ALSOGHIER, A. (2023) - Elongated styloid syndrome mimicking temporomandibular joint disorders: a case report and short literature review


Elongated styloid syndrome (ESS) can present with myriad symptoms that mimic common features of orofacial pain, such as temporomandibular joint disorders (TMJDs), often causing a challenge and delay in diagnosis. We report the case of a 52-year-old male with a three-year history of non-painful clicking during jaw movement initially diagnosed as TMJD-related internal derangement. The patient presented with a history of annoying jaw sounds for three years, described as a popping sound without bilateral clicking or crepitation. Tinnitus and progressive hearing loss were observed in the right ear, and a hearing aid was recommended by an otolaryngologist. The patient was initially diagnosed with TMJD and managed accordingly; nevertheless, his symptoms persisted. Imaging revealed prominent bilateral styloid process elongation that exceeded the recognized cut-off level of >30 mm for elongation. The patient was informed of his diagnosis and its treatment but opted only for further swallowing and auditory assessments of his ear and nose symptoms. Clinicians should consider including ESS as a differential diagnosis in patients presenting with non-specific chronic orofacial symptoms for timely diagnosis and favorable clinical outcomes.

Keywords: Case reports; Eagle’s syndrome; Elongated styloid process syndrome; Facial pain; Temporomandibular joint disorders.


What a shame the patient didn’t opt to have his elongated styloid removed. It might have helped restore his hearing & certainly would have reduced or ended the “annoying jaw sounds.”


I think some of us lose the confidence that anything positive will come out of it here in the UK. Super long waits unless you can self fund, inability to be taken seriously, hundreds of phone calls and long waits in OP clinics. And of course advancing age and drs doing their best to put you off of surgical intervention till in the end you doubt yourself :smiling_face_with_tear:

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Socialized medicine is a mixed bag @Mcwelly. I would say even though our wait times aren’t what you experience, what we have in the US has many similar problems. Because we pay for medical insurance & sometimes even a large percent of the cost of medical care if our insurance doesn’t help much, there are many people here who have huge financial debt due to ongoing medical costs or don’t bother to get treatment because they feel they can’t afford it.

I’m sorry for your situation & hope you’ve been able to see a doctor who is knowledgeable about ES & have gotten on the surgery schedule even if it’s months away.

NEVER doubt yourself. You alone know your body & how your symptoms are affecting you. Just because a doctor is unable to pinpoint what may be causing those symptoms doesn’t mean they aren’t real.


Thank you for your reply @ Isaiah_40_31. I totally agree with your observations and comments, I read a lot about people in the US who have insurance turn them down, not just for Eagles I imagine!

I’ve never been formally diagnosed with ES, only elongated styloids with a lot of my symptoms improving after another (bilateral) washout of the TMJs and manipulation. Unfortunately my right sided neck/occipital pain has now worsened, it’s unbearable at night, and moving my head is almost impossible. I know I have degenerative changes but what? The compression bang on the head nearly 2 years ago may be to blame - was thought to be a # of C2 on x Ray.

I have a long awaited appointment at pain management clinic in a few weeks but to be honest before pain is managed in any way, surely some sort of origin or diagnosis is needed? I’m hoping I can be pointed in The right direction with appropriate care/excerise/PT etc but seems to be too much to ask and support meetings/psych appointments won’t help me sort out my head mobility.

I’m positive sort of, if somewhat very cynical!

These forums are supportive, even if I don’t always participate as knowing that you’re not the only one is weirdly reassuring.

Have a lovely weekend all :heart:

@McWelly - your symptoms are somewhat ambiguous, but I’d wager that getting at least the right styloid out would help reduce the pain you have. I do hope your pain management doctor is willing to send you for an additional scan to look at your neck vertebrae. If nothing serious is going on there, you can chalk your symptoms up to your styloid(s) & know that you have ES.

I expect you know that elongated styloids w/o symptoms isn’t considered ES but once there are symptoms present, the diagnosis becomes ES. @PamelaInNYC recently posted a link to a somewhat brief research article that has good information in it that may help you come up w/ questions/suggestions for the type of scans that would benefit you. It’s worthwhile reading before your appt.


Thank you for this post….I had TMJ, swallowing issues, reflux and developed tinnitus. After surgery all but tinnitus improved.


I didn’t mention the swollen knee, finger joints and toes on one foot. GP dismissed all but referred to podiatrist who says it is gout! No treatment offered. A weird question but does anyone ever feel like they are shrinking when walking along? Sometimes I feel like I am getting shorter and going into the ground, daren’t mention that as yes another symptom!

