Giant styloid process: causes, symptoms, diagnosis, treatment

The styloid process originates in the region of the temporal part of the temporal bone, but its origin is not genetically related to the latter, since it is formed from the lower part of the second branchial arch, in the area of which the embryonic cartilage appears on the third month of the uterine life, a bunch that gradually ossifies with age. In children, the styloid process consists entirely of cartilaginous tissue, and since it is attached to it by three muscles that carry out constant traction, then with the ossification of the appendage delayed, this cartilaginous tissue lengthens and together with the subsequent ossification of the awl-hyoid ligament forms a giant subulate process. Elongated styloid process occurs in 4% of cases, mainly in men and on the left, clinical manifestations of the syndrome of the styloid process occur after 30-40 years of life. This syndrome is most often manifested in weakened individuals, psychasthenics and "tired intellectuals."

The giant styloid process, directed by its body from above-anterior and inward, reaches its end of the lower pole of the palatine tonsil. It passes in the immediate vicinity of the lateral surface of the facial nerve, between the external and internal carotid arteries. The deviation of the styloid process outside or inside leads to its contact with one of the carotid arteries and irritation of the sympathetic plexus, which causes the appearance of the corresponding syndrome: the syndrome of the internal carotid artery manifests itself in the parietal and orbital regions, and the external carotid artery syndrome - pains in the lower part of the temporal and retroorbital regions.

With a significant deviation of the styloid process to the inside, its end can reach the trunk of the glossopharyngeal nerve, and at a length of 5 cm it can reach the capsule of the palatine tonsil. In this case, penetrating through the upper constrictor of the pharynx, the styloid appendage comes into contact with the palatal plexus formed by the fibers of the glossopharyngeal and lingual nerves.

The clinical manifestations of this anomaly of the development of the styloid process, as noted above, occur approximately to the 40th year of life and, depending on the direction of the styloid process, they can consist of pain during swallowing or when turning the head. Sometimes transient aphonia arises. In some cases, the end of the styloid process may be in close proximity to the cervical vertebrae, in this case, when the head turns, the styloid can come into contact with the second or third cervical vertebra, which causes the patient to feel a scraping sound. Irritation with the end of the styloid process of the palatine plexus leads to so-called stylalgia, manifested by unilateral pain in the throat, radiating to the corresponding temporomandibular joint and external auditory canal. The pain radiating into the ear and arising upon swallowing is caused by the irritation of the glossopharyngeal nerve that passes over the back surface of the stylus and ends at the base of the tongue, forming a lingual plexus branched in the region of the blind hole and the terminal sulcus of the tongue. Pains in the ear irradiate along the tympanic nerve, which originates in the jugular node of the glossopharyngeal nerve, enters the tympanic canal, the entrance of which is located on the lower-posterior wall of the stony part of the temporal bone, and innervates the mucosa, tympanic membrane and auditory tube. Stylalgia in its severity can simulate the essential neuralgia of the glossopharyngeal nerve. The syndrome of the giant styloid process often leads to the development of patients with carcinophobia.

The diagnosis in some cases can be established with bimanual palpation from the side of the pharynx and the angle of the lower jaw: when the palpation on the left, the examiner places the eponymous finger on the area of the lower pole of the amygdala behind the anterior arch, where a dense, slightly supple lobe is palpable. At the same time, the right index finger makes pressure behind the angle of the lower jaw. They also make an x-ray examination - lateral radiographs of the skull and especially important images in the frontal-nasal projection, in which the elongated subulate processes are visualized against the background of the orbits and maxillary sinus.

Treatment of the giant styloid process is surgical - external access to the area of the stylophyllum (danger of damage to the facial nerve) or transfraneal with the preliminary removal of the corresponding palatine tonsil and access through its niche. With this method, after removal of the palatine tonsil in its niche under the palpatory control of the second finger of the hand, groping for the styloid process, a vertical incision is made and the end of the styloid process, on which the Luke forceps ring is put on, is produced by the blunt rasparator. After this, the body of the styloid process is vyseparivyvayut, pushing the thorns upward by 2-3 cm. Then the styloid process is bored, and the wound in the niche of the palatine tonsil is applied 2-3 catgut suture. The proximity of the carotid arteries requires the surgeon great care when performing this surgery.

[1], [2], [3], [4], [5], [6]