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Bilateral Elongated Styloid Process: Reports of Two Rare Cases

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Bilateral Elongated Styloid Process: Reports of Two Rare Cases International Journal of Current Medical And Applied Sciences, vol.6. Issue 1, March: 2015. PP: 78-80 Bilateral Elongated Styloid Process: Reports of Two Rare Cases M.Y Dofe*, M.M.Meshram**, A.P. Kasote*** & Tiwari**** *Assistant Professor, **Head of Department, ***Associate Professor & ****Post Graduate student, Department of Anatomy, Government Medical College Nagpur [MS], India. Corresponding Email ID : [email protected] Case Report Subject: Anatomy ----------------------------------------------------------------------------------------------------------------------------- --------------- Abstract: In routine osteology discussion classes for under The length of the styloid process is usually 2-3 cm [2]. graduate students, we came across the two human dry When it’s more than 3 cm long it is called elongated skulls. In both the skulls it was observed that there is styloid process. This elongation was first describe in elongated styloid process. In one skull, on right side 1652 by Italian surgeon Pietro Marchetti. In 1937. 38.99 mm long styloid process with 4.22 mm thick at Watt W. Eagle coined the term stylalgia to describe the the base .On left side 42.52 mm long styloid process pain associated with elongation of styloid process [3]. and 9.08 mm thick at the base. In another case the The elongated styloid process or ossified stylohyoid total length of the stylohyoid complex 62 mm on the ligament can compress some of these structures, right side and 61 mm on left side. These skull were leading to mild or severe clinical syndromes, such as studied as an example of extreme development of the sore throat, dysphagia,otalgia,the sensation of a styloid process or ossification of stylohyoid ligament. foreign body in the throat, facial pain radiating to the Which would causes severe pain and restriction of ear or along the mandible and head and neck pain [4 ]. head and neck movement due to compression of The aim of this study is to describe the morphological underlying structures. appearance of the bilateral elongated styloid process Key words: styloid process, skull. and ossification of the stylohyoid ligament found in a ---------------------------------------------------------------------- dry human skull. Introduction: Styloid process of temporal bone is a slender During the routine osteology discussion classes, we projection attached to base of skull and extend came across two cases of skull with bilateral downwards, forwards and slightly medially. From its elongation of styloid process. In Case: 1- skull with extremity the stylohyoid ligament passes downward bilateral elongated styloid process. In Case -2-skull and forward to the lesser horn of the hyoid bone [1]. with bilateral elongation of styloid process with Many important anatomical structures are in close ossified stylohyoid ligaments. proximity to the styloid process and the stylohyoid In both the cases morphological appearance of skull ligament. Just posterior to the styloid process lies the show that no noticeable deformities with marked stylomastoid foramen, through which the facial nerve muscular attachments strongly developed temporal exits. The internal carotid artery, the internal jugular lines, prominent supercilliary ridges, well-developed vein and the accessory and vagus nerves lie medially. external occipital protuberance, indicative of a male The external carotid artery runs laterally to the skull (Fig. 1, 2& 3). stylohyoid ligament.The glossopharyngeal nerve exists An anatomical study was performed on the styloid in close proximity under the styloid process, process on both sides of the skull. The length of the stylohyoid muscle and the stylopharyngeal muscle. It styloid process or osseous complex was measured is therefore worth studying the variability of these using a digital sliding calliper. structures and analysing the possible effects of an elongated styloid process and ossified stylohyoid complex. Copyright @ 2015 Logic Publications, IJCMAAS,E-ISSN:2321-9335,P-ISSN:2321-9327. Page | 78 M.Y.Dofe, M.M.Meshram, A.P Kasote & Tiwari Case Report 1 : Visual inspection of skull (Figure 1&2) shows elongated styloid process on both side with thin on right and thick on left side. Figure 1: Figure 1 & 2: Basal view of skull with elongated styloid process With thick styloid process on left side and thin on right side. Figure 2: Table : 1 Case 1 Styloid process Length Right side Left side Case 1 Styloid process Styloid process Length 38.99 mm 42.52 mm Thickness 4.22 mm(base) 9.08 mm(base) 1.66 mm(apex) 6.5mm(apex) Distance between two styloid process (Base) 82.22 mm Distance between Two styloid process 62.78 mm Case Report: 2 Visual inspection of skull (Figure 3) show elongated styloid process with ossification of stylohyoid ligament. Close observation of styloid process revealed a bulge of bony mass in the middle parts of the ossified complexes. Its presence may indicate the place of attachment of the ligament to the styloid process (Figure 3). This place was therefore regarded as the end of the styloid process and served as a landmark for measuring the distance to the cranial base. Figure 3 : Shows basal view of skull with elongated styloid process with ossified styloidligment. This difference between the origins and ends of the two stylohyoid complexes expresses a strong mutually convergent course towards the mid-sagittal plane. Copyright @ 2015 Logic Publications, IJCMAAS,E-ISSN:2321-9335,P-ISSN:2321-9327. Logic Publications @ 2015, IJCMAAS, E-ISSN: 2321-9335,P-ISSN:2321-9327. Right side Left side Case -2 Styloid process Styloid process lengthstyloid process 32mm 29mm stylohyoid ligment 30mm 32mm Thickness 5mm 4.99 mm Distance between two styloid process (Base) 90mm Distance between 50mm Two styloid process(apex) Discussion: and significantly restricted head and neck movement due to compression of underlying structures. The styloid process , stylohyoid ligment and lesser cornu of the hyoid bone are derived from Reicherts cartilage, which arises from second branchial arch.[5].The cause of elongation of the styloid process Reference: has not been fully elucidated. Several theories have 1. Williams PL. Gray’s Anatomy. 38th Ed., London, been proposed.[6]- ELBS with Churchill Livingstone. 1999; 592. Congenital elongation due to persistence of a 2. Sokler K, Sandev S. New classification of the styloid cartilaginous analog of stylohyal. process length--clinical application on the Calcification of stylohyoid ligament by biological base. Coll Anthropol. 2001; 25: 627–632. unknown process. 3. Kim E, Hansen K, Frizzi J. Eagle syndrome: case report and review of literature. Ear Nose Throat J. Growth of osseous tissue at the insertion of 2008; 87: 631–633. the stylohyoid ligament. 4. Feldman v Eagle syndrome a case of symptomatic The styloid process and stylohyoid ligment have been calcification of stylohyoid ligament . J Canchiropr linked to Eagle s syndrome ,which has Assoc 2003,47;21:27. symptomatology characterized by sensation of having 5. Moor KL, Persaud TVN ; The developmental Human a foreign body in the pharynx, causing difficult and Clinically Oriented Embryology; Paperback,2011. painful swallowing and earache, It can also cause 6. Murtagh RD, Caracciolo JT, Fernandez G. CT vertigo ,tinnitus, pain on turning the head ,reducing findings associated with eagle syndrome. AJNR Am mandibular opening, change in voice , hyper salivation, Neuroradiol 2001; 22: 1401–1402. and even alteration in taste .It is also referred as styloid syndrome, stylohyoid syndrome , stylalgia, 7. Rodriguez-Vazquez JF, Merida-Velasco JR, neuralgia of styloid process.[7] Verdugo-Lopez S, Sanchez-Montesinos I, Merida- If ,in human skulls elongation of the styloid process Velasco JA. Morphogenesis of the second and ossification of stylohyoid ligment can occur. This pharyngeal arch cartilage (Reichert’s cartilage) in condition is regarded as an anatomical anomaly. This human embryos. J Anat. 2006; 208: 179–189. anomaly appears in adults with varying frequency, 8. Zaki HS ,Greco CM, etal; Elongated styloid process ranging from 2% to 30% [8]. According to scafetal in a temporo mandibular disorder sample unilateral elongation is more frequent [9]. prevalence and treatment outcome J.Prothet There are many reports of elongated styliod process Dent,1996,75:399-405. but all of them have measured only the length .Massey 9. Scaf .G de Freitas DQ castro,Monteiro Loffredo .L observed 11 cases of elongated styloid process having Diagnostic reproducibility of the elongated styloid length of more than 4cm out of 2000cases studied process.J Appol Oral Sci, 2003,11:120-124 [10]. 10. Massey EW. Facial pain from an elongated styloid process. (Eagles syndrome). South Med J .1978; 71: Conclusion: 1156–1159. The cases are studied with good example of ------------------------------------------------------------------ anatomical anamoly with extreme development of the stylohyoid complex, which could cause severe pain International Journal of Current Medical And Applied Sciences [IJCMAAS], volume.6. Issue 1. Page | 80 .
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