01Jan 2019

ROLE OF PHARMACOTHERAPY AS DIAGNOSTIC THERAPEUTIC TEST IN MANAGEMENT OF PERSISTENCE OF PAIN ASSOCIATED WITH MYOFASCIAL PAIN DYSFUNCTION SYNDROME IN PATIENTS WITH ELONGATED STYLOID PROCESS.

  • Associate Professor of Oral and Maxillofacial Surgery, College Of Oral and Dental Surgery, Misr University for Science and Technology, Egypt.
  • Lecturer of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt.
Crossref Cited-by Linking logo
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Objectives: Study the response of cases with myofascial pain dysfunction syndrome (MPDS) associated with elongated styloid process to pharmacotherapy. Patients and Methods: Thirty patients with 60 styloid process have been involved in the present study. They were suffering from MPDS. Styloid process length, angulation and morphology were assessed from the panoramic view bilaterally. Treatment plan for MPDS was started gradually from simple short period method (pharmacotherapy for two weeks), to conventional long period one (intraoral occlusal splint fabrication and insertion or therapeutic ultrasonic sessions for three months). The response to the treatment was used as diagnostic therapeutic test. Treatment outcome of patients with and without an elongated styloid process were compared using visual analog scale (VAS) and maximum interincisal mouth opening (MIO). Results: Patients group with severely elongated styloid process (mean length 32.95 mm) showed no improvement after two weeks of treatment by drugs; so they subjected to intraoral occlusal splint fabrication or therapeutic ultrasonic sessions. The mean length of styloid process was 28.2 mm and mean angle was 60.73o in both sides of all subjects included in this study. Assessment of the styloid process morphology resulted in; 30 sides showed uninterrupted elongated pattern, 12 sides were psudosegmented and 18 sides were segmented. Conclusions: There was tendency for elongation of styloid process among patients with MPDS. Response of drug treatment in MPDS patients with elongated styloid process was questionable in this study, and the diagnostic therapeutic test is useful in detection of such cases. Persistence of pain among MPDS patients could be attributed to the elongation of their styloid process.


