Supra Digastric Muscles Approach for Styloid Process Resection

Abstract

Objective

Eagle syndrome, categorized into classical styloid syndrome and stylocarotid syndrome, presents challenges in determining the optimal surgical approach for styloid process (SP) resection. While intraoral resection suffices for many cases, especially classical styloid syndrome cases, stylocarotid syndrome sometimes demands a transcervical resection due to its intricate spatial dynamics. We describe a step-by-step procedure for modified transcervical resection using a supra digastric muscle approach (SDMA) for SP, emphasizing anatomical precision.

Methods and Results

The approach is described in the case of a 60-year-old woman with acute cerebral infarction from left internal carotid artery dissection. Employing carotid artery stenting, we identified SP elongation as the underlying cause requiring transcervical resection to avoid stent damage. The operative procedure involves meticulous dissection via a linear skin incision, exposing key anatomical structures such as the sternocleidomastoid muscles, digastric muscles (DMs), and the transverse process of the atlas. Surgical corridor via supra DM space is an invaluable technique, offering the shortest distance to the SP without compromising nearby nerves. The SP, covered by muscles and ligaments, is carefully stripped off, enabling its amputation near the temporal skull base. The entire procedure is performed under a microscope to preserve surrounding nerves.

Conclusion

The SDMA is a simple and safe technique, offering enhanced anatomical precision and minimizing the risk of nerve damage.

Keywords

stylocarotid syndrome - elongated styloid process - transcervical resection - supra digastric muscle approach

Ethical Approval and Patient Consent

All procedures in this study were performed in accordance with the 1964 Declaration of Helsinki. A series of treatments were performed after obtaining appropriate written informed consent from the patients. The requirement for additional written consent for inclusion in this study was waived by the Ethics Committee of Saiseikai Shiga Hospital because of the retrospective and observational nature of the study (permission number; 634).

Declaration of Generative AI and AI-assisted Technologies in the Writing Process

During the preparation of this work, I used ChatGPT 3.5 to improve the language. After using this tool/service, I reviewed and edited the content as needed. I take full responsibility for the content of the publication.

Publikationsverlauf

Eingereicht: 09. Mai 2024

Angenommen: 29. Juli 2024

Accepted Manuscript online:
31. Juli 2024

Artikel online veröffentlicht:
20. August 2024

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