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cone beam – international magazine of cone beam dentistry

I case report _ CBCT in diagnosis Thesymptomswilldependontheareaofcontact withthestyloidprocess.3,4,12–14 Ingeneral,symptoms have been described as pain and feeling of a foreign objectontheneck,pharyngealpain,dysphagia,otal- gia, temporomandibular joint pain and pain irradi- ated to the superior structures. Also, paraesthesia of the hand, pain in the temporal area with photop- siaandhypacusis,vertigo,carotidynia,tinnitus,dys- phonia, limited mouth opening, taste alteration and ptyalism have been reported.5 The majority of the symptoms are present during normal physiological movements, such as chewing, biting, speaking, openingthemouth,yawning,coughingandturning the head. _Diagnosis The diagnosis is based primarily on clinical signs andsymptomsandanimmunologicalanalysis.Ow- ing to the great variety of symptoms, it is necessary tohaveadifferentialdiagnosis,whichcouldinclude the following:2,4 _Temporomandibular dysfunction _Laryngo-pharyngeal dysaesthesia _Chronic tonsillo-pharyngitis _Hyoid bursitis _Sluder syndrome _Ernest syndrome _Pseudo-stylohyoid syndrome _Glossopharyngeal neuralgia _Trigeminal neuralgia _Migraine _Sphenopalatine neuralgia _Cervical arthritis _Temporal arthritis _Impacted molars _Otitis _Salivary gland disorders _Tumours. _Imaging diagnosis The evolution of techniques used for the diag- nosis has been rapid and ongoing. In many of the previous studies, transcranial and lateral radio- graphs were used at 20–30 degree angles extend- ingtotheneckandevenapanoramicradiographas the method of choice to evaluate the styloid process.3,4,14–16 However, all of these techniques produce a magnified image and/or distortion and for this reason cannot be considered 100% accu- rate when measuring structures. Because of this, themethodchosenforthepresentstudywasCBCT, given its characteristics of less radiation and high accuracy, and the excellence and precision of the associated software. _Treatment The initial treatment is infiltration of analgesics and local corticosteroids, with favourable and signif- icantresultsindecreasingpain.Ifthistreatmentfails, surgical resection is indicated.2,3,5 _Clinical case A 50-year-old female patient attended for a con- sultationafterhavingseenseveralspecialists.Several radiographic examinations had been performed, the most important of which were a lateral cranial radi- ograph,ananteroposteriorradiographandaheadCT scan,insearchofvascularproblems,tumours,haem- 26 I cone beam4_2015 Fig. 5a Fig. 5b Fig. 6

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