Fractures of the Stylomandibular Complex: A Prospective Study Proposing a Classification and Clinical Protocol

Mandibular trauma can result in stylomandibular complex (SMC) fractures with clinical symptoms including glossopharyngeal neuralgia, globus pharyngeus, otalgia, and dysphonia. Fracture of the styloid process is noteworthy because of its proximity to numerous vital structures. The study objectives were 1) to determine the incidence of SMC fractures and develop a clinical grading system and 2) to institute and assess a treatment protocol.

This prospective clinical trial involved 206 patients with mandibular trauma based on a set of inclusion and exclusion criteria. On the basis of the clinical presentation of symptoms, patients were categorized as mild, moderate, or severe, and the radiographic features were characterized as type 1, 2, or 3. Patients were treated by an institutional protocol, and outcome was evaluated. A grading system was developed by correlating clinical features with imaging. Data were analyzed using SPSS software (version 22; IBM, Armonk, NY). Descriptive and analytic statistics were computed.

The incidence of styloid fracture was 11.17%. The most common concomitant mandibular fractures were condyle (13 patients) and angle (7 patients) fractures. Dysphagia and restricted mouth opening were the most common symptoms. The distribution of radiographic types 1, 2, and 3 was 26.1%, 69.6%, and 4.3%, respectively. A significant correlation (P < .001) was found between clinical symptoms and radiographic types using the Fisher exact test.

This study proposes a clinical grading system for SMC fractures and a symptom-based management algorithm.