From the Guidelines
Stylohyoid syndrome should be managed with a combination of conservative measures, including NSAIDs, muscle relaxants, and physical therapy, to alleviate swelling and pain in the submandibular gland. The syndrome can cause swelling of the submandibular gland due to compression of the stylohyoid ligament on surrounding structures. Treatment typically involves conservative management with NSAIDs like ibuprofen (400-600mg three times daily) for pain and inflammation, muscle relaxants such as cyclobenzaprine (5-10mg three times daily), and warm compresses applied to the affected area for 15-20 minutes several times daily. Some key points to consider in the management of stylohyoid syndrome include:
- Physical therapy focusing on stretching and strengthening exercises for the neck and jaw can help relieve pressure on the submandibular gland.
- If conservative measures fail after 4-6 weeks, corticosteroid injections around the styloid process may be considered.
- In severe cases that don't respond to these treatments, surgical intervention to shorten the elongated styloid process may be necessary. The swelling occurs because the abnormally elongated styloid process or calcified stylohyoid ligament compresses neurovascular structures and the submandibular gland, leading to inflammation, reduced salivary flow, and potential obstruction of the submandibular duct, as noted in the context of salivary gland disorders 1. Patients should maintain good hydration and practice gentle massage of the submandibular area to help stimulate salivary flow and reduce swelling. Imaging modalities such as MRI may be useful in characterizing the anatomy of the stylohyoid ligament and detecting potential complications, but the use of combined pre- and postcontrast imaging is not supported by current literature 1. In the context of salivary gland tumors, MRI has been shown to have superior soft tissue contrast resolution and is considered the modality of choice for initial staging 1.
From the Research
Stylohyoid Syndrome and Swollen Submandibular Gland
- The stylohyoid syndrome is a condition characterized by an elongated styloid process, which can cause severe cranio-facial/cervico-facial pain 2.
- The syndrome is not usually seen clinically until after the age of 30, and there is little correlation between the size and extent of the anomaly and the predictability of patients having symptoms related to the anomaly 3.
- A swollen submandibular gland is not a commonly reported symptom of stylohyoid syndrome in the provided studies.
- However, pain and foreign body sensation in the oropharyngeal area are common symptoms of stylohyoid syndrome, accounting for 83% of symptoms in one study 4.
- The diagnosis of stylohyoid syndrome is essential for proper treatment, and a complete medical history, careful palpation of the oral pharyngeal area, and radiographic examination are necessary for diagnosis 4.
- Treatment options for stylohyoid syndrome include styloidectomy via transoral or extraoral approach, which can provide relief from symptoms 2, 4, 5.
Symptoms and Diagnosis
- Symptoms of stylohyoid syndrome can include pain and foreign body sensation in the oropharyngeal area, headache, tongueache, and periauricular discomfort 4.
- Females are more often affected than males, and the age peak is in the 50s and 30s 4.
- The length of the styloid process can vary, but most excised styloid processes are longer than 3cm in length 4.
- Radiographic examination, such as computed tomographic scan, can help identify the pathologic condition 5.
Treatment Options
- Styloidectomy via transoral or extraoral approach can provide relief from symptoms of stylohyoid syndrome 2, 4, 5.
- The choice of approach depends on the individual case and the surgeon's preference.
- Transcervical styloidectomy is an effective treatment for exposure and resection of the styloid process with minimal complications in patients with stylo-stylohyoid syndrome 2.