Güneydoğu Anadolu'da stiloid proses uzamasının görülme sıklığı

Year 2025, Volume: 6 Issue: 4, 403 - 408, 31.08.2025

Mehmet Emrah Polat , Halil İbrahim Durmuş , Gökhan Dönmez

https://doi.org/10.47582/jompac.1747974

Abstract

Özet

Giriş:
Stiloid çıkıntı, temporal kemiğin alt kısmından uzanan silindirik bir kemik çıkıntısıdır. Uzunluğu 30 mm’den fazla olan stiloid çıkıntı, uzamış stiloid çıkıntı (ESP) olarak tanımlanır ve boğaz ağrısı, disfaji (yutma güçlüğü) ve nörolojik rahatsızlıklar gibi Eagle Sendromu ile ilişkili semptomlara yol açabilir. Stiloid çıkıntının uzamasının kesin etiyolojisi tam olarak bilinmemekle birlikte, doğuştan gelen uzama, stilo-hiyoid bağın kalsifikasyonu ve bağın tutunduğu bölgelerdeki kemik proliferasyonu gibi nedenler öne sürülmektedir. Bu çalışma, Harran Üniversitesi Diş Hekimliği Fakültesi'ne başvuran hastalarda stiloid çıkıntı uzamasının insidansını belirlemeyi ve elde edilen bulguları küresel epidemiyolojik verilerle karşılaştırmayı amaçlamaktadır.

Gereç ve Yöntem:
Bu retrospektif çalışma, Ocak 2023 ile Aralık 2023 tarihleri arasında Harran Üniversitesi Ağız, Diş ve Çene Cerrahisi Anabilim Dalı’nda tedavi gören 1.107 hastanın (534 erkek, 573 kadın) arşivlenmiş panoramik radyografileri kullanılarak gerçekleştirilmiştir. Stiloid çıkıntının uzunluğu, timpanyik plak ile uç noktası arasından ölçülmüş ve 30 mm’yi aşan ölçümler uzama olarak kaydedilmiştir. Veriler, kategorik değişkenler için Pearson Ki-kare testi ile analiz edilmiştir. İstatistiksel anlamlılık için p < 0.05 kabul edilmiştir.

Bulgular:
İncelenen popülasyonda uzamış stiloid çıkıntı (ESP) prevalansı %8.8 olarak bulunmuştur. Erkekler (%44.3) ve kadınlar (%55.7) arasında istatistiksel olarak anlamlı bir fark gözlenmemiştir (p = 0.420). Ayrıca ESP ile yaş grupları arasında da anlamlı bir ilişki saptanmamıştır (p = 0.451). Ölçülen en uzun stiloid çıkıntı 42 mm, en kısa ise 14 mm’dir. Erkeklerde ortalama uzunluk 22 mm, kadınlarda ise 21 mm olup cinsiyetler arasında anlamlı fark bulunmamıştır. ESP tanısı alan hastaların %66’sında sistemik hastalık bulunmazken, en yaygın eşlik eden hastalıklar hipertansiyon (%8.2) ve tip 2 diyabet (%5.2) olmuştur.

Sonuç:
Güneydoğu Anadolu bölgesindeki popülasyonda uzamış stiloid çıkıntı (ESP) prevalansı %8.8 olarak saptanmış olup bu oran, diğer popülasyonlarda bildirilen bulgularla uyumludur. ESP ile cinsiyet veya yaş grupları arasında anlamlı bir ilişki bulunmamıştır. Farklı bölgelerdeki prevalans değişkenliği göz önünde bulundurulduğunda, tanısal doğruluğun artırılması ve olası klinik etkilerin değerlendirilmesi amacıyla CBCT ve BT görüntüleme tekniklerini kullanan ileri çalışmalara ihtiyaç vardır.

Keywords

Uzamış stiloid çıkıntı , Eagle sendromu , prevalans , panoramik radyografi , anatomik varyasyon

Ethical Statement

The study protocol was approved by the Ethics Committee of Harran University Ethics Committee (HRÜ/24.21.51).

The prevalence of styloid process elongation in Southeastern Anatolia

Abstract

Aims: Styloid process is a cylindrical bony projection extending from the inferior part of the temporal bone. A styloid process measuring more than 30 mm in length is defined as elongated styloid process (ESP) and may lead to symptoms associated with Eagle syndrome, such as throat pain, dysphagia, and neurological discomfort. Although the exact etiology of styloid process elongation is not fully understood, proposed causes include congenital elongation, calcification of the stylohyoid ligament, and osseous proliferation at the ligament’s attachment sites. This study is designed to determine the incidence of styloid process elongation in patients attending the Faculty of Dentistry at Harran University and to analyze the findings in relation to global epidemiological data.
Methods: This retrospective study was conducted using archived panoramic radiographs of 1.107 patients (534 males, 573 females) treated at the Harran University, Department of Oral and Maxillofacial Surgery between January 2023 and December 2023. The length of the styloid process was measured from the tympanic plate to its tip. Elongation was recorded for measurements exceeding 30 mm. The data were analyzed using the Pearson’s Chi-square test for categorical variables. A p-value of <0.05 was considered statistically significant.
Results: The prevalence of ESP in the studied population was found to be 8.8%, with no statistically significant difference between males (44.3%) and females (55.7%) (p=0.420). Additionally, no significant association was identified between ESP and age groups (p=0.451). The longest measured styloid process was 42 mm, while the shortest was 14 mm. The average length was 22 mm in males and 21 mm in females, with no significant difference observed between sexes. Among patients diagnosed with ESP, 66% had no systemic disease; the most common comorbidities were hypertension (8.2%) and type 2 diabetes (5.2%).
Conclusion: The prevalence of ESP in the Southeastern Anatolian population was determined to be 8.8%, which is consistent with findings reported in other populations. No significant association was found between ESP and either gender or age groups. Considering the variability in prevalence across different regions, further advanced studies utilizing CBCT and CT imaging techniques are necessary to improve diagnostic accuracy and assess potential clinical implications.

