What is the significance of stylomandibular (temporomandibular joint related) ligament calcification?

From the Guidelines

Stylomandibular ligament calcification is a benign condition that typically doesn't require treatment unless it causes symptoms, and the most recent evidence suggests that physical therapy and occlusal splints may be beneficial in managing symptoms 1.

Overview of Stylomandibular Ligament Calcification

Stylomandibular ligament calcification is a condition where calcium deposits form in the stylomandibular ligament, which connects the styloid process of the temporal bone to the mandible. This condition may be associated with aging or chronic inflammation. Patients might experience pain with jaw movement, limited mouth opening, or discomfort while chewing.

Diagnosis and Differentiation

It's essential to differentiate this condition from Eagle syndrome, which involves elongation or calcification of the styloid process itself rather than the ligament. The condition is often discovered incidentally on dental or head and neck imaging.

Treatment Options

If symptomatic, treatment options include:

• Pain management with NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for acute pain episodes
• Physical therapy focusing on jaw exercises and stretches to improve mobility and reduce discomfort 1
• Occlusal splints may be beneficial in patients with orofacial symptoms and/or TMJ dysfunction 1
• For severe cases that don't respond to conservative measures, surgical intervention to remove the calcified portion of the ligament might be considered

Monitoring and Prevention

Regular dental check-ups can help monitor the condition if it's known to be present. There is no direct evidence on the prevention of stylomandibular ligament calcification, but maintaining good oral health and addressing any underlying inflammatory conditions may help reduce the risk of developing symptoms.

Note that the provided evidence 1 does not directly address stylomandibular ligament calcification, but the recommendations for managing TMJ arthritis and orofacial symptoms can be extrapolated to this condition. However, the most recent and relevant evidence for managing stylomandibular ligament calcification symptoms is from 1.

From the Research

Stylomandibular Ligament Calcification

• Stylomandibular ligament calcification is a condition that can cause pain in the preauricular area and mandibular angle, radiating to the neck, shoulder, and eye on the same side, and is associated with pain during palpation of the ligament 2.
• This condition is also known as Ernest syndrome, and its diagnosis is primarily based on symptomatology, physical examination, and radiographic investigations 2, 3.
• The treatment of stylomandibular ligament calcification can involve injection of corticosteroids, such as triamcinolone acetonide, at the mandibular insertion of the stylomandibular ligament, which has been shown to be effective in resolving the syndrome completely in some cases 2.
• In some cases, surgical treatment may be necessary, such as partial removal of the styloid process, which can be performed through an intraoral approach 4.
• Stylomandibular ligament calcification can be associated with other conditions, such as Eagle syndrome, which is a constellation of signs secondary to an elongated styloid process or mineralization of the stylohyoid or stylomandibular ligament 5, 6.
• The diagnosis of stylomandibular ligament calcification can be challenging, and it is important for clinicians to be aware of this condition to contribute to a better diagnosis and therapeutic procedure 6, 3.

Clinical Characteristics

• The clinical characteristics of stylomandibular ligament calcification include pain in the preauricular area and mandibular angle, radiating to the neck, shoulder, and eye on the same side, and associated with pain during palpation of the ligament 2, 3.
• The pain can be chronic and debilitating, and can radiate to the temple, lateral side of the neck, and temporomandibular joint (TMJ) 3.
• The diagnosis is confirmed by palpation of the stylomandibular ligament and local anesthetic block at the insertion of the ligament 3.

Treatment Options

• The treatment options for stylomandibular ligament calcification include injection of corticosteroids, such as triamcinolone acetonide, at the mandibular insertion of the stylomandibular ligament 2.
• Surgical treatment, such as partial removal of the styloid process, may be necessary in some cases 4.
• Medical treatment with pregabalin (75 mg/day) may also be effective in achieving short-term pain relief 5.
• Tonsillo-styloidectomy surgery has been shown to produce satisfactory results in stylalgia, with the majority of surgically-managed cases achieving a definitive benefit 5.