International Journal of Anatomy, Radiology and Surgery, 2014 Sep, Vol-3(3): 6-9 6 ID: IJARS/2014/9667:2005 Case Report Keywords: Styloid process, Skull, Stylohyoid ligament ABSTRACT The styloid process is a long cylindrical process arising from the temporal bone. It is usually 20-30 mm long. If it is more than 30 mm long, it is said to be elongated styloid process. It may be due to ossification of stylohyoid ligament and may be unilateral or bilateral. The material for the pres- ent study comprised of a skull prepared in the Department of Anatomy, Govt. Medical College, Amritsar after routine undergraduate dissection. The styloid processes in the said skull were elongated on both the sides, the length being 76 mm on right and 71 mm on left side. These were fused with the hyoid bone at site of lesser cornua. A knowledge of such variation may be of interest not only for anatomist but also for physicians and surgeons. An elongated styloid process may be responsible for different sets of clinical features like cervicofacial pain or feeling of foreign body in pharynx. These may be attributed to compression of some neural or vascular structure by it. Anatomy Section Bilaterally Elongated Styloid Process – A Case Report RAJAN KUMAR SINGLA, BHAGYA SHREE, RAVI KANT SHARMA INTRODUCTION Styloid process of temporal bone is a long, cylindrical, bony projection attached to the base of the skull and extends down- wards, forwards and slightly medially. It gives attachment to the muscles and ligaments which have a role in mastication and swallowing [1]. One of these ligaments, the stylohyoid ligament passes downwards and forwards from its extremity to the lesser horns of the hyoid bone [2]. Usually the styloid process is 20- 30 mm long [3]. If it is > 30 mm long, it is said to be elongated styloid process. It may be due to ossification of stylohyoid ligament and may be unilateral or bilateral [1]. Elongation of styloid process and or ossification of stylohyoid ligament may result in styloid stylohyoid syndrome which is also known as Eagle syndrome, elongated styloid process syndrome, styloid process- carotid artery syndrome, sty- lohyoid syndrome or styloid process neuralgia [4]. According to Kim et al [5] the elongation was Ist described in 1652 by an Italian surgeon Marchetti and Eagle [6] coined the term styalgia to describe the pain associated with elongation of styloid process. He primarily described the two types of syndrome associated with elongated styloid process in 4% of population and stressed that not all cases of elongation are symptomatic [7]. The classic styloid syndrome is usually seen after tonsillectomy as pharyngodynia localised in the tonsillar fossa, sometimes with dysphagia, odynophagia, hypersaliva- tion, foreign body sensation and more rarely by temporary voice changes, all of which presumably occur when tight- ened tonsillectomy scar tissue moves across the tip of the elongated styloid process during functional movements. The stylo-carotid syndromes (Carotidynia and Ernst syndrome) are due to compression of the internal and /or the external carotid arteries and especially their perivascular sympathetic fibers, resulting in a persistent pain radiating to the carotid territory, as headache, chronic neck pain, pain upon turning the head and pain radiating to the eye. Ear pain and vertigo are other possible complaints. Patients with any of these clinical mani- festations may thus present to dental, otorhinolaryngology, [Table/Fig-1]: Bilaterally elongated styloid process [Table/Fig-2]: Fusion of styloid process with hyoid bone at site of lesser cornua [Table/Fig-3]: Medial extent of tips of two styloid processes