Keywords

Elongated styloid process , Eagle syndrome , prevalence , panoramic radiography , anatomical variation

Ethical Statement

Çalışma protokolü, Harran Üniversitesi Etik Kurulu tarafından onaylanmıştır (HRÜ/24.21.51).

References

• Koshy JM, Narayan M, Narayanan S, Priya BS, Sumathy G. Elongated styloid process: a study. J Pharm Bioall Sci. 2015;7(Suppl 1):S131-S133. doi:10.4103/0975-7406.155861
• Alzarea BK. Prevalence and pattern of the elongated styloid process among geriatric patients in Saudi Arabia. Clin Interv Aging. 2017;12:611-617. doi:10.2147/CIA.S129818
• Vieira EM, Guedes OA, Morais SD, Musis CR, Albuquerque PA, Borges ÁH. Prevalence of elongated styloid process in a central Brazilian population. J Clin Diagn Res. 2015;9(3):ZC90-ZC92. doi:10.7860/JCDR/ 2015/14599.6567
• Custodio ALN, Alves e Silva MRM, Abreu MH, Araújo LRA, Oliveira LJ. Styloid process of the temporal bone: morphometric analysis and clinical implications. Anat Res Int. 2016;2016:8792725. doi:10.1155/ 2016/8792725
• Abuhaimed AK, Alvarez R, Menezes RG. Anatomy, Head and Neck, Styloid Process. In: StatPearls. StatPearls Publishing; January 9, 2023.
• Assiri AH, Estrugo-Devesa A, Roselló Llabrés X, et al. The prevalence of elongated styloid process in the population of Barcelona: a cross-sectional study and review of literature. BMC Oral Health. 2023;23:674. doi:10.1186/s12903-023-03405-0
• Shankland WE 2nd. Anterior throat pain syndromes: causes for undiagnosed craniofacial pain. Cranio. 2014;32(1):50-59. doi:10.1179/crn.2010.007
• Kaufman SM, Elzay RP, Irish EF. Styloid process variation: radiologic and clinical study. Arch Otolaryngol. 1970;91(6):460-463. doi:10.1001/archotol.1970.00770040654013
• Camarda AJ, Deschamps C, Forest DI. Stylohyoid chain ossification: a discussion of etiology. Oral Surg Oral Med Oral Pathol. 1989;67(5):508-514. doi:10.1016/0030-4220(89)90264-8
• Kaffe I, Fishel D, Gorsky M. Panoramic radiography in dentistry. Refuat Hapeh Vehashinayim. 1977;26(2):25-30.
• Larheim TA, Westesson PL. Maxillofacial Imaging. Berlin, Germany: Springer; 2006.
• van der Stelt PF. Panoramische röntgenopnamen in de tandheelkundige diagnostiek. Ned Tijdschr Tandheelkd. 2016;123(4):181-187. doi:10.5177/ntvt.2016.04.15208
• Çakur B, Şahin A, Dağistan S, et al. Dental panoramic radiography in the diagnosis of osteoporosis. J Int Med Res. 2008;36(4):792-799. doi:10. 1177/147323000803600422
• Farman AG, Farman TT. Extraoral and panoramic systems. Dent Clin North Am. 2000;44(2):257-272. doi:10.1016/S0011-8532(22)01302-7
• Patil S, Ghosh S, Vasudeva N. Morphometric study of the styloid process of temporal bone. J Clin Diagn Res. 2014;8(9):AC04-AC06. doi:10.7860/JCDR/2014/9419.4867
• Alsweed A, Almutairi BM. Elongation pattern of styloid process in Saudi population: a factor to remember in the prevention of Eagle syndrome. Folia Morphol (Warsz). 2021;80(4):843-849. doi:10.5603/FM.a2021.0077
• Jung T, Tschernitschek H, Hippen H, Schneider B, Borchers L. Elongated styloid process: when is it really elongated? Dentomaxillofac Radiol. 2004;33(2):119-124. doi:10.1259/dmfr/13491574
• Kaaki M, Alassaf MS, Alolayan A, et al. Evaluation of styloid process elongation in Madinah, Saudi Arabia: a retrospective radiographic investigation. Cureus. 2024;16(1):e53136. doi:10.7759/cureus.53136
• Okabe S, Morimoto Y, Ansai T, et al. Clinical significance and variation of the advanced calcified stylohyoid complex detected by panoramic radiographs among 80-year-old subjects. Dentomaxillofac Radiol. 2006; 35(3):191-199. doi:10.1259/dmfr/12056500
• Shaik MA, Kaleem SMN, Wahab A, Hameed S. Prevalence of elongated styloid process in Saudi population of Aseer region. Eur J Dent. 2013;7(4): 449-454. doi:10.4103/1305-7456.120687
