The stylohyoid ligament is a fibrous band connecting the tip of the styloid process of the temporal bone to the lesser cornu of the hyoid bone. It represents the remnant of the second pharyngeal arch cartilage (Reichert cartilage) and is considered a vestigial structure in most adults. The middle constrictor muscle partially attaches to it. The ligament can partially or fully ossify, particularly in older individuals.
In most adults it is functionally vestigial, providing minimal suspension of the hyoid bone. When present as a true ligament it contributes to the suprahyoid suspension complex and may guide hyoid movement during swallowing.
Elongation or ossification of the styloid process and stylohyoid ligament complex produces Eagle syndrome, characterised by throat pain, dysphagia, foreign body sensation in the pharynx, and referred ear pain. The elongated styloid or ossified ligament can be palpated in the tonsillar fossa after tonsillectomy and is visible on panoramic dental X-ray or CT. Treatment of symptomatic Eagle syndrome involves surgical shortening of the styloid process via an intraoral or external cervical approach.
An elongated styloid process or ossified stylohyoid ligament compresses adjacent structures in the parapharyngeal space, producing throat pain, dysphagia, and a sensation of a foreign body in the throat, most commonly symptomatic after tonsillectomy when the styloid becomes directly palpable, requiring CT for diagnosis and styloidectomy for definitive treatment.
