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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 3  |  Issue : 2  |  Page : 37-39

Prevalence of elongated styloid process and elongation pattern on digital panoramic radiographs in Saudi Population, Jeddah


1 Department of Oral and Maxillofacial Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
2 International Medical Center, Jeddah, Saudi Arabia
3 Department of Maxillofacial and Head and Neck Oncology, King Abdulaziz University, Jeddah, Saudi Arabia

Date of Web Publication29-May-2019

Correspondence Address:
Dr. Kamal Kanthan Ravikumar
International Medical Center, Jeddah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijosr.ijosr_2_19

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  Abstract 


Aim: The aim of our research is to establish the prevalence of Elongated Styloid Process in Saudi Arabia Jeddah using panoramic radiographs and the assessment of the patient's age, gender, sides, and type. Materials and Methods: This study was performed as a retrospective analysis on digital panoramic radiographs using the record base archives of the International Medical Center, dental department in Jeddah. In this study, 1971 radiographs were examined. The radiographs reviewed were taken between January 2010 - January 2017 using KaVo radiographic machine model OP300-1. The patient demographics, length of the SP at the right and left side and the classification pattern were entered in spreadsheet in microsoft excel 2007; and the statistical calculation were obtained by using SPSS ( Statistical Package for Social Science ) version 21 software. 0.01. Result: The mean length of the styloid process was 29.05 mm in our study . In females it was 29.17 mm and in males it was 31.30 mm with the length being more in males than in females and the result being statistically significant with p value (0.000). The length of the styloid process increased with the age progressively and it was statistically significant with p value 0.004. The average length of right side styloid process in all age groups is 30.2mm and the left side is 29.6mm with the right side being more than the left and the results were statistically significant p value (0.00). SP Type I elongation was the highest on both the right and left sides and also in all the age groups as compared to Types II and III.

Keywords: Eagle's syndrome, panoramic radiograph, styloid process (elongated)


How to cite this article:
Jamal BT, Ravikumar KK, Alyawar SH, Maghrabi IN, Alshaikh AM, Jabbad HH, Alsohaibi TH. Prevalence of elongated styloid process and elongation pattern on digital panoramic radiographs in Saudi Population, Jeddah. Int J Soc Rehabil 2018;3:37-9

How to cite this URL:
Jamal BT, Ravikumar KK, Alyawar SH, Maghrabi IN, Alshaikh AM, Jabbad HH, Alsohaibi TH. Prevalence of elongated styloid process and elongation pattern on digital panoramic radiographs in Saudi Population, Jeddah. Int J Soc Rehabil [serial online] 2018 [cited 2019 Aug 21];3:37-9. Available from: http://www.ijsocialrehab.com/text.asp?2018/3/2/37/259324




  Introduction Top


The word “styloid” is derived from the Greek word “stylos” which means “pillar.” The styloid process is a cylindrical pointed bony protuberance arising from the inferior surface of the temporal bone anterior to the stylomastoid foramen.[1] The end point of the styloid process is located between the external and internal carotid arteries, which assumes clinical importance.[2],[3]

Embryologically, it is derived from Reichert's cartilage of the second branchial arch.[4],[5] It serves as a point of attachment for the following muscles, namely stylohyoid, styloglossus, stylopharyngeus muscles, and the ligaments stylohyoid and stylomandibular[6],[7] [Figure 1].
Figure 1: Right styloid process muscle and ligament attachments – lateral view

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The mean length of the styloid process ranges from 10 to 30 mm as depicted in several studies.[8],[9] Elongated styloid process is associated with a syndrome called Eagle's syndrome identified by Watt. W. Eagle, an otorhinolaryngologist, in 1937 and he coined the term stylalgia which causes the following symptoms: foreign body sensation in the throat, pain on moving the head and neck, dysphagia, odynophagia, vertigo, facial pain, earache, headache, tinnitus, and trismus.[8] The symptoms associated with Eagle's syndrome is believed to be caused due to the compression of some neural and vascular structures.[9] An estimated 2%–4% of the general population present with ossification of the styloid process, and the majority of these patients are asymptomatic.[10] The aim of this study is to determine the prevalence of elongated styloid process in the Saudi population and the classification patterns.


  Materials and Methods Top


This study was performed as a retrospective analysis on digital panoramic radiographs using the record base archives of the International Medical Center, Dental Department, in Jeddah. Ethical approval was obtained from the Institutional Review Board. In this study, 1971 radiographs were examined and the patients were aged from 18 to 71 years.

The radiographs reviewed were taken between January 2010 and January 2017 using KaVo radiographic machine model OP300-1. All patients between 18 and 80 years old were included in which the panoramic film was of good quality and showed the styloid processes bilaterally. Poor-quality panoramic images which included magnification errors, superimposition of other anatomical structures, and questionable styloid process were excluded from our collected data.

The SP was measured using a reference point of the lower edge of the external auditory meatus and the end point of the styloid process.[11] Images were viewed in the CliniView software using its measurement tool to quantify the length of the right and left sides. The type of elongation of the styloid processes was also classified as per Langlais et al.[11] [Figure 2].

  • Type I characterized by a continuous and full mineralization of the complex
  • Type II pseudoarticulated in which the styloid process apparently interacts with the stylomandibular and stylohyoid ligaments by a single pseudojoint
  • Type III characterized by a lack of mineralization contiguity of the process or stylohyoid ligament and it is segmented. In this case, the measurement was performed from the initial point to the most distal point, regardless of the distance between the segments.


