Calcification of the stylohyoid ligament and elongated styloid process
a finding during a medical-legal autopsy for sudden death
DOI:
https://doi.org/10.16925/cf.v3i1.1176Keywords:
styloid process, stylohyoid ligament, sudden death, ossification, carotid sinus, Eagle syndromeAbstract
Purpose: The relationship between Eagle syndrome and both sudden death and
forensic sciences has been rarely described in the literature; then, it is necessary to consider this anatomical-pathological alteration both from a clinical and forensic point of view, since its few symptoms do not allow an early diagnosis, which can lead to death due to certain pre-existing physical conditions such as heart or vascular disease. Topics: Elongation of the styloid process and calcification of the stylohyoid ligament have been reported as a condition that causes pain in the neck and head, known as the Eagle syndrome. Development: The case of a 48-year-old man with underlying heart disease and whose cause of death, after dismissing toxicological causes, was correlated to the findings and an underlying heart disease. Conclusions: Anatomical-pathological changes should be considered when starting autopsies in case of death or any alteration during neck manipulation, such as physical therapies and contact sports, thus creating medical-legal responsibilities.
References
Kay DJ, Har-El G, Lucente FE. A complete stylohyoid bone with stylohyoid joint. Am J Otolaryngol. 2001;22(5):358-61.
Mendelsohn AH, Berke GS, Chhetri DK. Heterogeneity in the clinical presentation of Eagle’s syndrome. Otolaryngol Head Neck Surg. 2006;134(3):389-93.
Ruwanpura PR, Abeygunasekera AM, Tikiri GKMB. Sudden unexpected death probably due to Eagle's syndrome: a case report. Med Sci Law. 2008;48(4):350-3.
Gardner E, Gray DJ, O’Rahilly R. Anatomía. 3.a ed. Barcelona: Salvat Editores; 1981.
Testut, L. Tratado de anatomía humana. 8.ª ed. Barcelona: Salvat Editores; 1969.
Escolán Gelos A, Marín Lorente JM, Martínez Berganza R, De Miguel Hernández D. A propósito de algunos casos de apófisis estiloides larga. Acta ORL Esp. 1981;32(4),544-7.
Chaves H, Costa F, Cavlcante D, Ribeiro T, Gondim D. Asymptomatic bilateral elongated and mineralized stylohyoid complex report of one case. Rev Med Chil. 2013;141(6):793-6.
Bafaqeeh SA. Eagle syndrome: classic and carotid artery types. J. Otolaryngol. 2000;29(2):88.
Kaufman SM, Elzay RP, Irish EF. Styloid process variation. Arch Otolaryngol. 1970;91(5):460-3.
Camarda AJ, Deschamps C, Forest D. Stylohyoid chain ossification: a discussion of etiology. Oral Surg Oral Med Oral Pathol. 1989;67(5):508-14.
Omnell KH, Gandhi C, Omnell ML. Ossification of the human stylohyoid ligament: a longitudinal study. Oral Surg Oral Med Oral Pathol Oral Radiol and Endo. 1998;85(2):226-32.
Rodríguez-Vázquez JF, Mérida-Velasco JR, Verdugo-López S, Sánchez-Montesinos I, Mérida-Velasco JA. Morphogenesis of the second pharyngealarch cartilage (Reichert’s cartilage) in human embryos. J Anat. 2006;208(2):179-89.
Satyapal KS, Kalideen JM. Bilateral styloid chain ossification: case report. Surg Radiol Anat. 2000;22(3-4):211-2.
Eagle WW. Elongated styloid process: symptoms and treatment. AMA Arch Otolaryngol. 1958;67(2):172-6.
Handa PS. Elongated styloid process (a case report). Ind J Otolaryng. 1971;23(1):36-9
Ceylan A, Köybasioglu A, Celenk F, Yilmaz O, Uslu S. Surgical treatment of elongated styloid process: experience of 61 cases. Skull Base. 2008;18(5):289-95.
Unlu Z, Orguc S, Eskiizmir G, Aslan A, Bayindir P. Elongated styloid process and cervical spondylosis. Clin Med Case Rep. 2008;1:57-64
Klécha A, Hafian H, Devauchelle B, Lefèvre B. A report of post-traumatic Eagle’s syndrome. Int J Oral Maxillofac Surg 2008;37(10):970-2.
Piagkou M, Anagnostopoulo S, Kouladouro, K, Piagkos G. Eagle’s syndrome: a review of the literature. Clin Anat. 2009;22(5):545-58
Koivumäki A, Marinescu-Gava M, Järnstedt J, Sándor GK, Wolff J. Trauma induced Eagle syndrome. Int J Oral Maxillofac Surg. 2012;41(3):350-3.
Chuang WC, Short JH, McKinney AM, Anker L, Knoll B, McKinney ZJ. Reversible left hemispheric ischemia secondary to carotid compression in Eagle syndrome: surgical and CT angiographic correlation. AJNR Am J Neuroradiol. 2007;28(1):143-5.
Todo T, Alexander M, Stokol C, Lyden P, Braunstein G, Gewertz B. Eagle syndrome revisited: cerebrovascular complications. Ann Vasc Surg. 2012;26(5):729.e1-5.
Dao A, Karnezis S, Lane JS III, Fujitani RM, Saremi F. Eagle syndrome presenting with external carotid artery pseudoaneurysm. Emerg Radiol. 2011;18(3):263-5.
Green JH. Physiology of baroreceptor function: mechanism of receptor stimulation. En: Kezdi P, editor. Baroreceptors and hypertension. Oxford: Pergamon Press; 1967. p. 3-16.
Sigler LH. The cardioinhibitory carotid sinus reflex, its importance as a vagocardiosensitivity test. Am J Cardiol. 1973;12:175-83
Lynch M, Parker H. Forensic aspects of ocular inury. Am J Forensic Med Pathol. 2000; 21(2):124-6.
Magnano AR, Holleran S, Ramakrishnan R, Reiffel JA, Bloomfield DM. Autonomic modulation of the u wave during sympathomimetic stimulation and vagal inhibition in normal individuals. Pacing Clin Electrophysiol. 2004; 27(11):1484-92.
Schrag B, Vaucher P, Bollmann MD, Mangin P. Death caused by cardioinhibitory reflex cardiac arrest--a systematic review of cases. Forensic Sci Int. 2011:15;207(1-3):77-83.
Schrag B, Mangin P, Vaucher P, Bollmann MD. Death caused by cardioinhibitory reflex: what experts believe. Am J Forensic Med Pathol. 2012;33(1):9-12.

