PREVALENCE OF ELONGATED STYLOID PROCESS IN CENTRAL INDIA POPULATION- A PANORAMIC RADIOGRAPHIC STUDY

Objectives: The aim of this study is to determine the prevalence of styloid process elongation (SPE) in Central India population and to investigate the SPE incidences in relation to the age subgroups, gender, types of calcification, unilateral or bilateral occurrence and symptomatic presentation. Methods: 407 PRs with their clinical record were randomly retrieved from the archival records at Oral Diagnosis Department of People’s University Bhopal, India. The subjects were divided into 4 age subgroups: 30–39, 40–49, 50– 59 and 60 years and older. Kodak 8000C Digital Panoramic system was used to make the radiographs. The length of the styloid process and/or ossification of stylohyoid ligament which were longer than 30 mm were considered as elongated. Results. Out of 407, 65 OPGs (15.97%) showed styloid complex ossification, 36 OPGs of male patients and 29 OPGs of female patient showed styloid process elongation (SPE). Only 5 OPGs showed pseudo articulated styloid process, 8 OPGs showed segmented styloid process and rest 52 OPGs showed elongated type of ossification. In 53.8% cases elongation was bilaterally and in 46.2% cases elongation was unilaterally present. The highest prevelance of SPE was seen in age group of 30-39 years. Only 3 Patients had cervicopharyngeal symptoms and were diagnosed to have Eagle’s syndrome. Conclusion: This study gives a preliminary data regarding SPE for this geographic region. Results suggests that there is considerable variation for the prevalence of SPE when compared to other populations Panoramic radiographs may be used for investigating the ESP in the patients presenting with complaints suggesting of SPE. INTRODUCTION The styloid process arises from the temporal bone immediately in front of the stylomastoid foramen. 1 Its shape is cylindrical, tapering gradually toward the apex like a pinnacle. The apex of the styloid process is clinically important, because it is located between internal and external carotid arteries, just lateral to the tonsillar fossa within the lateral pharyngeal wall. The tip of the styloid process is continuous with the stylohyoid ligament, which extends to the lesser cornu of the hyoid bone. Muscular and ligamentous structures are attached at various locations of the process. 2 The stylohyoid process and ligament are derived from the first and second branchial arches, in addition to Reichert’s cartilage. It has been demonstrated that during fetal development Reichert’s cartilage links the styloid bone to the hyoid bone. In the adults the stylohyoid ligament, which is normally composed of dense fibrous connective tissue, may retain some of its embryonic cartilage and thus have the potential to become partially or completely ossified. If these structures solidify they may develop inflammatory PREVALENCE OF ELONGATED STYLOID PROCESS IN CENTRAL INDIA POPULATIONA PANORAMIC RADIOGRAPHIC STUDY4(2);2018 49 Journal Of Applied Dental and Medical Sciences 4(2);2018 changes or impinge on the adjacent arteries or sensory nerve endings and can cause pain and suffering present in symptomatic cases 3,4. The frequency of ossification of the styloid complex has been found to vary from 4% to 30% 5 . This complex, also called stylohyoid chain, is composed of the styloid process, stylohyoid ligament and the stylomandibular ligament. 6, 7 The normal SP length is approximately 20-30 mm and if it is beyond 30mm it is considered to be elongated. 3 Radiographic classification system of SPE includes three types of radiographic appearances. The Type I pattern represents an uninterrupted, elongated styloid process; Type II is characterized by the styloid process apparently being joined to the stylohyoid ligament by a single pseudoarticulation. This gives the appearance of an articulated elongated styloid process and Type III consists of interrupted segments of the mineralized ligament, creating the appearance of multiple pseudoarticulations within the ligament. 8 MATERIALS AND METHODS The study is based on 407 PRs randomly retrieved from the archival records. All the PRs were retrieved from the Oral Diagnosis Department at People’s University. The PRs of the 407 patients had originally been taken for routine examination and diagnostic purposes. The PRs were excluded where radiograph quality was not good enough; stylohyoid complex was not clearly identified and superimposed on the temporal bone. The subjects were divided into 4 age subgroups: 30–39, 40–49, 50–59 and 60 years and above. All the PRs were done and evaluated in the same fashion. Kodak 8000C Digital Panoramic and cephalometric system was used to make the radiographs. Digital ruler inbuilt in the Kodak digital imaging software 6.12. 10.0 was used to analyze the length of styloid process. The apparent lengths of styloid process were measured, from the point of emergence of the process to their tips, regardless of whether or not the styloid process was segmented. The length of the styloid process and/or ossification of stylohyoid ligament which are longer than 30 mm were considered as elongated. RESULTS A total of 407 patient’s OPG were examined from the database of college records (2009-2012). 242 OPGs were of male patients and 165 OPGs were of females. Out of 407, 65 OPG (15.97%) showed styloid complex ossification, 36 OPGs of male patients and 29 OPGs of female patient showed styloid process elongation (SPE). The percentage of SPE was 55.3% in males and in females it was 44.2% . There were three patterns seen of styloid complex ossification. These were elongated, pseudo articulated and segmented. Only 5 OPGs showed pseudo articulated styloid process, 8 OPGs showed segmented styloid process and rest 52 OPGs showed elongated type of ossification. In 53.8% cases elongation was bilaterally and in 46.2% cases elongation was unilaterally present. The patients were divided into 4 age groups. In group I with the patients of age group 30 – 39, 18.8% OPG showed SPE out of which 25 OPG showed elongated SP, 3 showed pseudo articulated and 5 showed segmented SP. Group II (40 – 49 years), III (50 59) and IV (60 years and above) only showed elongated type of SPE with prevalence of 13.33%, 13.2% and 15.9% respectively. When archival case records were analyzed, two out of 407 (0.49%) patients who previously had undergone tonsillectomies and had PREVALENCE OF ELONGATED STYLOID PROCESS IN CENTRAL INDIA POPULATIONA PANORAMIC RADIOGRAPHIC STUDY4(2);2018 50 Journal Of Applied Dental and Medical Sciences 4(2);2018 Fig. 1