OBJECTIVE: This study aimed to identify the prevalence of an elongated styloid process and analyze the presence of its calcification in the Saudi population using panoramic radiographs.
METHODS: The Taibah Outpatient Dental Clinic\'s OPG radiographs for 962 patients who attended screening clinics between December 2022 and October 2023 were all included in the study. Patients\' demographics, such as age, gender, and nationality, as well as radiological data, were included in the following study variables: the presence of an elongated styloid on both sides of a panoramic radiograph, right side styloid length, left side styloid length, right side distal end thickness, and left side distal end thickness.
RESULTS: The study evaluated 438 (45.5%) processes found in individuals aged 16-80 years old. The elongated process length ranged from 30.0 to 40.1 mm, and the diameter ranged from 0.81 to 7.79 mm at the origin to 0.56-3.79 mm at the end. There was no statistically significant difference in process length across genders or age groups. The diameters of the styloid bones on the left side vary significantly across genders at the start and completion of the process.
CONCLUSIONS: The prevalence of elongated styloids in the studied population was 4.26%. The radiological evaluation of the styloid process is a crucial stage in dental surgery planning.

Calcium oxalate crystals were observed on the leaf epidermis of Agave potatorum surrounding the stomatal complex. Their morphology corresponded to the styloid type, and the chemical composition using EDS spectrum confirms calcium oxalate. A significantly higher abundance of crystals was observed on the adaxial leaf side in comparison with the abaxial side (p < 0.05). Crystals grew up in bundles in a range of 6-8 elements into idioblasts. A light microscope reveals that these crystals reflect part of the incident light. Cuticle from the abaxial leaf side was thicker and had a special structure formed by six papillae surrounding a larger central papilla, which was observed as star-like. This could be related to the evolutionary adaptation of this Agave species to drought stress conditions.

Eagle\'s syndrome is a condition of orofacial pain related to the elongated styloid process or the calcification of the stylohyoid ligament. It affects around 4-10% of the population. The average length of the styloid process is about 15,2-47 mm, over 30 mm may be the cause of the Eagle\'s syndrome. Authors searched PubMed and Google Scholar using searchterms Eagle\'s syndrome, styloid process, stylohyoid ligament, orofacial pain. We manually searched the references of selected articles for additional relevant articles. We selected articles relevant to a general medicine readership, prioritizing systematic reviews, cases and clinical practice guidelines. The literature contains the latest reports on the Eagle\'s syndrome. The researches, in which orofacial pain or other symptoms were connected to other disorders, have been rejected. Symptoms of Eagle\'s syndrome are: odynophagia, dysphagia, dysphonia, dizziness or difficulty in swallowing. Clinicians should pay attention to Eagle\'s syndrome in the differentiation. Treatment includes conservative approach such as NSAIDs, anticonvulsants, antidepressants, steroids, surgical approach as the main form of the treatment and manual therapy. Eagle\'s syndrome symptoms may be problematic to diagnose and what is the most important, they worsens the quality of patients\' life. Clinicians should pay attention to differentiation with other diseases.

Safety with upper cervical interventions is a frequently discussed and updated concern for physical therapists, chiropractors and osteopaths. IFOMPT developed the framework for safety assessment of the cervical spine, and this topic has been discussed in-depth with past masterclasses characterizing carotid artery dissection and cervical arterial dysfunction. Our masterclass will expand on this information with knowledge of specific anatomical anomalies found to produce Eagle\'s syndrome, and cause carotid artery dissection, stroke and even death. Eagle\'s syndrome is an underdiagnosed, multi-mechanism symptom assortment produced by provocation of the sensitive carotid space structures by styloid process anomalies. As the styloid traverses between the internal and external carotid arteries, provocation of the vessels and periarterial sympathetic nerve fibers can lead to various neural, vascular and autonomic symptoms. Eagle\'s syndrome commonly presents as neck, facial and jaw pain, headache and arm paresthesias; problems physical therapists frequently evaluate and treat.
This masterclass aims to outline the safety concerns, assessment and management of patients with Eagle\'s syndrome and styloid anomalies. By providing evidence of this common anomaly found in almost one-third of the population, hypothesis generation and clinical reasoning with patients presenting with head and neck symptoms can improve.
Including styloid anomalies as potential hypotheses for patients with head and neck complaints can assist therapists in safe practice and expedite referral. The authors recommend updating the IFOMPT framework to incorporate Eagle\'s syndrome, a comprehensive autonomic assessment, and palpation of the stylohyoid complex to avoid potentially serious complications from conceivably hazardous interventions.

