Stylohyoid complex syndrome: A new diagnostic classification

Objective: To describe stylohyoid complex syndrome (SHCS) as a new diagnostic classification of all lateral neck and/or facial pain conditions resulting from an elongated styloid process, ossified stylohyoid ligament, or elongated hyoid bone. All of these pathologic conditions result in tension and reduced distensibility of the stylohyoid complex (SHC), with resultant irritation of the surrounding cervical structures with movement of the complex. Design: A retrospective medical chart review was performed to identify a cohort of patients who underwent surgical intervention for lateral neck and/or facial pain due to pathologic SHCS. Follow-up time of greater than 1 year is reported in 5 of 7 patients. Setting: Tertiary, academic referral center. Patients: Patients included were those given a diagnosis of SHCS who underwent surgical intervention from June 2006 through September 2009. There were 7 patients, 5 of whom were female. The age range was 38 to 53 years at time of presentation (mean age, 45.3 years). Common presenting complaints were lateral neck and oropharyngeal pain exacerbated by tongue and head movements. Intervention: The pathologic areas were surgically addressed through transoral or cervical approaches. Main Outcome Measure: Symptoms following surgical intervention. Results: Seven patients (8 sides) were identified as having SHCS. Computed tomographic findings included elongated styloid processes (3 sides), ossified stylohyoid ligaments (2 sides), and elongated hyoid bones (3 sides). Computed tomographic scan, frequently with volumerendered 3-dimensional reconstructions, identified the pathologic condition. All patients experienced clinically significant relief of presenting symptoms following surgical intervention. Conclusions: Stylohyoid complex syndrome includes all lateral neck and/or facial pain conditions resulting from an elongated styloid process, ossified stylohyoid ligament, or elongated hyoid bone. Surgical intervention directed at any pathologic point to disrupt this complex relieves tension and offers patients relief of symptoms.