Using digital panoramic radiographs to examine temporal styloid process elongation

Abstract

O processo estiloide do osso temporal é uma projeção óssea localizada anteriormente ao forame estilomastoide, entre as artérias carótidas interna e externa e posteriormente à faringe. O comprimento médio normal do processo estiloide é de 20 a 30 mm. O objetivo deste estudo foi avaliar os comprimentos médios do processo estiloide em pacientes submetidos a radiografias panorâmicas em uma clínica privada. Foi realizado um cálculo amostral para definir o tamanho mínimo necessário para representar todo o estado do Ceará, Brasil. Após estabelecer um nível de confiança de 95% e uma margem de erro de 5%, foi determinado um mínimo de 385 radiografias panorâmicas. Seguindo os critérios de inclusão e exclusão, ao final foram incluídas 503 radiografias panorâmicas. A fim de avaliar as associações entre comprimentos de processos estilóides e sexo / idade. Processo estilóide alongado foi encontrado em 56% das radiografias de pacientes do sexo masculino e 41% das do sexo feminino. A média do comprimento do processo estiloide foi de 33,51 mm para homens e 31,17 mm para mulheres. A relação entre o comprimento do processo estiloide e a idade foi significativa apenas se o lado direito for considerado. A calibração inter e intraexaminador foi avaliada pelo Teste Kappa. A normalidade dos dados dos erros foi avaliada por meio do Teste de Shapiro-Wilk. Em seguida, os dados foram analisados com ANOVA, teste t de Student e teste qui-quadrado. Entre todos os participantes, 46,2% exibiram processos estilóides alongados com base em suas respectivas radiografias.

Prevalence and characterization of the elongated styloid process in a population of southern Brazil

“…Eagle (1958) stated that the styloid process can be considered elongated when it presents a length greater than 25mm and, being associated with the presence of symptoms, can be classified as Eagle Syndrome or Styloid Syndrome. However, other authors report that this structure should be considered elongated only when it has a length above 30mm (BALDINO et al, 2020;NUNES et al, 2021;DUARTE-CELADA et al, 2021;WOLINSKA et al, 2021). However, it is worth mentioning that in the literature there is a study report, where the Computed Tomography scans of 133 individuals diagnosed with Eagle Syndrome were evaluated, where the authors observed that about 15.4% of the cases had a styloid process with a length of less than 30 mm (CHEN et al, 2017;LISAN et al, 2019).…”

“…According to Guimarães et al (2010), this prolongation may also be accompanied by calcification of the stylohyoid and stylo-mandibular ligament, which may cause symptoms such as craniofacial and cervical pain. NUNES et al, 2021;OZTAS;Orhan, 2012;PEREIRA et al, 2022; SANCHEZ-LEGAZA; REPETTO-LOPEZ; GALLEGO-GALLEGO, 2017;WOLINSKA et al, 2021).…”

“…The styloid process is a thin bone projection that measures approximately 25 mm in length, originating in the temporal bone, anterior and medially to the stylomastoid foramen, from where the facial nerve arises (BRUNO et al, 2022;CAVALCANTE et al, 2017;GUIMARÃES et al, 2010;HANDEM et al, 2016;LINDENBLATT et al, 2018;Martello et al, 2019;Millán et al, 2019;NUNES et al, 2021;ÖZTAS;ORHAN;2012;PEREIRA et al, 2022;PIGACHE et al, 2018;RAFARE;CHAGAS;SAMPAIO et al, 2021). Amid this process are still located important structures such as the internal jugular vein, external and internal carotid artery, and the vagus, glossopharyngeal, accessory, and hypoglossal nerves (BALDINO et al, 2020;MUÑOZ-LEIJA et al, 2020;NUNES et al, 2021;PEREIRA et al, 2022;SAMPAIO et al, 2021;SOUZA et al, 2020).…”

“…The cause of its elongation is not yet clearly described in the literature (BADHEY et al, 2017;BEDI et al, 2019; MAHMOUD; ASHOUR; 2020; Martello et al, 2019;NUNES et al, 2021; Prevalence and characterization of the elongated styloid process in a population of southern Brazil CHAPTER SAMPAIO et al, 2021;WATERS et al, 2019), but studies state that its incidence has been observed between 1.4% and 30% of the population, being more frequent in individuals over 30 years of age and occurring more frequently in women than in men, presenting a ratio of 3:1 (BADHEY et al, 2017;BEDI et al, 2019;JALISI;JAMAL;GRILLONE;MAHMOUD;ASHOUR;Martello et al, 2019;SAMPAIO et al, 2021;WATERS et al, 2019).…”

“…Studies have described that due to the symptoms resembling several pathologies, the elongation of the styloid process can be easily misdiagnosed (such as temporomandibular joint disorder, temporal arteritis, glossopharyngeal or trigeminal neuralgia, and migraine, among others), negatively impacting its treatment, since the diagnosis will not occur in the proper way (GRACCO et al, 2017;Aguiar et al, 2020;NUNES et al, 2021;SAMPAIO et al, 2021). Fernandes et al (2016) reported that countless times these patients are misdiagnosed, leading to the underdiagnosis of this condition and consequently causing its incidence to be underestimated.…”