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Stylohyoid Complex Syndrome: Is 1 More Classification Needed?—Reply

Stylohyoid Complex Syndrome: Is 1 More Classification Needed?—Reply In reply We thank Deeb for his comments. Pain in the lateral aspect of the neck is a common symptom that can be associated with many conditions, including submandibular gland pathology, temporomandibular joint disorder, cervical spine pathology, along with pathology in the stylohyoid complex. The original description of Eagle syndrome involved an elongated styloid process as the cause of pain in the ears and the lateral aspect of the neck. The subsequent identification of the same symptom complex in patients with a calcified stylohyoid ligament led to this abnormality also being categorized as Eagle syndrome. That 2 different pathologic conditions could result in the same symptom complex indicates that these abnormalities are acting on the same underlying structures. In several cases in our series, patients presented with the same symptom complex but not with either an elongated styloid process or a calcified stylohyoid ligament. The 3-dimensional computed tomograms showed that the greater horn of the hyoid bone was extending more posteriorly than expected. While we do not have measurements for normal hyoid bones, it was apparent that the hyoid bones in our patients were positioned more closely to the neurovascular structures in the neck than usual. The findings at surgery confirmed the abnormally posterior position of the greater cornu of the hyoid bone, and all patients responded to resection of the lateral portion of the hyoid bone to include the lesser cornu, thus also releasing the stylohyoid ligament. It is also possible that the hyoid bones were positioned more posteriorly because of the indistensibility of the stylohyoid complex and that the hyoid bones only appeared elongated because of their more posterior positioning. While we agree that plain film imaging can be useful in identifying an elongated styloid process or a calcified stylohyoid ligament, it does not allow identification of soft-tissue pathology or the relationship of the bony structures to the neurovascular structures in the neck. Using computed tomography as an initial diagnostic modality obviates the need for more than 1 imaging study, as may be necessary if the results of the lateral neck film are negative because the pathology involves the soft tissue of the neck and not the stylohyoid complex. We advocate the use of the term stylohyoid complex syndrome to include conditions caused by pathology in any of the structures that make up the stylohoid complex. Back to top Article Information Correspondence: Dr Del Gaudio, Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, 1365 Clifton Rd NE, Room A2328, Atlanta, GA 30322 (jdelgau@emory.edu). Financial Disclosure: None reported. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Stylohyoid Complex Syndrome: Is 1 More Classification Needed?—Reply

Stylohyoid Complex Syndrome: Is 1 More Classification Needed?—Reply

Abstract

In reply We thank Deeb for his comments. Pain in the lateral aspect of the neck is a common symptom that can be associated with many conditions, including submandibular gland pathology, temporomandibular joint disorder, cervical spine pathology, along with pathology in the stylohyoid complex. The original description of Eagle syndrome involved an elongated styloid process as the cause of pain in the ears and the lateral aspect of the neck. The subsequent identification of the same symptom...
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Publisher
American Medical Association
Copyright
Copyright © 2011 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archoto.2011.143
Publisher site
See Article on Publisher Site

Abstract

In reply We thank Deeb for his comments. Pain in the lateral aspect of the neck is a common symptom that can be associated with many conditions, including submandibular gland pathology, temporomandibular joint disorder, cervical spine pathology, along with pathology in the stylohyoid complex. The original description of Eagle syndrome involved an elongated styloid process as the cause of pain in the ears and the lateral aspect of the neck. The subsequent identification of the same symptom complex in patients with a calcified stylohyoid ligament led to this abnormality also being categorized as Eagle syndrome. That 2 different pathologic conditions could result in the same symptom complex indicates that these abnormalities are acting on the same underlying structures. In several cases in our series, patients presented with the same symptom complex but not with either an elongated styloid process or a calcified stylohyoid ligament. The 3-dimensional computed tomograms showed that the greater horn of the hyoid bone was extending more posteriorly than expected. While we do not have measurements for normal hyoid bones, it was apparent that the hyoid bones in our patients were positioned more closely to the neurovascular structures in the neck than usual. The findings at surgery confirmed the abnormally posterior position of the greater cornu of the hyoid bone, and all patients responded to resection of the lateral portion of the hyoid bone to include the lesser cornu, thus also releasing the stylohyoid ligament. It is also possible that the hyoid bones were positioned more posteriorly because of the indistensibility of the stylohyoid complex and that the hyoid bones only appeared elongated because of their more posterior positioning. While we agree that plain film imaging can be useful in identifying an elongated styloid process or a calcified stylohyoid ligament, it does not allow identification of soft-tissue pathology or the relationship of the bony structures to the neurovascular structures in the neck. Using computed tomography as an initial diagnostic modality obviates the need for more than 1 imaging study, as may be necessary if the results of the lateral neck film are negative because the pathology involves the soft tissue of the neck and not the stylohyoid complex. We advocate the use of the term stylohyoid complex syndrome to include conditions caused by pathology in any of the structures that make up the stylohoid complex. Back to top Article Information Correspondence: Dr Del Gaudio, Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, 1365 Clifton Rd NE, Room A2328, Atlanta, GA 30322 (jdelgau@emory.edu). Financial Disclosure: None reported.

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Sep 19, 2011

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