Cervical radiograph performed for neck pain in an elderly patient.
Neck pain in an elderly patient. Bilateral calcifications of the stilo-hyoid ligaments are seen, as an incidental finding. Degenerative arthrosis changes seen in the cervical spine.
A ligamentous band, called the stylohyoid ligament, may be described in connection with the stylohyoideus muscle. It is a fibrous cord, which is attached to the tip of the styloid process of the temporal and lesser cornu of the hyoid bone. It frequently contains a little cartilage in its center (which continues the styloid process to the hypoid bone), is often partially ossified, and in many animals forms a distinct bone, called the epihyal (7). The first report of calcification of the stylo-hyoid ligament in the medical literature is in 1958, in a case of atypical facial paralysis, associated with temporomandibular joint arthrosis (1). Other reports of its occurrence have often been associated with anesthetic problems, as the calcification of the stylohyoid ligament is said to be a possible cause of difficult intubation (2), and glossopharyngeal neuralgia (3), or Eagle's syndrome (4). According to some authors the length of the stylohyoid ligament has appeared to correlate with serum calcium concentration and heel bone density (5), and its prevalence, length and appearance might depend on race and ethnicity (6), given the fact they seem to be mpre frequent as age advances.
Bilateral calcification of the stilohyoid ligaments.
On the lateral cervical spine X-ray, a slender, band-like high-density shadow can be observed in the area between the temporal bone styloid process and the hyoid bone, resembling calcified or ossified tissue, suggesting partial or complete calcification/ossification of the stylohyoid ligament. No obvious acute fracture signs are detected in the cervical spine sequence, and the vertebral alignment appears relatively normal. The facet joints and intervertebral spaces are acceptable. No significant widespread destruction or focal abnormal hyperdensity of the cervical vertebrae is noted. The remaining soft tissues of the neck show relatively uniform density, with no significant masses or abnormal calcifications (apart from the aforementioned stylohyoid ligament).
Based on the patient’s advanced age of 79, symptoms of neck pain, and clear imaging evidence of stylohyoid ligament calcification, the most likely diagnosis is “Stylohyoid Ligament Calcification (Eagle Syndrome)” or related presentations. If the patient’s symptoms are primarily limited to neck pain, further correlation with clinical symptoms, physical examination, and other investigations (such as CT scan, 3D reconstruction, or endoscopic examination) is recommended to rule out other potential neck pathologies and to determine whether glossopharyngeal nerve compression or other concomitant issues exist.
Based on the patient’s specific symptoms and functional status, the following treatment strategies and rehabilitation plans may be considered:
The rehabilitation program should be tailored to the patient’s bone health and cardiopulmonary function, following a gradual progression and adhering to the FITT-VP principle (Frequency, Intensity, Time, Type, Volume/Progression, and individualization). An example is as follows:
Throughout the rehabilitation process, close collaboration with rehabilitation specialists or physical therapists is essential. Cervical spine range of motion and pain levels should be evaluated regularly. If the patient has bone fragility, compromised cardiopulmonary function, or any other special conditions, exercises must be performed under the guidance of a physician and trained professionals for safety.
Disclaimer: This report is based solely on current imaging and the information provided, and does not replace an in-person consultation or the diagnostic and treatment advice of a qualified physician. If you have any questions or if symptoms worsen, please seek medical attention promptly.
Bilateral calcification of the stilohyoid ligaments.