This study used a 3-dimensional (3D) craniocervical junction model of styloidogenic jugular venous compression (SJVC) syndrome to simulate and evaluate intracranial pressure (ICP) after internal jugular vein (IJV) compression by an elongated styloid process during axial rotation. The 3D-printed model created using data from an SJVC-syndrome patient included an articulating occipital-cervical junction, simplified arteriovenous system, gauge to measure simulated ICP, fixed obstruction simulating left-sided venous occlusion, and right-sided vascular tubing to simulate IJV compression. The model was rotated axially to its extreme right and left; maximum degree of motion and pressure were recorded for 3 cycles. Measurements were repeated after styloid resection in 25% increments. The extreme right rotation (11°) of the intact styloid condition yielded a mean pressure of 15.34 ± 2.85 mmHg. After 25% styloid resection, extreme rotation (11°) yielded 13.96 ± 2.88 mmHg. After 50%, extreme rotation increased to 16° yielding 17.41 ± 3.52 mmHg; 11° rotation was 2.76 ± 1.96 mmHg. After 75%, extreme rotation increased to 19° yielding -0.86 ± 1.08 mmHg; 16° and 11° rotation yielded -0.69 ± 1.19 and -0.86 ± 1.08 mmHg, respectively. After 100%, extreme rotation to 19° yielded -1.21 ± 0.60 mmHg; 16° and 11° rotation yielded -0.34 ± 0.30 and 0.00 ± 0.00 mmHg, respectively. Extreme left rotations (11°) yielded mean pressures of -0.17 ± 0.00 (intact), -0.17 ± 0.30 (25%), 2.24 ± 0.79 (50%), 0.34 ± 0.30 (75%), and 0.17 ± 0.30 mmHg (100%). Simulated ICP increased proportionally to maximum ipsilateral axial rotation, and was highest after 50% styloid resection. Contralateral axial rotation did not increase pressure. IJV compression was relieved at 75% resection, suggesting that partial (75%) or complete styloidectomy is a potentially efficacious treatment for SJVC syndrome.

OBJECTIVE: (1) To define patient demographics and common symptoms in patients who undergo styloidectomy for stylohyoid pain syndrome (Eagle\'s syndrome). (2) To evaluate the effectiveness of styloidectomy in reducing symptoms of Eagle\'s syndrome.
METHODS: Retrospective chart review and prospective case series. We retrospectively gathered demographic data on all patients at a single institution who underwent styloidectomy during a 5-year period. Using a patient symptom survey, we also gathered prospective data on a cohort of these patients presenting during the second half of the timeframe.
RESULTS: Thirty-two patients underwent styloidectomy for Eagle\'s syndrome between November 2010 and June 2015. Of these patients, 22 (68.8%) were female, 29 (90.6%) were Caucasian, and 10 (31.3%) reported history of tonsillectomy. Mean age was 46.0 years, and mean BMI was 26.1 kg/m2. Nineteen patients completed the prospective survey. Average styloid length was 45.3 mm. Most severe preoperative symptoms were neck pain, otalgia, globus, facial pain, headache, and discomfort with neck turning. Thirteen of 17 individual symptoms demonstrated significant decrease in symptom scores after styloidectomy. Aggregate symptom scores also showed significant decrease postsurgically. Longer styloid length correlated with increased scores for dysphagia and odynophagia but not with conglomerate symptom scores.
CONCLUSIONS: Patients with Eagle\'s syndrome were mostly female, Caucasian, and had near-normal BMI. There is wide variability in presenting symptoms of Eagle\'s syndrome, but nearly all demonstrate improvement after styloidectomy. Thus, in appropriately selected patients, styloidectomy can effectively and reliably produce improvement in patient symptoms.

