Diagnostic And Treatment Application Of Three-dimensional Reconstruction Of Multi-slice Spiral CT In Patients With Styloid Process Syndrome

Objective: Use of Three-dimensional Reconstruction of Multi-slice Spiral CT(MSCT)to measure the length, internal oblique angle, anterior oblique angle of styloid process and to find a correlation with the degree of pharyngeal pain of the styloid process syndrom,thus to provide a plan for diagnosis and treatment approach of styloid process syndrom.Materials and methods:1.We conducted a retrospective study on 32 patients(41 sides)between December2013 and February 2015 at the Second Hospital of Dalian Medical University Otorhinolaryngology department. Inclusion criteria were patients >18 years old and having one/two sides of pharyngeal pain,the tenderness of the pain side is positive, or can reach the tips of styloid process or cords. All patients completed the study(n = 32),the age is from 27 to 85 years old with a mean age of(54.75 ± 14.13) years old,of which 12 were males and 20 were females with a ratio of male to female(1:1.78).The exclusion criteria were patients with acute/chronic pharyngitis,acute/ chronic tonsillitis,chronic rhinosinusitis, cervical spondylosis, gastroesophageal reflux disease,glossopharyngeal nerve inflammation,thyroiditis and thyroid gland tumor. All patients were inquired by medical history, clinical questionnaire, palpation of the tonsillar fossa and underwent MSCT.2.Application of visual analogue scale(VAS) to grade the pharyngeal pain of 32patients(41 sides), and according to the grading results to classificate the degree of pharyngeal pain.3.Measurement of the length, internal/ anterior oblique angle, observation of shape of styloid process of all patients and the final diagnosis was possible with the use of three-dimensional reconstruction of MSCT. Taking into account the severity of the clinical symptoms and the results of CT, the choice about the method of treatment was decided.4.SPSS 13.0 statistical software was used to analyze these data.We used Spearman correlation to correlate the degree of pharyngeal pain of patients with the length, and/or with anterior/ internal oblique angle to obtain the correlation coefficients and P values.A difference of P < 0.05 was considered statistically significant.We used t test to compare the length and internal oblique angle of conservative treatment group and surgery group. A difference of P < 0.05 was considered statistically significant.Results:1. By three-dimensional reconstruction of MSCT, the mean length was(30.69±2.97)mm, mean inclined oblique angle was(25.41±3.59)oand the mean anterior angle was(22.95±2.04)o.2.We use Spearman correlation to analysis the correlations between the pain level(Y)and the length(X1), and inclined oblique angle(X2),and anterior oblique angle( X3).There was a positive correlation between the pain level and the length, and inclined oblique angle(r= 0.814, P=0.00 and r=0.479,P=0.002).No correlation was found between the pain level and inclined oblique angle(r=-0.063,P=0.693).3.The classification of degree of pharyngeal pain of 32 patients(41 sides)is: 1degree(mild) 13 sides, 2 degree(moderate) 22 sides, 3 degree(severe) 6 sides.4.Of all the 32 patients(41 sides) with styloid process syndrome, 27 cases(33 sides)take conservative treatment, 5 cases(8 sides) treated with surgery, and all with interal approach surgery.Conclusion:1. Three-dimensional reconstruction of MSCT can clearly display the anatomy of styloid process and its relationship with adjacent tissue,directly and accurately measure the length, internal oblique angle, anterior oblique angle of styloid process,and has an important significance in the diagnosis of styloid process syndrome.2. MSCT shows that the longer the length/the bigger the angle of the styloid process,the heavier the degree of pharyngeal pain,and it provides the basis for the choice of surgical indications..