Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Japan.
J Craniofac Surg. 2021 Jun 1;32(4):e377-e378. doi: 10.1097/SCS.0000000000007298.
An elongated styloid process (ESP) causes symptoms such as pharyngeal pain, swallowing pain, and discomfort during mouth opening. The main treatment is surgical resection of the ESP. The authors present a case of ESP with skeletal mandibular protrusion. Because mandibular setback by sagittal splitting ramus osteotomy (SSRO) may lead to deterioration of symptoms of ESP, resection of ESP and bilateral SSRO were performed simultaneously. The patient was a 50-year-old man who visited our department with chief complaints of mandibular protrusion and pain in the left pharynx on mouth opening and swallowing. A lateral cephalogram helped in diagnosis of skeletal mandibular protrusion. In addition, an approximately 42-mm left styloid process elongated inferomedially was observed. Left styloidectomy was first performed via the cervical approach, followed by SSRO. Occlusion, facial appearance, and preoperative symptoms due to the ESP improved after surgery. The cervical appearance was esthetically satisfactory. In a case of ESP with skeletal mandibular protrusion with potential aggravation of symptoms because of mandibular setback of the ESP, resection of the styloid process is necessary together with orthognathic surgery.
茎突过长（ESP）可引起咽部疼痛、吞咽疼痛和张口不适等症状。主要治疗方法是 ESP 的手术切除。作者报告了一例伴有下颌骨前突的 ESP 病例。由于矢状劈开下颌支截骨术（SSRO）后退下颌可能导致 ESP 症状恶化，因此同时进行了 ESP 切除和双侧 SSRO。患者为 50 岁男性，因下颌前突和张口、吞咽时左咽部疼痛就诊于我科。侧位头颅定位片有助于诊断为骨骼性下颌前突。此外，还观察到大约 42mm 长的左侧茎突向内侧下方延伸。首先通过颈侧入路行左侧茎突切除术，然后行 SSRO。术后咬合、面部外观和因 ESP 引起的术前症状均得到改善。颈部外观美观满意。对于因 ESP 后退而导致症状可能加重的伴有骨骼性下颌前突的 ESP 患者，需要进行茎突切除术和正颌手术。
