CASE REPORTS J Oral Maxillofac Surg 65:1346-1353, 2007 Styloid-Stylohyoid Syndrome: Literature Review and Case Report Felipe Ladeira Pereira, DDS,* Liogi Iwaki Filho, DDS, PhD,† Angelo José Pavan, DDS, PhD,‡ Gustavo Jacobucci Farah, DDS, PhD,§ Evelyn Almeida Lucas Gonçalves, DDS, PhD, Vanessa Cristina Veltrini, DDS, PhD,¶ and Edevaldo Tadeu Camarini, DDS, PhD# The first reports on enlargement of the styloid pro- cess date from the 17th century, when anatomists explored this region. These postmortem findings were only useful as a mere anatomic curiosity and had no clinical correlation. In 1937, W.W. Eagle reported various cases of a cervicopharyngeal symptomatology and associated them with radiographic findings. It was believed that trauma in the cervicopharyngeal region, especially after tonsillectomy, might stimulate a subsequent growth of the styloid process. 1-3 Various names were proposed for the syndrome: styloid process neuralgia, 4 styloid syndrome, 5 stylohy- oid syndrome, 3 elongated styloid process syndrome, 4 Eagle’s syndrome, 6 and styloalgia. 7,8 The most appro- priate, however, is styloid-stylohyoid syndrome be- cause such anomalies may be of the styloid process, of the stylohyoid ligament, or a combination of both, 3 although it has been divided into 4 syndromes in recent literature. 1 Differential diagnoses are innumerable because many of the symptoms detected in the enlargement of the styloid process (orofacial pains and dysfunctions) are also found in patients without presence of the elongated process. Furthermore, its attachments may be susceptible to stretch and whiplash type injuries, in which an acute force exceeds the physiologic lim- its of the temporal bone attachment. 9 The objective of this article is to present a com- prehensive systematic review of literature and to report a case of stylohyoid ligament ossification with 2 pseudoarticulations. Literature Review The styloid process is a slender projection con- nected to the inferior aspect of the petrous part of the temporal bone just below the tympanic membrane and behind the tympanic plaque which shields its attachments. It lies behind the pharyngeal wall of the palatine fossa, between the internal and external ca- rotid arteries. 9 Innervation comprises the glossopha- ryngeal nerve in the posterior lateral wall of the ton- sillar fossa (medial to the process), and the facial nerve emerging from the stylomastoid foramen which is slightly posterolateral to the base of the styloid process. The accessory nerve, the hypoglossal nerve, and the vagus nerve are placed medially to the pro- cess, together with the internal jugular vein and the internal carotid artery with its sympathetic chain. 9,10 The normal size of the styloid process varies signif- icantly in the literature (Table 1). According to Camarda et al, 1 the ceratohyal ele- ment degenerates with time. Nonetheless, its fibrous sheath persists as the stylohyoid ligament, containing a cartilaginous and bone potential because the styloid process normally ossifies 5 to 8 years after birth. *Oral and Maxillofacial Surgeon, Private Practice, São Paulo, Bra- zil. †Professor of Oral and Maxillofacial Surgery, State University of Maringá, Maringá, Paraná, Brazil. ‡Professor of Oral and Maxillofacial Surgery, State University of Maringá, Maringá, Paraná, Brazil. §Professor of Oral and Maxillofacial Surgery, CESUMAR Denistry School, Maringá, Paraná, Brazil. Professor of Oral Pathology and Diagnosis, State University of Maringá, Maringá, Paraná, Brazil. ¶Professor of Oral Pathology, Diagnosis, and Radiology, CE- SUMAR Dentistry School Maringá, Paraná, Brazil. #Professor of Oral and Maxillofacial Surgery, State University of Maringá, Maringá, Paraná, Brazil. Address correspondence and reprint requests to Dr Camarini: Department of Dentistry, State University of Maringá, Av. Curitiba, 486 Sala 701, CEP 87013-380, Maringá, Paraná, Brazil; e-mail: edevaldocamarini@wnet.com.br © 2007 American Association of Oral and Maxillofacial Surgeons 0278-2391/07/6507-0014$32.00/0 doi:10.1016/j.joms.2006.07.020 1346