The lesser horns (lesser cornua) are small paired conical projections at the junction of the greater horns and the hyoid body. They are remnants of the Reichert cartilage (second pharyngeal arch) and connect via the stylohyoid ligament to the tip of the styloid process. They may fuse with the body or greater horn, or remain as separate ossicles. The chondrohyoid membrane (stylohyoid ligament) attaches at their tips.
The lesser horn and the stylohyoid ligament attached to it are clinically relevant in Eagle syndrome, where an elongated styloid process or calcified stylohyoid ligament compresses the glossopharyngeal nerve, internal carotid artery, or surrounding structures, producing oropharyngeal pain, foreign body sensation, and dysphagia. The stylohyoid ligament may ossify from the styloid tip to the lesser horn creating a bony bar. The lesser horn is the attachment point for stylohyoid muscle and the posterior digastric sling.
Ossification of the stylohyoid ligament from the styloid tip to the lesser horn of the hyoid creates a bony bar that compresses the glossopharyngeal nerve and carotid vessels, producing oropharyngeal pain, foreign body sensation, and sometimes carotid artery compression symptoms; CT 3D reconstruction demonstrates the elongated bony complex and surgical styloidectomy provides relief.
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