A Multivariate CT-Based Model for Differentiating Styloid Syndrome From Asymptomatic Styloid Elongation: A Retrospective Comparative Study of Positional and Morphological Parameters.

Objective: To compare computed tomography positional and morphological parameters between patients with styloid syndrome and individuals with asymptomatic styloid elongation. Methods: A retrospective study of 151 patients with styloid syndrome and 162 individuals with asymptomatic styloid elongation was conducted. The styloid process length, stylopharyngeal distance, medial-lateral angle, anterior-posterior angle, as well as presence or absence of stylohyoid ligament calcification, styloid process curvature, and styloid process thickening were evaluated by computed tomography. Results: Styloid syndrome patients exhibited significantly shorter bilateral stylopharyngeal distances, smaller left anterior-posterior angle, and a higher prevalence of styloid process curvature. Individuals with asymptomatic styloid elongation showed higher rates of stylohyoid ligament calcification and styloid process thickening. A logistic regression model integrating bilateral stylopharyngeal distance, left anterior-posterior angle, styloid process curvature, stylohyoid ligament calcification, and age yielded an area under the curve of 0.902. Conclusion: Computed tomography parameters including shortened bilateral stylopharyngeal distance, reduced left anterior-posterior angle, and increased styloid process curvature effectively differentiate styloid syndrome from asymptomatic styloid elongation. Asymptomatic styloid elongation individuals are characterized by higher rates of stylohyoid ligament calcification and styloid process thickening. A logistic regression model integrating these indicators demonstrates promising discriminative potential, though external validation is required before clinical application. Level of Evidence: 3.