We thank Deeb for his comments. Pain in the lateral aspect of the neck is a common symptom that can be associated with many conditions, including submandibular gland pathology, temporomandibular joint disorder, cervical spine pathology, along with pathology in the stylohyoid complex. The original description of Eagle syndrome involved an elongated styloid process as the cause of pain in the ears and the lateral aspect of the neck. The subsequent identification of the same symptom complex in patients with a calcified stylohyoid ligament led to this abnormality also being categorized as Eagle syndrome. That 2 different pathologic conditions could result in the same symptom complex indicates that these abnormalities are acting on the same underlying structures. In several cases in our series, patients presented with the same symptom complex but not with either an elongated styloid process or a calcified stylohyoid ligament. The 3-dimensional computed tomograms showed that the greater horn of the hyoid bone was extending more posteriorly than expected. While we do not have measurements for normal hyoid bones, it was apparent that the hyoid bones in our patients were positioned more closely to the neurovascular structures in the neck than usual. The findings at surgery confirmed the abnormally posterior position of the greater cornu of the hyoid bone, and all patients responded to resection of the lateral portion of the hyoid bone to include the lesser cornu, thus also releasing the stylohyoid ligament. It is also possible that the hyoid bones were positioned more posteriorly because of the indistensibility of the stylohyoid complex and that the hyoid bones only appeared elongated because of their more posterior positioning.
Del Gaudio JM, Colby CC. Stylohyoid Complex Syndrome: Is 1 More Classification Needed?—Reply. Arch Otolaryngol Head Neck Surg. 2011;137(9):952. doi:10.1001/archoto.2011.143
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