Elongated styloid process is a relatively common cause of facial and neck pain, but it is often misdiagnosed due to its varied clinical presentation. Since an elongated styloid process is often confirmed by radiological means, it would be helpful to find a more accurate mode of depicting the styloid process. In this prospective study, 39 cases were evaluated. A three-dimensional computed tomography (3D CT) reconstruction of the styloid process was performed in 18 cases. In these patients, we compared the length and medial angulation of the symptomatic styloid process as viewed on an orthopantomogram and a 3D CT reconstruction. It was noted that a 3D CT reconstruction was more accurate in depicting the styloid process. This investigation can be considered as the 'gold standard' in the radiological diagnosis of an elongated styloid process.

Giant solitary submandibular duct calculus and multiple calculi of the gland are extremely rare. This occurrence along with more deep and proximally placed common calculi in submandibular gland may occasionally cause a dilemma in selection of the appropriate surgical approach in the present era of sialoendoscopic surgery. There is a high chance of fracture of the stone in a proximally placed stone in the gland followed by likely dissemination of fragments of the stone into the gland parenchyma during the procedure of sialoendoscopy which is a matter of grave concern. We authors believe that excision of the submandibular gland with the stone in such a situation should still be preferred as the gold standard of treatment leaving the ductal stone for endoscopic removal.

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