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Revista chilena de anatomía

Print version ISSN 0716-9868

Rev. chil. anat. vol.19 n.2 Temuco Aug. 2001

http://dx.doi.org/10.4067/S0716-98682001000200004 

DISSECTION OF THE STYLOHYOID CHAIN. A METHOD OF APPROACH

DISECCIÓN DE LA CADENA ESTILOHIOÍDEA. DESCRIPCIÓN DE UN MÉTODO

* Silva, H. J.; **Moraes, S. R. A.; ***Santos, L. C. F.; ***Albuquerque, C. I. & **** Leonel, T.

***** MS Graduate in Morphology at UFPE (Federal University of Pernambuco), Brazil.
*****PhD in Morphology at UFPE (Federal University of Pernambuco), Brazil.
*****Undergraduates in Phonoaudiology at UFPE (Federal University of Pernambuco), Brazil.
*****Graduate in Phonoaudiology

SUMMARY: The stylohyoid chain has caught the attention due to the big incidence of the elongated styloid process of temporal bone with characterizes the Eagle's Syndrome, rating 28% of the population. The purpose of this work is to describe the method of approach by the macroscopic dissection of the stylohyoid chain. Using 15 neck regions of male sex dead bodies, the method has brought a result of 30 stylohyoid chains and verified that the approach from both edges of the chain, prevents the risk of lesion the styloid ligament and preserves the entirety of the stylohyoid chain.

KEY WORDS: 1. Anatomy; 2. Process styloid; 3. Dissection; 4. Stylohyoid chain.

INTRODUCTION

The Stylohyoid Chain has been studied for 400 years at least. (Omnell, 1998). Also named as Stylohyoid Set (Leite et al., 1988) is formed by the Styloid Process, which is at the base of temporal bone, the stylohyoid ligament and the lesser cornua of the hyoid bone. (Stafne, 1962; Kopstein, 1975; Nicolli Filho et al., 1986; Leite et al.; Omnell et al. and Chi & Harkness, 1999).

The atypical elongated styloid process or the atypical calcification of stylohyoid ligament, compressing the 5th and the 9th nerve, characterizes the Eagle's Syndrome (Rizzati-Barbosa et al., 1999). Medical Reports relate the incidence of the elongated styloid process between 4% and 28% of the population (Rechtweg & Wax, 1998).

Various studies has approached the stylohyoid chain based on the Eagle's Syndrome, by its related clinical cases (Babbitt, 1933; Loeser & Cardwell, 1942; Shmidt, 1951; Douglas & Huebsch, 1953; Ettinger & Hanson,1975; Sander & Weiner, 1977; Reichart & Sooss, 1976; Fredman & Hooley,1968; Gross & Fister, 1978; Madeira et al., 1979; Haidar & Kalamchi, 1980; Correll & Wescott,1982 and Chi & Harkness); the longitudinal radiologic studies (Ferrario et al., 1990; Omnell et al.; Langlais et al., 1986; Kaufman et al., 1970; Keur et al., 1986;); or the surgical approach studies (Chase et al., 1986) and also studies with maceration of stylohyoid chain completely ossified (Dwight, 1907; Liphutz, 1922; Fritz, 1940).

However, was observed the absence of studies of the stylohyoid chain and its elements by the macroscopic dissection.

The purpose of this study is to describe a method of approach which enables the observation of stylohyoid chain preserving its elements.

MATERIAL AND METHOD

Fifteen neck regions of male sex dead bodies were used. The corpses belong to the Departmento de Anatomia da Universidade Federal de Pernambuco (UFPE). The macroscopic dissection was the chosen method. Photographs was taken of the obtained material.

RESULTS

Thirty stylohyoid dissected chains with its elements emphasized (Fig.1) was considered the best method of approach of the chain, by the following steps:

1º. Superficial dissection of regions of anterior and posterior trigons of neck, showing the submandibular gland, the platysma, the sternocleidomastoideus and the superior trapezius muscles;

2º. Separation of masseter muscle and lateral ligament of ATM, releasing the mandibular branch and angle facilitating so the visibility of the chain as the next steps of the approaching method.