Styloid process length and styloid/hyoid bone proximity to the internal carotid artery (ICA) have been implicated in certain carotid pathologies (e.g. carotid artery dissection). Neck movement or trauma may contribute to some of these carotid pathologies. Styloid/hyoid bone to ICA distances have never been systematically analyzed in regard to head rotation and head flexion-extension. We studied axial slices on computed tomography angiograms of 103 nondissection patients showing > 1° head rotation. We measured the distance between ICA and the hyoid bone (HICA) and the closest point and the tip of the styloid bone (SCICA and STICA, respectively), the length of the styloid, and the angle of head rotation and head flexion-extension. STICA distances were significantly smaller on the right as compared to the left side in both the right and the left rotating patient groups (right STICA, 4.4 mm for the right rotating group and 6.4 mm for the left rotating group, p = 0.0091; left STICA, 5.1 mm for the right rotating group and 6.9 for the left rotating group, p = 0.034). No significant differences were observed for SCICA and HICA distances between right and left rotating groups, and head flexion-extension did not altered significantly SCICA, STICA, or HICA distances. Both right- and left-sided head rotation seems to be associated with decreased right-sided and increased the left-sided styloid tip to internal carotid artery distances. This has to be studied and confirmed in single patient analyses using more severe head rotation and flexion-extension angles.

The aim of this investigation was to evaluate the length, thickness, sagittal and transverse angulations and the morphological variations of the stylohyoid complex (SHC), to assess their probable associations with age and gender, and to investigate the prevalence of it in a wide range of a Turkish sub-population by using cone beam computed tomography (CBCT).
The CBCT images of the 1000 patients were evaluated retrospectively. The length, thickness, sagittal and transverse angulations, morphological variations and ossification degrees of SHC were evaluated on multiplanar reconstructions (MPR) adnd three-dimensional (3D) volume rendering (3DVR) images. The data were analysed statistically by using nonparametric tests, Pearson\'s correlation coefficient, Student\'s t test, c2 test and one-way ANOVA. Statistical significance was considered at p < 0.05.
It was determined that 684 (34.2%) of all 2000 SHCs were elongated (> 35 mm). The mean sagittal angle value was measured to be 72.24° and the mean transverse angle value was 70.81°. Scalariform shape, elongated type and nodular calcification pattern have the highest mean age values between the morphological groups, respectively. Calcified outline was the most prevalent calcification pattern in males. There was no correlation between length and the calcification pattern groups while scalariform shape and pseudoarticular type were the longest variations.
We observed that as the anterior sagittal angle gets wider, SHC tends to get longer. The most observed morphological variations were linear shape, elongated type and calcified outline pattern. Detailed studies on the classification will contribute to the literature. (Folia Morphol 2018; 77, 1: 79-89).

OBJECTIVE: Carotid artery dissection (CAD) is more common with increased styloid process length. Our goal was to determine whether proximity of the styloid process and the hyoid bone to the internal carotid artery (ICA) was a risk factor for CAD.
METHODS: We studied axial slices on computed tomography angiograms of 88 patients with nonaneurysmal CAD, from 88 age- and sex-matched controls without dissection, and from 32 nonage-/sex-matched nonaneurysmal vertebral artery dissection control patients. We measured the nearest distance between the ICA and both the styloid and the hyoid bones, blinded to clinical information and radiological reports.
RESULTS: Styloid-ICA and hyoid-ICA distances were significantly shorter on the side of the CAD as compared with nondissection control patients (P<0.0001 for the styloid-ICA distance; and P=0.0037 for the hyoid-ICA distance). Styloid-ICA distances, regardless of the side of the dissection, were shorter in CAD patients compared with the nondissection control group (right side, P=0.001; left side, P=0.0002) and the vertebral artery dissection control group (right side, P=0.0031; left side, P=0.0067). Direct mechanical contact of the styloid with the ICA was more common in CAD patients.
CONCLUSIONS: Shorter distances between the styloid and ICA (and possibly also the hyoid and the ICA) are important risk factors for CAD. Further study is needed to determine whether dissections result from direct injury to the outer vessel wall of the carotid artery.