male. Moreover, the elongated variant dominated among the older individuals than adult and younger age groups. Considering age as the parameter Type IV category prevails in younger age group.
1):The two new morphological variants among the elongated variant of styloid process categorized as tapered and wavy were identified, which is to be included in existing classification. 2): Elongated variant is most predominantly seen, of which tapered variety is common among elongated variety, 86.6% was seen in females and 83.8% was seen in males; 3): Wavy variant was dominant in males with 16.1%, whereas in females it was 13.3%. 4): Contemplation of gender as parameter, manifested male predilection to elongated category. 5): Relatively high prevalence of type IV category was analyzed next to elongated variant among age group upto 20 years.
