以头颈部疼痛为首发症状的茎突综合征分析

Styloid process syndrome with head and neck pain as the initial symptom

目的探讨茎突综合征患者的临床表现、手术方式及术后效果,增强耳鼻咽喉科医师对该疾病的认识。方法回顾性分析我科2012年12月~2017年1月收治的24例以头颈部疼痛为首发症状的茎突综合征患者的手术方式,并使用视觉模拟评分法(visual analogue scale,VAS)评估患者术后效果。结果首发症状表现为咽痛14例,颈部胀痛5例,耳痛4例,颌面部疼痛1例。茎突CT三维重建示24例患者患侧茎突长度均>30 mm。全部患者扁桃体窝触痛阳性。18例患者经颈外入路茎突截短术,6例患者经口扁桃体切除后行茎突截短术。术后随访3~20个月,21例症状缓解,3例症状较前无改善,有效率87.5%。VAS评分术前与术后比较差异有统计学意义(t=10.112,P<0.05)。结论以头颈部疼痛就诊的茎突综合征患者易被误诊为咽炎、外耳道炎、淋巴结炎等疾病,扁桃体窝触诊是重要的辅助手法,茎突CT三维重建具有确诊价值。诊断明确者可考虑行茎突截短术,术后效果较满意。

OBJECTIVE To explore the clinicalfeatures, treatment, surgical approach and operation results of styloid process syndrome. METHODS Clinical data of24 patients with head and neck pain as the initial symptoms of styloid process syndrome treated in our hospital from2012 to 2017 were analyzed retrospectively. RESULTS The initial symptoms included sore throat in 14 cases, neck pain in 5 cases, earache in 4 cases and maxillofacial pain in 1 case. And the three-dimensional reconstruction of styloid process showed that the length of the styloid process in all 24 cases were longer than 30 mm. The tonsillar palpation of all patients was positive. Eighteen patients underwent truncation of the styloid process through the external cervical approach, and 6 patients through tonsillar fossa after tonsillectomy. All patients were followed up for 3 to 20 months. The symptoms were relieved in 21 patients after operation. The effective rate was 87.5%, and there was a statistically significant difference between the VAS score before and after operation（t =10.112, P 〈0.05）.CONCLUSION Patients with styloid process syndrome presented with head and neck pain as the first visit were easily misdiagnosed as pharyngitis, otitis externa and lymphadenitis. The tonsillar palpation was an important auxiliary technique. The three-dimensional reconstruction of the styloid process was gold standard. Operation should be done after right diagnosis, and the results were satisfactory.