X Ray Styloid Process

The styloid process is a slender, pointed bony projection. The best-known styloid process arises from the temporal bone of the skull, projecting downward and forward just below the ear as an attachment for muscles and ligaments. There are also smaller styloid processes at the wrist: on the distal ends of the radius and ulna, felt as bony prominences near the thumb and little-finger sides.

The normal adult styloid process is about 2.5–3.0 cm (25–30 mm) in length. It is generally considered elongated when exceeding approximately 30 mm, though some criteria use >25 mm. Individual variation exists, and elongation or ossification of the stylohyoid ligament can cause throat, ear, or facial pain (Eagle syndrome), prompting clinical evaluation.

On CT, use bone window and multiplanar reconstruction (MPR) or 3D reformats to align along the styloid’s long axis. Identify the base at the temporal bone and the tip. Measure the maximum linear length from base to tip on reformatted sagittal or oblique images following the ossified axis. Repeat bilaterally; lengths >30 mm are commonly considered elongated.

Eagle syndrome can sometimes be seen on plain X‑rays: an elongated styloid process or calcified stylohyoid ligament may appear on panoramic or lateral skull radiographs. However, plain films are limited by overlap and poor spatial detail. CT or cone‑beam CT with 3‑D reconstruction is the preferred imaging for accurate measurement (styloid >30 mm often considered elongated) and assessment of surrounding neurovascular relationships.

Yes. Symptoms from an elongated styloid process (Eagle syndrome) can often be relieved with pain relievers, anti-inflammatory medications, local steroid/anesthetic injections and physiotherapy. Definitive cure usually requires surgical shortening or removal of the styloid (styloidectomy), done transorally or via an external approach. Surgical outcomes are generally good, and most patients experience lasting symptom relief.

Yes. The radial and ulnar styloid processes at the wrist are commonly felt as firm bony bumps on either side of the wrist. The temporal styloid (near the ear/throat) is usually deeper and not easily palpable, but can be felt or tender in some people—especially if elongated (Eagle syndrome) or inflamed. Persistent pain, numbness, swelling or functional change warrants medical assessment and imaging.