STYLOID PROCESS PAIN?
WHAT’S THAT?
Do you have pain during swallowing?
Do you have a nagging persistent pain during neck movement?
Do you have a foreign body sensation in throat?
Does your pain refuse to go away in spite of various medicine?
Did your doctor tell you it’s not your tonsil?
Did your doctor talk to you about Styloid process pain?
WHAT’S THE STYLOID PROCESS?
Styloid process, in this case, refers to a long slender stylus like bony projection from the temporal bone.
That’s one of the skull bones.The bony part of the ear is inside the temporal bone (Yes , the ear has a bony part.)
Everybody has a Styloid process in each of, their temporal bones.One on each side of the head.That’s perfectly normal.But everyone doesn’t have pain!
WHAT EXACTLY CAUSES STYLOID PROCESS PAIN?
Fortunately most people don’t ever realise the existence of their Styloid process.It’s only when a mysterious pain occurs on the throat/neck that the Styloid process becomes the favourite diagnosis.
If you are reading this , it’s likely you know somebody who has this problem.Or you suspect you have this problem.
Styloid process enlargement or calcification of the Stylohyoid ligament causing pain (stylalgia) is a rare problem called Eagle’s syndrome
Only 4% of the general population has enlarged styloid process.Among these, people with orofacial pain due to Styloid process can be seen in about 4 to 10%.
But even among these, people with orofacial pain due to Styloid process can be seen in about 4 to 10%.
Females are 3 times more likely to have stylalgia than males.
Stylalgia can present as tonsillar pain, facial pain and the is an important part of the differential diagnosis of orofacial pain , due to an unknown cause.
On palpation of the tonsillar fossa of the affected side, there is a pain.
WHY DOES STYLOID PROCESS PAIN OCCUR?
Stylalgia occurs due to compression of the sympathetic nerve bundle around the carotid vessels.
The enlarged Styloid process or calcified Stylohyoid ligament causes this neuralgic pain.
It’s a pain, due to the “nerves crying”.
WHAT ARE THE TESTS YOU MAY NEED FOR SUSPECTED STYLALGIA?
Orthopantomography: That’s an X-ray of your mandible, maxilla and all your teeth, which also shows the Styloid process.
Your doctor will measure the length of Styloid process,on X-ray.
If it’s causing pain it’s generally equal to or more than 20mm.
Confirmation of diagnosis may be done by intraoral lignocaine injection .Lignocaine is a local anaesthetic agent.It’s injected into the tonsillar fossa to sedate the nerves around the Styloid process.
If the pain is due to nerve compression , this test is positive and pain is relieved.
This test is generally performed before going for surgery.
A CT scan is a good tool preoperatively.
It gives a good estimate of size , angulation and relation of the Styloid process with other structures.
WHAT ARE THE TREATMENTS AVAILABLE?
- Depending on the position of the styloid process ,a tonsillectomy(the tonsil gland of the side with enlarged Styloid process is removed) may be needed to approach the Styloid process intraoperatively.
The Styloid process is the surgically removed with due precautions.
- However if not willing for surgery immediately, some medical management maybe tried.
Under a doctor’s supervision, a trial of Carbamazepine , may be started.
This is a popular antiseizure drug often used in nerve pains.The dose and duration of the drug needs sensitive titration.
But since this drug has some pretty , serious side effects.
These include
- bone marrow depression
- severe skin reaction,
- hypo-vitaminosis D,
- liver dysfunction
- multiple gastrointestinal side effects
Several blood tests like Haemoglobin , CBC, peripheral smear,liver function test, need to be done , before starting the drug .
Carbamazepine , should strictly be taken under a doctor’s prescription after the blood tests.
WHAT TO DO AFTER SURGICAL REMOVAL OF STYLOID PROCESS AND YOU ARE AT HOME?
- Bed rest as needed.
- Plenty of fluids.
- Maintain oral hygiene by frequent gargling.
- Have soft, semi-solid, cold diet.
- Avoid heavily spiced oily food.
In the case of increasing pain in the tonsillar region, fever, blood specks during gargling, consult your surgeon urgently.
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