AL-AMAD, et al. (2023) - Stylohyoid Ligament Calcification and Its Association With Dental Diseases

Here is an interesting article that Dr. Heim pointed out today on his instagram channel with his comment (translated):

》Eagle syndrome caused by dental work?!Why does the stylohyoid ligament ossify and are there risk factors? For me, it has become clear in recent years that the usual “suspects”, such as tonsillectomy (removal of the tonsils), are not a consistent risk factor. However, temporomandibular joint problems seem to be related to true lengthening (class 1). When it comes to ossification, however, opinions differ. Now an interesting work has been published at #pubmed. 175 patients were included. Trauma and tonsillectomy could not be identified as significant risk factors. However, a correlation between root canal treatment and the ossification of the ligament could be shown. Caution! This does not mean that every root canal treatment leads to Eagle Syndrome. However, it underscores the assumption that ossification has an inflammatory component and that old ideas need to be put to the test. 《



This research aimed at investigating the relationship between calcification of the stylohyoid ligaments (SHLs) and odontogenic inflammatory events.


Cone-beam computed tomography scans of 175 patients were retrospectively assessed for presence of SHL calcifications. Frequencies of 4 types of odontogenic inflammatory events were assessed using the same scans, namely dental extractions, root canal treatments, furcation lesions, and periapical lesions. Patients were telephone-interviewed and asked about histories of tonsillectomy and head and neck trauma. Mann–Whitney U and binary logistic regression tests were used to assess associations between SHL calcification and mean ranks of odontogenic inflammatory events.


Calcification of SHLs was detected in 71 (41%) and 58 (33%) patients on the right and left sides, respectively. Tonsillectomy and trauma were reported in 14% and 10% of the sample, respectively. Amongst all inflammatory events, root canal treatments were significantly associated with SHL calcification (U = 2755; Z = −2.1; P = .035). This association was independent from patient age, tonsillectomy, trauma, and other inflammatory events (odds ratio, 1.2; 95% confidence interval, 1.0–1.4; P = .036).


This study presents new evidence that intra-oral inflammatory events, particularly related to root canal treatments, have a stronger association with SHL dystrophic calcification than that associated with traditional predisposing factors (ie, old age, tonsillectomy, and trauma).

Key words: Stylohyoid ligaments, Styloid process, Eagle syndrome, Root canal treatment, Dental pathologies, CBCT


Interesting! I wonder if also the common dental treatment of removing teeth to make more space then fitting braces would also have the same potential inflammatory response? I was told by a dentist (& I think I’ve read it somewhere too) that this practice used by most orthodontists can cause TMJD & was warned off having it done to my boys- all to do with the shrinking gums after teeth are removed & then expanding with having braces fitted…


Awhile ago, someone suggested that having braces may have caused her to develop ES. I thought it was an interesting idea. @Jules, you’re correct about braces causing the gums to recede. My brother has very recessed gums from braces. I’ve had them twice & have some problem with that. As we get older it’s worse because the roots to the teeth become more exposed & that causes tooth sensitivity & need for further dental work to protect the roots.