From the Research
Stylohyoid syndrome causing unilateral submandibular swelling should be treated with a combination of conservative measures and targeted interventions, with surgical intervention considered in severe cases that don't respond to conservative treatment after 3-6 months, as supported by the most recent study 1.
Initial Management
Initial management includes nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily for 7-10 days to reduce inflammation and pain. Local heat application for 15-20 minutes several times daily can help relieve muscle tension.
Physical Therapy
Physical therapy focusing on stretching and strengthening exercises for the neck and jaw muscles should be performed 2-3 times weekly for 4-6 weeks.
Trigger Point Injections
For persistent symptoms, consider trigger point injections with 1-2ml of 1% lidocaine with or without a small amount of corticosteroid (such as 10mg triamcinolone) into tender areas of the stylohyoid ligament.
Surgical Intervention
In severe cases that don't respond to conservative treatment after 3-6 months, surgical intervention to partially remove the elongated styloid process may be necessary, as shown in a study published in 2022 1. This condition occurs when an elongated styloid process or calcified stylohyoid ligament irritates surrounding structures, causing inflammation and swelling in the submandibular region. The unilateral presentation is typical, as the anatomical abnormality often affects one side more than the other.
Diagnosis
Proper diagnosis typically requires imaging studies such as panoramic radiographs or CT scans to visualize the elongated styloid process, as noted in various studies 2, 3, 4, 5. Some key points to consider:
- The stylohyoid syndrome is a rare cause of cranio-facial pain, and the transcervical approach is an effective treatment for exposure and resection of the styloid process with minimal complications 5.
- Patients with Eagle's syndrome were mostly female, Caucasian, and had near-normal BMI, and styloidectomy can effectively and reliably produce improvement in patient symptoms 4.
- A delay in surgical intervention can lead to complications such as complete ossification of the stylohyoid complex and impingement on surrounding structures, increasing intra-operative complexity 1.