Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, Washington Hospital Center and Georgetown University Hospital, Washington, DC.
In their article, “Stylohyoid Complex Syndrome: A New Diagnostic Classification,” Colby and Del Gaudio1 review their experience in the surgical treatment of 7 patients who presented with symptoms of pain in the lateral aspect of the neck and face that fit into what they propose as a new classification of the stylohyoid complex syndrome. Three patients underwent external resection of the lesser and greater cornua of the hyoid because of an “elongated” hyoid bone. What part of the hyoid bone was elongated and what reference for normal dimensions of this bone the authors followed are not mentioned in the text. It seems that this subgroup of patients underwent what can be appropriately called a lateral hemihyoidectomy for a symptom complex that is rare and vague at best, without a clear definition of an elongated hyoid bone. This procedure may result in temporary or chronic dysphagia because of disruption of the suprahyoid musculature.
The classic definition of Eagle syndrome is a history of recurring pain in the neck and throat that usually radiates to the ipsilateral aspect of the ear and the presence of tenderness on palpation of the area at or near the posterior tonsillar pillar. This palpation is essential because it elicits the patient's presenting symptoms. The radiographic sine qua non is a calcified stylohyoid ligament. The 3-dimensional computed tomographic images in the article are impressive and prove that this technology can be helpful in some cases in which the underlying cause is not obvious. I have been in practice at a major tertiary care and teaching hospital for more than 30 years. I find the lateral neck view obtained in the correct soft-tissue technique to be a simple, rapid, panoramic, and sufficient study to visualize a calcified stylohyoid ligament at the initial encounter with the patient. This view gives the examiner an idea about the degree of laryngeal calcification and may reveal the presence of cervical osteophytes, which in themselves can account for symptoms of pain in the lateral aspect of the neck.
I also believe that the use of the term ossification to describe the changes in the stylohyoid ligament may be inappropriate because it implies orderly laying of bone by osteoblasts, when it is more likely a process of deposition of calcium salts in the soft tissue of the ligament, similar to calcifications in other parts of the body. None of the references in the article include histologic evidence of ossification. Before this new classification is accepted, it would be reasonable to establish reference standards of hyoid dimensions and undertake histologic studies before the term ossification is used.
Correspondence: Dr Deeb, Department of Otolaryngology–Head and Neck Surgery, Washington Hospital Center, 110 Irving St, Washington, DC 20010 (ziad.e.deeb@medstar.net).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Archives of Otolaryngology editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.