• de Andrade KM, Rodrigues CA, Watanabe PCA, Mazzetto MO. Styloid process elongation and calcification in subjects with TMD: clinical and radiographic aspects. Braz Dent J. 2012;23(4):443-450. doi:10.1590/s0103-64402012000400023
• Erol B. Radiological assessment of elongated styloid process and ossified stylohyoid ligament. J Marmara Univ Dent Fac. 1996;2(2-3):554-556.
• Chen G, Yeh PC, Huang SL. An evaluation of the prevalence of elongated styloid process in Taiwanese population using digital panoramic radiographs. J Dent Sci. 2022;17(2):744-749. doi:10.1016/j.jds.2021.09.033
• Nalçacı R, Mısırlıoğlu M. Yaşlı bireylerde stiloid prosesin radyolojik olarak değerlendirilmesi. Atatürk Üniv Diş Hek Fak Derg. 2006;2006(3):1-6.
• Sancio-Gonçalves FC, Abreu MHNG, Soares JMN, et al. Stylohyoid complex ossification in temporomandibular disorders: a case-control study. J Prosthet Dent. 2013;109(2):79-82. doi:10.1016/S0022-3913(13) 60019-0
• Rizzatti-Barbosa CM, Ribeiro MC, Silva-Concilio LR, Di Hipolito O, Ambrosiano GM. Is an elongated stylohyoid process prevalent in the elderly? A radiographic study in a Brazilian population. Gerontology. 2005;22(2):112-115. doi:10.1111/j.1741-2358.2005.00046.x
• More CB, Asrani MK. Evaluation of the styloid process on digital panoramic radiographs. Indian J Radiol Imaging. 2010;20(4):261-265. doi:10.4103/0971-3026.73537
• Anbiaee N, Javadzadeh A. Elongated styloid process: is it a pathological condition? Indian J Dent Res. 2011;22(5):673-677. doi:10.4103/0970-9290.93455
• Al-Khateeb TH, Al Dajani TM, Al Jamal GA. Mineralization of the stylohyoid ligament complex in a Jordanian sample: a clinicoradiographic study. J Oral Maxillofac Surg. 2010;68(6):1242-1251. doi:10.1016/j.joms.2009.07.090
• Basekim CC, Mutlu H, Güngör A, et al. Evaluation of styloid process by three-dimensional computed tomography. Eur Radiol. 2005;15(1):134-139. doi:10.1007/s00330-004-2354-9
• Gözil R, Yener N, Çalgüner E, Araç M, Tunç E, Bahçelioğlu M. Morphological characteristics of styloid process evaluated by computerized axial tomography. Ann Anat. 2001;183(6):527-535. doi:10. 1016/S0940-9602(01)80060-1
• Gokce C, Sisman Y, Ertas ET, Akgunlu F, Ozturk A. Prevalence of styloid process elongation on panoramic radiography in the Turkey population from Cappadocia region. Eur J Dent. 2008;2(1):18-22.
• Gossman JR, Tarsitano JJ. The styloid-stylohyoid syndrome. J Oral Surg. 1977;35(7):555-560.
• Monsour PA, Young WG. Variability of the styloid process and stylohyoid ligament in panoramic radiographs. Oral Surg Oral Med Oral Pathol. 1986;61(5):522-526. doi:10.1016/0030-4220(86)90399-3
• Ferrario VF, Sigurtá D, Daddona A, et al. Calcification of the stylohyoid ligament: incidence and morphoquantitative evaluations. Oral Surg Oral Med Oral Pathol. 1990;69(4):524-529. doi:10.1016/0030-4220(90) 90390-e
• Radfar L, Amjadi N, Aslani N, Suresh L. Prevalence and clinical significance of elongated calcified styloid processes in panoramic radiographs. Gen Dent. 2008;56(6):e29-e32.
• Bagga MB, Kumar CA, Yeluri G. Clinicoradiologic evaluation of styloid process calcification. Imaging Sci Dent. 2012;42(3):155-161. doi:10.5624/isd.2012.42.3.155
• Chabikuli NJ, Noffke CEE. Styloid process elongation according to age and gender: a radiological study. S Afr Dent J. 2016;71(10):470-473.
• Rai S, Misra D, Singh N, et al. Prevalence and calcification of stylohyoid complex in North West part of India and its correlation with general and dental health condition. J Indian Acad Oral Med Radiol. 2017;29(3):174-179. doi:10.4103/jiaomr.JIAOMR_135_16
• Gracco A, De Stefani A, Bruno G, et al. Elongated styloid process evaluation on digital panoramic radiograph in a North Italian population. J Clin Exp Dent. 2017;9(3):e400-e404. doi:10.4317/jced.53450