Weidenbecher M, Schick B, Iro H
Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg.
Laryngorhinootologie. 2006 Mar;85(3):184-90. doi: 10.1055/s-2005-870504.
An elongation of the styloid process or an ossification of the stylohyoid ligament can be the cause for a styloid syndrome and may lead to craniocervical pain, globus sensation and dysphagia. Pathophysiologically, the styloid syndrome is related to an irritation of the surrounding nerves, the carotid artery or the pharyngeal mucosa. There are various alternatives for its treatment.
This study analyzed retrospectively the data of eleven patients, who were treated for a styloid syndrome. All patients were placed on a stepwise therapy plan, which began with a medicamentous treatment, followed by a surgical treatment, if the problems persisted. The surgical approach included a transoral styloid fracture and/ or a surgical styloid shortening, which was carried out either transorally or transcervically.
Three of the eleven patients presented no complaints after the medical treatment and did not require any further therapy. In two out of five patients, transoral fracturing of the styloid was successful. Six patients underwent surgical resection of the styloid process. In five cases a transoral route was used and in one cases a transcervical route. Postoperatively, four patients were free of symptoms and did not present any functional deficit. Two patients experienced severe complications with an ipsilateral medial cerebral artery infarction. These were related to a dissection of the internal carotid artery (ICA) in one case, and an arrosion bleeding of the ICA after the formation of an abscess of the parapharyngeal space in the other case.
A stepwise therapy of the styloid syndrome including medicamentous treatment, transoral styloid fracture and resection of the styloid process has proven to be of value. If the styloid process can be palpated submucosally, a transoral resection may be chosen. However, using this route, the possibility of severe complications has to be taken into consideration, such as injury of the internal carotid artery.
茎突过长或茎突舌骨韧带骨化可能是茎突综合征的病因，可导致颅颈疼痛、咽部异物感和吞咽困难。从病理生理学角度来看，茎突综合征与周围神经、颈动脉或咽黏膜受到刺激有关。其治疗方法有多种。
本研究回顾性分析了11例接受茎突综合征治疗的患者的数据。所有患者均接受逐步治疗方案，首先进行药物治疗，若问题持续存在则进行手术治疗。手术方法包括经口茎突骨折和/或手术缩短茎突，可经口或经颈进行。
11例患者中有3例在药物治疗后无不适，无需进一步治疗。5例患者中有2例经口茎突骨折成功。6例患者接受了茎突切除术。5例采用经口途径，1例采用经颈途径。术后，4例患者无症状且无任何功能缺陷。2例患者出现严重并发症，发生同侧大脑中动脉梗死。其中1例与颈内动脉夹层有关，另1例与咽旁间隙脓肿形成后颈内动脉侵蚀性出血有关。
事实证明，茎突综合征的逐步治疗，包括药物治疗、经口茎突骨折和茎突切除术是有价值的。如果能在黏膜下触及茎突，可选择经口切除。然而，采用这种途径时，必须考虑到严重并发症的可能性，如颈内动脉损伤。
