Assessment of stylohyoid ligament in patients with Eagle’s syndrome and patients with asymptomatic elongated styloid process: A cone-beam computed tomography study

Document Type: Original Article(s)


1 Assistant Professor, Dental Research Center AND Department of Oral and Maxillofacial Radiology, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran

2 Associate Professor, Dental Research Center AND Department of Oral and Maxillofacial Radiology, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran

3 Associate Professor, Maxillofacial Diseases Research Center AND Department of Oral and Maxillofacial Surgery, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran

4 Department of Oral and Maxillofacial Radiology, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran

5 MSc Student, Department of Prosthodontics, School of Dentistry, Shahed University of Medical Sciences, Tehran, Iran

6 Oral and Maxillofacial Diseases Research Center AND Department of Oral and Maxillofacial Radiology, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran


BACKGROUND AND AIM: This study was performed to evaluate and compare the calcification patterns of the stylohyoid ligament in Eagle’s syndrome (ES) patients, and asymptomatic patients with elongated styloid process (SP) via cone-beam computed tomography (CBCT).METHODS: A total of 52 CBCT images in two symptomatic (ES) and asymptomatic groups (n = 26 per group) were assessed. The mean length and thickness of the SP, morphology, and pattern of calcification between the two sides in each group and between ES and asymptomatic groups were compared. The t-test was used for comparison. Fisher exact and chi-square tests were used to determine the relationship between different types of calcification pattern and morphology. The level of significance was considered at P < 0.050.RESULTS: The SP was thicker in the ES group than the asymptomatic group. However, the styloid length showed no significant difference among the ES and asymptomatic groups. The most common pattern of calcification in both groups was partially calcified with no significant difference between the two study groups. The most common morphology in the asymptomatic and ES groups was “segmented” and “elongated,” respectively.CONCLUSION: The morphology and thickness of the SP showed a significant difference between the ES and asymptomatic groups. This can be helpful in differential diagnosis of facial, pharyngeal, and tonsillar pain.


  1. Lee S, Hillel A. Three-dimensional computed tomography imaging of Eagle's syndrome. Am J Otolaryngol 2004; 25(2): 109.
  2. Beder E, Ozgursoy OB, Karatayli Ozgursoy S, Anadolu Y. Three-dimensional computed tomography and surgical treatment for Eagle's syndrome. Ear Nose Throat J 2006; 85(7): 443-5.
  3. Keur JJ, Campbell JP, McCarthy JF, Ralph WJ. The clinical significance of the elongated styloid process. Oral Surg Oral Med Oral Pathol 1986; 61(4): 399-404.
  4. Roopashri G, Vaishali MR, David MP, Baig M. Evaluation of elongated styloid process on digital panoramic radiographs. J Contemp Dent Pract 2012; 13(5): 618-22.
  5. Ghafari R, Hosseini B, Shirani AM, Manochehrifar H, Saghaie S. Relationship between the elongated styloid process in panoramic radiographs and some of the general health conditions in patients over 40 years of age in the Iranian population. Dent Res J (Isfahan) 2012; 9(Suppl 1): S52-S56.
  6. Mortellaro C, Biancucci P, Picciolo G, Vercellino V. Eagle's syndrome: importance of a corrected diagnosis and adequate surgical treatment. J Craniofac Surg 2002; 13(6): 755-8.
  7. Oztas B, Orhan K. Investigation of the incidence of stylohyoid ligament calcifications with panoramic radiographs. J Investig Clin Dent 2012; 3(1): 30-5.
  8. Okabe S, Morimoto Y, Ansai T, Yamada K, Tanaka T, Awano S, et al. Clinical significance and variation of the advanced calcified stylohyoid complex detected by panoramic radiographs among 80 year-old subjects. Dentomaxillofac Radiol 2006; 35(3): 191-9.
  9. Anbiaee N, Javadzadeh A. Elongated styloid process: is it a pathologic condition? Indian J Dent Res 2011; 22(5): 673-7.
  10. Kursoglu P, Unalan F, Erdem T. Radiological evaluation of the styloid process in young adults resident in Turkey's Yeditepe University faculty of dentistry. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100(4): 491-4.
  11. Slavin KV. Eagle syndrome: entrapment of the glossopharyngeal nerve? Case report and review of the literature. J Neurosurg 2002; 97(1): 216-8.
  12. Nayak DR, Pujary K, Aggarwal M, Punnoose SE, Chaly VA. Role of three-dimensional computed tomography reconstruction in the management of elongated styloid process: a preliminary study. J Laryngol Otol 2007; 121(4): 349-53.
  13. Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. J Can Dent Assoc 2006; 72(1): 75-80.
  14. Andrei F, Motoc AG, Didilescu AC, Rusu MC. A 3D cone beam computed tomography study of the styloid process of the temporal bone. Folia Morphol (Warsz) 2013; 72(1): 29-35.
  15. Ilguy M, Ilguy D, Guler N, Bayirli G. Incidence of the type and calcification patterns in patients with elongated styloid process. J Int Med Res 2005; 33(1): 96-102.
  16. Khairallah A. Cone beam computed tomography (CBCT) findings of complete calcification of the stylohyoide ligament: Case series. Smile Dent J 2011; 6(3): 26-9.
  17. Mayrink G, Figueiredo EP, Sato FR, Moreira RW. Cervicofacial pain associated with Eagle's syndrome misdiagnosed as trigeminal neuralgia. Oral Maxillofac Surg 2012; 16(2): 207-10.
  18. Tsiklakis K, Syriopoulos K, Stamatakis HC. Radiographic examination of the temporomandibular joint using cone beam computed tomography. Dentomaxillofac Radiol 2004; 33(3): 196-201.
  19. Langlais RP, Miles DA, Van Dis ML. Elongated and mineralized stylohyoid ligament complex: a proposed classification and report of a case of Eagle's syndrome. Oral Surg Oral Med Oral Pathol 1986; 61(5): 527-32.
  20. Okur A, Ozkiris M, Serin HI, Gencer ZK, Karacavus S, Karaca L, et al. Is there a relationship between symptoms of patients and tomographic characteristics of styloid process? Surg Radiol Anat 2014; 36(7): 627-32.
  21. Oztunc H, Evlice B, Tatli U, Evlice A. Cone-beam computed tomographic evaluation of styloid process: a retrospective study of 208 patients with orofacial pain. Head Face Med 2014; 10: 5.
  22. Kosar MI, Atalar MH, Sabanciogullari V, Tetiker H, Erdil FH, Cimen M, et al. Evaluation of the length and angulation of the styloid process in the patient with pre-diagnosis of Eagle syndrome. Folia Morphol (Warsz) 2011; 70(4): 295-9.
  23. Shaik MA, Naheeda, Kaleem SM, Wahab A, Hameed S. Prevalence of elongated styloid process in Saudi population of Aseer region. Eur J Dent 2013; 7(4): 449-54.
  24. Mohammed ARS, Abbas F, Hassan NA. Radiographical evaluation of styloid process (A comparative study between panoramic and skyview cone beam computed tomography) in Iraqi population. Life Sci J 2014; 11(6): 450-7.
  25. More CB, Asrani MK. Evaluation of the styloid process on digital panoramic radiographs. Indian J Radiol Imaging 2010; 20(4): 261-5.