@Mcwelly - the shrinking/being closer to the ground than you are can be a symptom of intracranial hypertension. That is a repercussion of internal jugular vein compression caused by an elongated styloid &/or the transverse process of the C-1 vertebra. @Jules had a similar symptom as a result of her IJV compression. I expect she’ll comment on that.

My brother-in-law has gout. There is medication that can treat gout symptoms, & there are certain foods you should avoid as they can cause gout to flare up. I’m actually surprised the doctor you saw didn’t offer any of this information to you.

That’s very interesting, thank you for that @Isaiah_40_31. I’ve suspected gout for a while and try to eat healthily and follow a Mediterranean diet - been a bit hard past 6 weeks of touring in France and being naughty and eating sardines, tuna, pate, red wine and even liver! Did eat a lot of cherries though if that excuses me?:joy:. I have suspected and queried the connection between a lot of these things and bit by bit the puzzle will get completed. Hopefully I can get my cervical xx ray and ct (2021) and get my son to help me upload it into 3D.

Ps you’re so knowledgeable!

I’m glad you’ve been having a wonderful vacation. It’s really hard to be disciplined w/ food & drink while in an area that offers a different variety than when at home. I’d be doing the same as you!

My knowledge has been born of many years on this forum, plus, I’d be nowhere if not for Google. I can’t rely on Google entirely because it’s not always accurate, but it’s a starting point. I also have a slightly medical background (grew up w/ a dad who was a doctor) so have long had an interest in the human body & what makes us tick as well as what can go wrong.

I recall my brother-in-law’s gout is set off instantaneously by asparagus which he loves but now must avoid. Doesn’t sound like you dove into a huge serving of asparagus on your trip though. :joy:

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Good evening! Yes Google, an enquiring mind and a little medical bent go a long way to the understanding of illness! I have a copy of ct and X-ray sent to me digitally but how do I look at it, particularly in 3D? I usually use an iPad as my pc is do old it doesn’t do much! Does IOS need different software to PC operating systems. Many thanks :crossed_fingers::heart:

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An x-ray is only 2-dimensional. A CT scan is essentially a 3D x-ray but is done in slices as you know. To convert the CT scan into 3D, try following the 3D slicer instructions on our forum:

Another free 3D slicer program some of our members have liked is A third option, if you have a disc reader, is to copy the info on your disc into your computer hard drive & create a file with it then upload it onto which may have options to convert it to 3D (not totally sure about that though).

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Many thanks for the info. I’m not sure still as tutorial speaks of PC rather than iOS, has anyone else got apple and how do they get on?

Osteopath says probable slow draining of blood from the head, in any case he can’t treat ES but also try and ease tight band of muscles at skull base.

Does ES and TOS cause problems when flying, ie less O2 at altitude: hypotension, fainting, nausea etc?

Here’s a link to a post by someone who has a Mac & successfully used the tutorial link I posted, but I also recall someone else who has a Mac noting that RadiAnt worked well for him/her.

I think some people have done ok w/ flying where for others it was more challenging. Since the plane cabin is pressurized, that helps, though we all can still feel the altitude changes.

Thank you @Isaiah_40_31 :+1:. I will ask my son to help me I think!

This is all I can muster!

Yes, as @Isaiah_40_31 says, I had the feeling of being shorter than I am before surgery- it’s so weird! That was along with some other weird Intracranial Hypertension symptoms…
Re flying, I didn’t fly before surgery, but later when I did a longer flight I did get some head pressure symptoms back.
Hope your holiday was good!

@McWelly, I had to ask my son to help me load my scans onto my computer. Putting them on is very helpful as there are many things you can do w/ the images once they’re in the Dicom Library. It’s hard to see any significant detail in the image you sent, but I applaud you for being able to come up with the one you posted on your own! I couldn’t have done as much!!

I’ve circled what I think is your styloid. If I’m right, it’s quite a dagger!! Slow draining from your head would indicate IJV compression somewhere along it’s course, most likely at C-1/styloid junction. Also, I noted that your cervical spine is pretty straight i.e. the lordotic curve is gone. Once you have the IJV compression/styloid taken care of, working on regaining your cervical curve will help your head, neck, shoulders & upper back & beyond be more comfy.

Many thanks for looking at this and I hope to get better views of this in due course (this was a screenshot ):pray:. The image was taken lying down as at the time they were looking to exclude fracture of C2 (which they did). No incidental findings ie ES were mentioned. I’m not surprised about the loss of lordosis as I have this in my lower back too- age and several traumas including a fall from height as a child and the last huge bang on the head 2 years ago etc.

Another piece of the puzzle slots in ……

Thank you all and yes, Jules, lovely being away and having fewer people and traffic around!

Have a great weekend xx


I rotated the image to a “standing position” so I could see the detail better. I think most of us had our CT scans lying down. :blush: