•  
  •  
 

Abstract

Background: Accurate evaluation of craniofacial anatomy is essential for diagnostic planning. Variations of the styloid process (SP) provide anatomical data that guide evidence-based clinical and surgical decisions in the head and neck region.

Methods: Retrospective cone-beam computed tomography (CBCT) scans retrieved from the Department of Oral and Maxillofacial Radiology were examined. SP length, medial angles, calcification patterns, and the radiomorphometric index were assessed.

Results: Middle-aged adults represented the majority of the sample. Gender had a statistically significant effect on SP morphology Type 1 was the most common bilaterally, followed by Type 2. Calcification patterns varied between genders but showed no age-related differences. Pattern C was predominantly associated with Type 1 morphology, while Pattern D occurred more frequently in Types 2 and 3. The right SP was significantly longer than the left, particularly in males. Anteroposterior angles did not differ significantly by age or gender, although females demonstrated slightly higher right-sided values.

Conclusions: Recognition of elongated SPs is clinically important because they are often incidentally detected on panoramic radiographs and may be linked to craniofacial or cervical symptoms. Comprehensive CBCT assessment, in conjunction with clinical evaluation, enables accurate diagnosis and supports appropriate management of patients with symptomatic SP variations.

References

  1. Priyadharshini S, Gopal KS, Srinivasan S. Cone-beam computed tomography evaluation of morphology and orientation of styloid process and prevalence of its elongation in age and gender: an institutional-based retrospective study-a dentist perspective. Indian J Otology. 2022;28(2):119–25.
  2. Guarna M, Lorenzoni P, Volpi N, Aglianò M. Elongated styloid process: literature review and morphometric data on a collection of dried skulls. Ital J Anat Embryol. 2022;125(1):11–7.
  3. Ahmed HA, Estrugo-Devesa A, Llabrés XR, Egido-Moreno S, López-López J. The prevalence of elongated styloid process in the population of Barcelona: a cross-sectional study & review of literature. BMC Oral Health. 2023;23:674.
  4. Bargiel J, Gontarz M, Gąsiorowski K, Marecik T, Wyszynska-Pawelec G. Outcomes of elongated styloid process syndrome treated with minimally invasivecervical styloidectomy (MICS)–a single-center retrospective study. J Clin Med. 2024;13(21):6409.
  5. Jeyaraj P. Histopathological analysis of elongated styloid processes: a new light on etiopathogenesis of Eagle’s syndrome. Indian J Otolaryngol Head Neck Surg. 2021;74(Suppl 3):4510–20.
  6. Pagano S, Ricciuti V, Mancini F, Barbieri FR, Chegai F, Marini A, et al. Eagle syndrome: an updated review. Surg Neurol Int. 2023; 14:389.
  7. Xu Z, Shi P, Zhang P. Eagle syndrome: A rare neuropathic disorder affecting head and neck. Medicine. 2024;103(19):e38128.
  8. Dziedzic M, Możdżeń K, Murawska A, Bonczar M, Ostrowski P, Szczepanek M, et al. Eagle’s syndrome: a systematic review. Pol Otorhino Rev. 2023;12(2):25–38.
  9. Stopińska K, Domitrz I. Eagle’s syndrome: one cause, many problems. Presentation of a series of clinical cases with headaches and increased risk of stroke. Arch Med Sci. 2022;18(5):1420–2.
  10. Hebant B, Guegan-Massardier E, Macaigne V, Triquenot-Bagan A. Ischemic stroke due to internal carotid artery dissection associated with an elongated styloid process (Eagle syndrome). J Neurol Sci. 2017;372:466–7.
  11. 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.
  12. Ramadoss T, Sha K. Assessment of the styloid process by cone beam computed tomography. Int J Radiol Radiat Ther. 2017;2(5):123–7.
  13. Alsweed A, Almutairi BM. Elongation pattern of styloid process in Saudi population: a factor to remember in the prevention of Eagle syndrome. Folia Morphol. 2022;81:701–6.
  14. Czako L, Simko K, Thurzo A, Galis B, Varga I. The syndrome of elongated styloid process, the Eagle’s syndrome-from anatomical, evolutionary and embryological backgrounds to 3D printing and personalized surgery planning. Report of five cases. Medicina. 2020;56(9):458.
  15. Yang Z, Yuzi J, Beibei L. Cone-beam computed tomographic evaluation of styloid process: a retrospective study of 498 patients with maxillofacial diseases. BMC Med Imaging. 2024;24:333.
  16. Akçiçek G, Kara D, Uysal S, Zengin HY. Diagnostic accuracy of panoramic radiography in detecting styloid process elongation: a cone-beam computed tomography referenced retrospective study. BMC Oral Health. 2025;25(1):1969.
  17. Dursun A, Öztürk K, Şenel FA, Ayyıldız VA. A different perspective on the styloid process morphometry. Eur J Anat. 2021;25(3):301–10.
  18. Katı E. Prevalence of elongated styloid process on cone-beam computed tomographic images: a retrospective study. J Dent Sci Educ. 2023;1(3):61–5.
  19. Filho VTG, Andrade LGB, da Cruz PdSC, de Oliveira VdS, Rocha JF, de Freitas GB, et al. Prevalence of elongated styloid process in 1,000 panoramic radiographs of a Brazilian population. Eur J Med Health Sci. 2024;6(6):35–8.
  20. Jha R, Khatri M, Pathan F, Solanki M, Tandel H. An epidemiological study of elongation of styloid process in the Saurashtra population. Adv Hum Biol. 2022;12(2):202–6.
  21. Heim N, Kramer FJ, Götz W. Histological investigation on enlarged styloid processes and ossified stylohyoid ligaments in patients with Eagle syndrome. J Maxillofac Oral Surg. 2025.
  22. Triantafyllou G, Paschopoulos I, Duparc F, Tsakotos G, Papadopoulos-Manolarakis P, Piagkou M. The anatomy of the stylohyoid chain: a systematic review with meta-analysis. Diagnostics. 2025;15(7):925.
  23. Bhattarai C, Poudel PP, Gautam S, Basnet LM, Basnet SM, Sharma P, et al. Computed tomographic evaluation of the morphology of styloid process of temporal bone among people attending a tertiary care center in Nepal. Discov Imaging. 2025;2(14).
  24. de Ruiter RD, Treurniet S, Bravenboer N, Busse B, Hendrickx JJ, Jansen JC, et al. Eagle syndrome: tissue characteristics and structure of the styloid process. JBMR Plus. 2024;8(10):ziae115.
  25. Walters RK, Gudipudi R, Nguyen SA, O’rourke AK. Correlation between clinical presentation and treatment outcomes in Eagle syndrome: a cross-sectional study. AME Med J. 2024;9:32.
  26. Chu M-I, Chen C-H, Lee C-Y, Chen Y-K. Retrospective study of the styloid process in a Taiwanese population using cone beam computed tomography. J Dent Sci. 2022;17:345–33.
  27. Kaaki M, Alassaf MS, Alolayan A, Almuzaini ES, Alsaeedi AK, Habeeb A, et al. Evaluation of styloid process elongation in Madinah, Saudi Arabia: a retrospective radiographic investigation. Cureus. 2024;16(1):e53136.
  28. Abu-Taleb NS. Will cone-beam computed tomography add new to the stylohyoid complex analysis? Egypt Dent J. 2022;68(3):2419–31.

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.