3º. Disinsertion of sternocleidomastoideus muscle from the mastoid process of temporal bone, facilitating the visibility and dissection of structures wich are at the base of styloid process (venter posterious of digastric, jugular vein and the origin of the stylohyoid, the stylopharingeus and the styloglossus muscles);

4º. Disinsertion of thyrohyoideus muscle unilaterally showing the greater cornua of hyoid bone;

5º. Disinsertion of musculature which involves the greater cornua of hyoid bone towards the lesser cornua of it;

6º Disinsertion of chondroglossus and hyoglossus muscles to show the lesser cornua of hyoid bone;

7º Careful separation of musculature which involves the styloid process (the stylohyoid, the stylopharingeus and the styloglossus) till the visibility of its apex, and also the stylohyoid ligament apex;

8º. Disinsertion of hyoglossus muscle towards the medial part of stylohyoid ligament;

9º. Detachment of the hypoglossal nerve, the facial and lingual arteries, and together with the musculature mentioned before, showing the stylohyoid ligament;

10º. Disjoint of the first cervical vertebra improving the posterior visibility of the stylohyoid chain.

DISCUSSION

The radiographic studies in human beings, the inspection of macerate skulls and the dissection of dead bodies, has revealed a considerable anatomic variety of the stylohyoid chain, or mainly, size variations of the styloid process (Omnell et al.). However, the radiographic studies has showed that some techniques may distort the dimension of the styloid process of temporal bone (Ferrario). This affirmation was considered by Leite et al., in a study with 501 macerate skulls, which showed that some radiographic studies, concerning about measurement of this structure, may show some variations that do not correspond to real values of dimension of the styloid process.

Frommer (1974), tryed to demonstrate by dissection in adult dead bodies, the elements of the stylohyoid chain and its relatinoship with the soft near structures, usually obscures in radiologic examinations. Dwight was also concerned in establish the relationship between the dissection and the radiologic techniques of the stylohyoid chain investigation, that showed the importance of dissection to determine cases of complete ossification of the stylohyoid chain, which is not usually emphasized in radiologic images.

Fig. 1. Complete dissecation of styloid chain right side. a. styloid process; b. styloid ligament; c. lesser cornua of hyoid bone.

The radiologic investigation may not provide reliable data about the stylohyoid chain morphology. The dissection method brings an important resource to a better understanding of this complex structure, which enables the definition of anatomic parameters necessary for the comprehension of clinical aspects related to the stylohyoid chain.

Our study has verified the difficulty in separating and approaching the stylohyoid chain due to its depth and close relationship with other structures, and has set a method to study it, which must be applied from both edges of the chain, preventing the risk of lesion the ligament, preserving thus the entirety of the stylohyoid chain.

The study emphasizes a method of exposure the stylohyoid chain making easier the studies of this important apparatus which has a great clinical significance in its anatophysiopathology.

RESUMEN: La cadena estilohioídea está mereciendo considerable atención debido a la gran incidencia del alargue de uno de sus elementos llamado proceso estiloide del hueso temporal, que caracteriza al Síndrome de Eagle, llegando a alcanzar el 28% de la población. Nuestro trabajo tiene como objetivo describir un método de disección macroscópica para un abordaje de la cadena estilohioídea. Utilizando 15 regiones del cuello de cadáveres humanos, de sexo masculino se obtuvieron 30 cadenas estilohioídeas a través del método de disección macroscópica, observándose que el método de acceso por etapas, a partir de ambas extremidades de la cadena, es el que ofrece menor riesgo de lesión del ligamento estiloihíodeo preservándose, de esta manera, la integridad de la cadena estilohioídea.

PALABRAS CLAVE: 1. Anatomía; 2. Proceso estiloides; 3. Disección; 4. Cadena estilohioídea

Dirección para correspondencia:

Prof. Hilton Justino Da Silva
Rua da Saudade Nº 21 Quadra 31 Lote 12
Bairro Paratibe
Cidade Paulista - PE
CEP 53413-070
BRASIL

Recibido : 26-01-2001
Aceptado: 27-03-2001

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