  1. Reiter S,?Goldsmith C,?Emodi-Perlman A,?Friedman-Rubin P,?Winocur E: Masticatory muscle disorders diagnostic criteria: the American Academy of Orofacial Pain versus the research diagnostic criteria/temporomandibular disorders. J?Oral?Rehabil.2012 Dec; 39(12):941-7. doi: 10.1111/j.1365-2842.2012.02337.x. Epub 2012 Aug 9.
  2. Greene CS: The?etiology?of?temporomandibular disorders:?implications?for?treatment. J Orofac Pain.2001 Spring; 15(2):93-105; discussion 106-16.
  3. Renton T,?Durham J,?Aggarwal VR.: The?classification?and differential diagnosis of?orofacial pain: Expert Rev Neurother.2012 May; 12(5):569-76. doi: 10.1586/ern.12.40.
  4. Gauer RL,?Semidey MJ: Diagnosis and treatment of?temporomandibular?disorders. Am Fam Physician.2015 Mar 15; 91(6):378-86.
  5. Mohl ND,?McCall WD Jr,?Lund JP,?Plesh O.: Devices for the diagnosis and treatment of temporomandibular disorders. Part I: Introduction, scientific evidence, and jaw tracking. J?Prosthet?Dent.1990 Feb; 63(2):198-201.
  6. Elimairi I,?Baur DA,?Altay MA,?Quereshy FA,?Minisandram A: Eagle?s Syndrome. Head Neck Pathol.2015 Dec; 9(4):492-5. doi: 10.1007/s12105-014-0599-4. Epub 2014 Dec 24.
  7. Moon CS,?Lee BS,?Kwon YD,?Choi BJ,?Lee JW,?Lee HW,?Yun SU,?Ohe JY: Eagle?s syndrome: a case report. J Korean Assoc Oral Maxillofac Surg.2014 Feb; 40(1):43-7. doi: 10.5125/jkaoms.2014.40.1.43. Epub 2014 Feb 25.
  8. Sudhakara Reddy R,?Sai Kiran Ch,?Sai Madhavi N,?Raghavendra MN,?Satish A: Prevalence of elongation and calcification patterns of elongated styloid process in south India. J Clin Exp Dent.2013 Feb 1; 5(1):e30-5. doi: 10.4317/jced.50981. eCollection 2013 Feb 1.
  9. Strauss M,?Zohar Y,?Laurian N: Elongated styloid process syndrome: intraoral versus external approach for styloid surgery. 1985 Aug; 95(8):976-9.
  10. Baena Caldas GP, Rojas Zuluaga S, Peckham X: Anatomical and clinical relevance of elongated styloid process in a sample of the Colombian population. Morphol Sci.: 2017; 34; 36-39.
  11. Bouza?di K,?Daghfous A,?Fourati E,?Kechaou I,?Jabnoun F,?Chtioui I: Eagle?s syndrome. Acta Radiol Short Rep.2013 Jul 11; 2(5):2047981613495676. doi: 10.1177/2047981613495676. eCollection 2013.
  12. Cullu N,?Deveer M,?Sahan M,?Tetiker H,?Yilmaz M: Radiological evaluation of the styloid process length in the normal population. Folia Morphol (Warsz).2013 Nov; 72(4):318-21.
  13. Maggioni F,?Marchese-Ragona R,?Mampreso E,?Mainardi F,?Zanchin G: Exertional headache as unusual presentation of the syndrome of an elongated styloid process. 2009 May; 49(5):776-9. doi: 10.1111/j.1526-4610.2008.01267.x.
  14. Ferrario VF, Sigurt?a D, Daddona A, Dalloca L, Miani A, Tafuro F, and Sforza C: Calcification of the stylohyoid ligament: Incidence and morphoquantitave evaluations. Oral Surg Oral Med Oral Pathol.1990 Apr; 69(4):524-9.
  15. Monsour PA, and Yougn WG: Variability of the styloid process and stylohyoid ligament in panoramic radiographs. Oral Surg Oral Med Oral Pathol.1986 May; 61(5):522-6.
  16. Mohanty S,?Thirumaran NS,?Gopinath M,?Bambha G,?Balakrishnan S: Significance of styloidectomy in Eagle\\\\\\\'s syndrome: An analysis. Indian J Otolaryngol Head Neck Surg.2009 Dec; 61(4):262-5. doi: 10.1007/s12070-009-0079-4. Epub 2010 Jan 9.
  17. Langlais RP,?Miles DA,?Van Dis ML: Elongated?and?mineralized?stylohyoid?ligament?complex: a?proposed?classification?and?report?of a?case?of Eagle\\\\\\\'s?syndrome. Oral Surg Oral Med Oral Pathol.1986 May; 61(5):527-32.
  18. Zaki HS,?Greco CM,?Rudy TE,?Kubinski JA: Elongated?styloid?process?in a?temporomandibular?disorder?sample:?prevalence?and?treatment?outcome. J?Prosthet?Dent.1996 Apr; 75(4):399-405.
  19. Cuccia AM,?Caradonna C,?Caradonna D: Manual Therapy of the Mandibular Accessory Ligaments for the Management of Temporomandibular Joint Disorders: J Am Osteopath Assoc.2011 Feb; 111(2):102-12.
  20. da Cunha SC,?Nogueira RV,?Duarte AP,?Vasconcelos BC,?Almeida Rde A: Analysis of helkimo and craniomandibular indexes for temporomandibular disorder diagnosis on rheumatoid arthritis patients. Braz?J?Otorhinolaryngol.2007 Jan-Feb; 73(1):19-26.
  21. de Andrade KM,?Rodrigues CA,?Watanabe PC,?Mazzetto MO: Styloid Process Elongation and Calcification in Subjects with TMD: Clinical and Radiographic Aspects. Braz Dent J.?2012; 23 (4):443-450.
  22. AlZarea BK: Prevalence and pattern of the elongated styloid process among geriatric patients in Saudi Arabia. Clin Interv Aging.2017?Mar 30; 12: 611-617. doi: 10.2147/CIA.S129818. eCollection?2017.
  23. Kosar MI, Atalar MH, Sabancioğullari V, Tetiker H, Erdil FH, Cimen M, Otağ I: Evaluation of the length and angulation of the styloid process in the patient with pre-diagnosis of Eagle syndrome. Folia?Morphol?(Warsz).2011 Nov; 70(4):295-9.
  24. Onbas O, Kantarci M, Murat Karasen R, Durur I, Cinar Basekim C, Alper F, Okur A: Angulation, length, and morphology of the styloid process of the temporal bone analyzed by multidetector computed tomography. Acta Radiol.2005 Dec; 46(8):881-6.
  25. Thanuja Ramadoss and Karan Sha: Assessment of the styloid process by cone beam computed tomograph. Int J Radiol Radiat Ther. 2017; 2 (5):123‒127
  26. Mazzetto MO,?Andrade KM,?Magri LV,?Rodrigues CA,?Watanabe PC: Anterior and Medial Angulations of the Styloid Process in Subjects with TMD: Clinical and Radiographic Findings. Brazilian Dental Journal. 2013; 24 (1): 80-84.
  27. Ferrario VF,?Sigurt? D,?Daddona A,?Dalloca L,?Miani A,?Tafuro F,?and Sforza C:Calcification of the stylohyoid ligament: incidence and morphoquantitative evaluations. Oral Surg Oral Med Oral Pathol. 1990 Apr; 69 (4): 524-529.
  28. Krennmair G, and Piehslinger E: The incidence and influence of abnormal styloid conditions on the etiology of craniomandibular functional disorders. Cranio 1999 Oct; 17 (4):247-253.
  29. Josef J. Schimek, and F. Schimek.: The temporomandibular joint pain dysfunction syndrome and the Orofacial Pain. The Journal of Gnathology. 1988; 7: 19-30.
  30. Fini G, Gasparini G, Filippini F, Becelli R, and Marcotullio D. The long styloid process syndrome or Eagle\\\\\\\'s syndrome.?J Craniomaxillofac Surg.??2000 Apr; 28(2):123-7.
  31. Jain S,?Bansal A,?Paul S,?Prashar DV: Styloid-stylohyoid syndrome. Ann Maxillofac Surg.2012 Jan; 2(1):66-9. doi: 10.4103/2231-0746.95326.

[Abeer Kamal and Nesrine khairy. (2019); ROLE OF PHARMACOTHERAPY AS DIAGNOSTIC THERAPEUTIC TEST IN MANAGEMENT OF PERSISTENCE OF PAIN ASSOCIATED WITH MYOFASCIAL PAIN DYSFUNCTION SYNDROME IN PATIENTS WITH ELONGATED STYLOID PROCESS. Int. J. of Adv. Res. (1). 86-94] (ISSN 2320-5407). www.journalijar.com


Abeer Kamal
Associate Professor of Oral and Maxillofacial Surgery, College Of Oral and Dental Surgery, Misr University for Science and Technology, Egypt.

DOI:


Article DOI: 10.21474/IJAR01/8300       DOI URL: http://dx.doi.org/10.21474/IJAR01/8300


Share this article