11.8 Headache or facial pain attributed to inflammation of the stylohyoid ligament

Identification: Female patient, 42 years old, with left cervical and facial pain for 8 months.

History of Present Illness: Pain:

Location: Left submandibular region, radiating to the ipsilateral temporomandibular joint (TMJ) and ear

Characteristic: Deep stabbing, moderate to severe intensity (7/10), continuous with exacerbations

Triggers: Cervical rotation, swallowing, and prolonged phonation

Associated symptoms:

Intermittent odynophagia

Dysphagia for solids

Sensation of a pharyngeal foreign body ("globus")

Relevant history:

Tonsillectomy 15 years ago

Cervical trauma in a car accident 3 years ago

Physical Examination: Cervical palpation:

Pain on palpation of the lesser horn of the hyoid (Valleix point)

Hyperesthesia in the ipsilateral stylohyoid triangle

Provocative maneuvers:

Positive Eagle's sign (pain on digital compression between styloid and mandible)

Reproduction of pain with cervical hyperextension

Otorhinolaryngological examination:

Asymmetry of pharyngeal pillars

Transoral palpation of a rigid structure in the lateral pharyngeal wall

Neurological examination: Normal

Complementary Examinations: Cervical Computed Tomography with 3D Reconstruction:

Elongation of the left styloid process (32mm)

Partial calcification of the stylohyoid ligament

Anomalous proximity to the internal carotid artery

Cervical Doppler Ultrasound:

Peritendinous thickening (>3mm) of the stylohyoid complex

No dynamic vascular compression

Neck Magnetic Resonance Imaging:

Signs of perilamentous inflammation (post-contrast enhancement)