Clin Surg | Volume 6, Issue 1 | Research Article | Open Access

Etio-Histomorphogenesis of Styloid enlargement - A Novel & Extensive Light Microscopic Analysis of Ten cases of Eagle’s Syndrome

Colonel Priya Jeyaraj*

Department of Oral & Maxillofacial Surgery, Commanding Officer 33 Corps Dental Unit and Corps Dental Adviser 33 Corps, Indian Army, India

*Correspondance to: Colonel Priya Jeyaraj 

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Aim & Objectives: To carry out detailed light microscopic analysis of excised specimen of Elongated Styloid Processes (ESPs) from patients suffering from Eagle’s Syndrome (ES). To thus gain a clear and precise insight into the etiology, origin, development and progression of styloid enlargement, and to accurately hypothesize the underlying histopathological mechanisms bringing about their thickening and elongation. Study Design & Setting: This three-year study was conducted in ten patients of ES, who were treated by transoral styloidectomy. The excised ESPs were subjected to a systematic and comprehensive histological analysis of sections from their base, mid and apical thirds. Material & Methods: Imaging and diagnostic workup, operative procedure, post-surgical protocols & regimen, tissue processing & analysis of excised specimen were the same in all patients. Results: Immature woven bone trabecula and dystrophic calcifications were found within fibrocollagenous mesenchymal condensations of the Stylohyoid Ligament (SL) at the apical region of the ESPs, and in the tendinous insertions of the styloid group of muscles into the ESPs, indicative of their osseous metaplasia as a form of reactive response. Conclusion: Repetitive stress, traction or traumatic stimuli brought to bear upon the apices and lateral surfaces of styloid processes via tendinous insertions of the SL and styloid group of muscles, as a result of neck and hyoid movements, are likely to serve as triggering factors, stimulating an osseous metaplasia of connective cells within these mesenchymal structures as well as in the periosteal fibrous tissue, into osteoblasts and osteocytes. This reactive response is followed by osteogenesis and laying down of woven bone at these sites, resulting in increase in length and circumference of the SPs and their attendant, associated clinical sequela.


Eagle’s Syndrome (ES); Styloid Ligament (SL); Osseous metaplasia; Styloid enlargement; Elongated Styloid Process (ESP)


Jeyaraj CP. Etio-Histomorphogenesis of Styloid enlargement - A Novel & Extensive Light Microscopic Analysis of Ten cases of Eagle’s Syndrome. Clin Surg. 2021; 6: 3254..

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