The patient demographics, length of the SP at the right and left sides, and the classification pattern were entered in spreadsheet in Microsoft Excel 2007; and the statistical calculation was obtained using SPSS (Statistical Package for the Social Sciences) version 21 software 0.01 (IBM, USA).
Figure 2: Type of Elongation

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  Results Top


Out of the total number of 1971 X-rays examined, 1307 X-rays met our criteria and were included in the study. There were 837 females (64.03%) and 470 males (35.96%). The mean length of the styloid process was 29.05 mm in our study. In females, it was 29.17 mm, and in males, it was 31.30 mm, with the length being more in males than in females and the result being statistically significant with P = 0.000.

The age groups were characterized as follows: 18–30 years is Group A, 31–45 years is Group B, 46–60 years is Group C, and above 60 years is Group D. There were 374 patients in Group A, 450 in Group B, 322 in Group C, and 161 in Group D. The mean length of elongated styloid process in Group A is 27.69 mm, Group B 28.74 mm, Group C 30.59 mm, and Group D 30 mm. The length of the styloid process increased with age progressively and it was statistically significant with P = 0.004. Within the age groups, Group A has a lower length compared to Group C) and Group D, and it was statistically significant with P = 0.008 and 0.03, respectively.

The average length of the right-side styloid process in all age groups is 30.2 mm and the left side is 29.6 mm, with the right side being more than the left, and the results were statistically significant with P = 0.00.

Males have longer styloid process than females on the right side as well as on the left side, and the results are statistically significant with P = 0.00 and 0.003, respectively.

Regarding the calcification pattern of the elongated SP, Type I elongation was the highest on both the right and left sides and also in all the age groups as compared to Types II and III.

The results were as follows: Right side Type I – 47.8%, Type II – 22.7%, and Type III – 10.7%.

The calcification pattern on the left side showed Type I – 52.5%, Type II – 21.5%, and Type III – 10.5%.


  Discussion Top


The first and second brachial arches give rise to the styloid process and the ligament. Evaluation of elongated styloid process can be done using plain radiograph, panoramic film, anteroposterior Xray, lateral skull Xray and computed tomography scans.

The length of the styloid process on the radiograph ranges between 20 and 30 mm with the upper limit to be 30 mm according to certain studies.[7] In our current study, the average length of the styloid process in both the sexes, that is, the overall average length was 29.05 mm.

There was a progressive increase of the elongation of the styloid process with age. Group A (18–30 years) had a lower length compared to Group C (46–60 years) and Group D (above 60 years), and the results were statistically significant. It is similar to other studies with similar results.[3] It could be correlated with the age-related degeneration of styloid ligament. It is important to note if there is only a progressive increase of the number of patients showing an elongated styloid process or even a progressive increase of the elongation itself with age.

Males had longer SP as compared to females, and the results were statistically significant. Some studies showed that males had increased length of the styloid process than females,[10] while other studies inferred the opposite and certain studies found no difference at all.[10],[11]

Type I elongation was the most common in all the age groups and on both the right and left sides, a finding similar to several studies.[11]





Panoramic films are useful for the detection of elongated styloid process and ossification of styloid ligaments as they are the initial radiographs taken in dental clinics. Panoramic films are easy to interpret, low in radiation compared to CT or cone-beam CT, and low cost. It is important for a dentist to be aware of the variation in length of the styloid process which could be of clinical significance. It is always important to consider symptoms related to elongated styloid process in patients with undiagnosed neck, facial pain, odontogenic pain, and oropharyngeal pain.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Roopashri G, Vaishali MR, David MP, Baig M. Evaluation of elongated styloid process on digital panoramic radiographs. J Contemp Dent Pract 2012;13:618-22.  Back to cited text no. 1
    
2.
Eagle WW. Elongated styloid process; symptoms and treatment. AMA Arch Otolaryngol 1958;67:172-6.  Back to cited text no. 2
    
3.
Camarda AJ, Deschamps C, Forest D. II. Stylohyoid chain ossification: A discussion of etiology. Oral Surg Oral Med Oral Pathol 1989;67:515-20.  Back to cited text no. 3
    
4.
Chaurasia BD, editor. Styloid apparatus – Deep structures in the neck. In: Human Anatomy, Regional and Applied Dissection and Clinical Head, Neck and Brain. 4th ed., Vol. 3. New Delhi: CBS Publishers; 2004.  Back to cited text no. 4
    
5.
Soames RW. Skeletal system. In: Williams PL, editor. Gray's Anatomy. 38th ed. New York: Churchill Livingstone; 1995. p. 592.  Back to cited text no. 5
    
6.
Nishat S, Sachendra KM. The study of: A morphometric analysis with clinical implications. Indian J Forensic Med Pathol 2018;11:101-5.  Back to cited text no. 6
    
7.
Gokce C, Sisman Y, Ertas ET, Akgunlu F, Ozturk A. Prevalence of styloid process elongation on panoramic radiography in the Turkey population from Cappadocia region. Eur J Dent 2008;2:18-22.  Back to cited text no. 7
    
8.
Steinmann EP. A new light on the pathogenesis of the styloid syndrome. Arch Otolaryngol 1970;91:171-4.  Back to cited text no. 8
    
9.
Ilgüy D, Ilgüy M, Fişekçioǧlu E, Dölekoǧlu S. Assessment of the stylohyoid complex with cone beam computed tomography. Iran J Radiol 2012;10:21-6.  Back to cited text no. 9
    
10.
Lins CC, Tavares RM, da Silva CC. Use of digital panoramic radiographs in the study of styloid process elongation. Anat Res Int 2015;2015:474615.  Back to cited text no. 10
    
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;61:527-32.  Back to cited text no. 11
    


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