Panoramic (orthopantomogram) radiography is the preferred X‑ray view for assessing the styloid process because it provides bilateral visualization, accurate length measurement and orientation relative to adjacent structures. Lateral skull and AP‑axial (Towne) views may supplement findings. For symptomatic patients or surgical planning, CT (especially cone‑beam CT) gives definitive three‑dimensional detail. It is widely used as the initial imaging choice in suspected Eagle syndrome.

The styloid process is a slender, pointed bony projection of the temporal bone that extends anteromedially. On a Towne (AP axial) skull radiograph it appears as thin, pointed radiopaque projections inferior to the temporal bone and petrous ridges. The Towne view helps evaluate styloid process fractures, elongation (Eagle syndrome), or stylohyoid ligament calcification by showing length, alignment, and discontinuity.

The Towne view is an AP axial skull radiograph obtained with the patient’s head flexed (chin tucked) and the central ray angled caudally about 30° to the orbital‑meatal line (≈37° to the infraorbital‑meatal line). It projects the occiput, foramen magnum, occipital condyles and dorsum sellae, aiding evaluation of the posterior cranial fossa and basilar skull or occipital fractures.

The Towne (AP axial) skull view requires a caudal angulation of the central X‑ray beam: 30° downward to the orbitomeatal line (OML). If the infraorbitomeatal line (IOML) is used, angle about 37° caudad. Center the beam at the foramen magnum (≈2.5 in above the glabella) to adequately project the occiput and petrous ridges.

Panoramic (orthopantomogram), lateral skull and Towne’s projection radiographs, plus specific AP or occlusal views, visualize the styloid process. Cross-sectional imaging—CT, cone‑beam CT (CBCT), and 3D reconstructions—provides precise length, angulation, and relations; CT angiography can assess vascular proximity. Ultrasound may detect superficial portions; MRI is limited for bony detail. CT/CBCT are preferred for surgical planning.

The best X-ray view to detect spondylolysis is bilateral lumbar oblique views, which visualize the pars interarticularis as the “neck” of the Scottie dog—a defect appears as a collar or break. Lateral views help assess any associated spondylolisthesis. If X-rays are inconclusive or an acute stress injury is suspected, CT or SPECT/CT offers greater sensitivity.