o Ipsilateral tonsillectomy should be performed prior to surgery
o Tonsillar fossa mucosa is incised to reveal the superior constrictor muscles
o Superior constrictor muscles are incised to access the stylohyoid ligament
o Stylohyoid ligament is skeletonized with a Curved Allis and a periosteal elevator
o Surrounding parapharyngeal is retracted to prevent injury
o Kerrison rongeur is used to transect the styloid process superiorly
o Remaining in vivo portion is smoothed with rasp
o Superior constrictor muscle is reapproximated with absorbable suture

o Elongated (>30mm), misshapen, or calcified stylohyoid ligament with associated symptoms

o Mechanical trismus (<30mm)
o Coagulopathy

Tools necessary include Colorado bovie, curved Allis, periosteal elevator, Yankauer suction, Kerrison rongeur, rasp, and 3-0 Vicryl sutures.

o Panorex film can provide view of elongated stylohyoid ligament with or without calcification
o CT neck without contrast can be used for both confirmation of diagnosis and view of patient anatomy

o Tonsillar fossa
o Superior Constrictor Muscles
o Stylohyoid ligament

o Advantages of transoral resection compared to transcervical resection: no external scar, no risk to marginal mandibular nerve, lingual nerve, skull base structures
o Disadvantages of transoral resection compared to transcervical resection: increased recovery time, limited inferior extent of resection

o Injury to carotid artery
o Injury to glossopharyngeal nerve

o Injury to carotid artery
o Injury to glossopharyngeal nerve

o Emily M. Barrow, MD (Otolaryngology Resident)

1. Myers, E. 2009. Operative Otolaryngology: Head and Neck Surgery. Chapter 25, Transoral Removal of Elongated Styloid Process.
2. Colby CC, Del Gaudio JM. Stylohyoid complex syndrome: a new diagnostic classification. Arch Otolaryngol Head Neck Surg 2011;137:248�¢ï¿½ï¿½252.