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Table of Contents    
NEUROIMAGES
Year : 2018  |  Volume : 66  |  Issue : 6  |  Page : 1850-1851

Calcified stylohyoid ligament: A rare presentation as a thick cord-like structure during anterior cervical discectomy and fusion


Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA

Date of Web Publication28-Nov-2018

Correspondence Address:
Dr. Osmond C Wu
The Neurological Institute, Department of Neurological Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, Ohio 44106
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.246265

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How to cite this article:
Wu OC, Barath AS, Kasliwal MK. Calcified stylohyoid ligament: A rare presentation as a thick cord-like structure during anterior cervical discectomy and fusion. Neurol India 2018;66:1850-1

How to cite this URL:
Wu OC, Barath AS, Kasliwal MK. Calcified stylohyoid ligament: A rare presentation as a thick cord-like structure during anterior cervical discectomy and fusion. Neurol India [serial online] 2018 [cited 2018 Dec 17];66:1850-1. Available from: http://www.neurologyindia.com/text.asp?2018/66/6/1850/246265




A 58-year-old woman presented with signs and symptoms of cervical myelopathy. Magnetic resonance imaging of the cervical spine demonstrated C3–4 and C4–5 disc herniation with spinal cord compression. She underwent C3–4 and C4–5 anterior cervical discectomy and fusion. A hard cord-like structure with unclear etiology and origin was encountered in the retropharyngeal space anterior to the prevertebral fascia during the surgical exposure [Figure 1]a. An intraoperative ear nose throat (ENT) consultation confirmed the structure to be a calcified stylohyoid ligament. Careful review of the preoperative cervical X-rays and computed tomography of the cervical spine confirmed the presence of a calcified stylohyoid ligament correlating with the intraoperative findings [Figure 1]b, [Figure 1]c, [Figure 1]d. The calcified stylohyoid ligament had to be retracted medially with the anterior cervical retractor blade and the procedure was completed uneventfully.
Figure 1: (a) Intraoperative photograph demonstrating a calcified stylohyoid ligament (arrow). (b) Preoperative lateral X-ray of the cervical spine, (c) sagittal CT scan image of the cervical spine, and (d) three dimensional CT reconstruction of the cervical spine demonstrating the calcified stylohyoid ligament (arrows) between the tip of the styloid process of the temporal bone and the lesser horn of the hyoid bone

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The stylohyoid ligament is a fibrous cord between the tip of the styloid process of the temporal bone and the lesser horn of the hyoid bone and is a normal anatomical structure. Calcification of the stylohyoid ligament is not uncommon in the general population and is often a benign finding. Patients may present with symptoms such as chronic pain in the pharyngeal region, otalgia, phantom foreign body sensation, and dysphagia; however, it is often the etiology cited in patients with Eagle syndrome.[1],[2],[3] Visualization of a calcified stylohyoid ligament during anterior cervical exposure, as demonstrated in the clinical images, is exceptionally rare for spine surgeons and could possibly be due to the detachment of the ligament from the lesser horn of the hyoid bone during surgery, as likely happened in the present case. As it is usually attached to the lesser horn of the hyoid bone, it is not typically encountered during anterior exposure for cervical fusions. Awareness of this innocuous anatomical variant is important for spine surgeons and trainees to confirm the diagnosis during a high anterior cervical spine exposure and to avoid intraoperative concerns.

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Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ferrario VF, Sigurtá D, Daddona A, Dalloca L, Miani A, Tafuro F, et al. Calcification of the stylohyoid ligament: Incidence and morphoquantitative evaluations. Oral Surg Oral Med Oral Pathol 1990;69:524-9.  Back to cited text no. 1
    
2.
Öztaş B, Orhan K. Investigation of the incidence of stylohyoid ligament calcifications with panoramic radiographs. J Investig Clin Dent 2012;3:30-5.  Back to cited text no. 2
    
3.
Sudhakara Reddy R, Sai Kiran Ch, Sai Madhavi N, Raghavendra MN, Satish A. Prevalence of elongation and calcification patterns of elongated styloid process in south India. J Clin Exp Dent 2013;5:e30-5.  Back to cited text no. 3
    


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