Demographic variation of styloid process morphology in panoramic radiography

BACKGROUND: Elongation of the styloid process (SP) is frequently discussed in the context of Eagle syndrome (ES), with a length threshold of ≥ 30 mm commonly cited as indicative of elongation. However, this criterion is largely derived from heterogeneous imaging modalities and may not adequately account for demographic variability or the projection-related limitations of panoramic radiography. Given that panoramic radiographs (PRs) represent the most common first-line imaging modality in dental and maxillofacial practice, interpretation of SP morphology in this setting warrants critical evaluation. The aim of this study was to characterize demographic variation in SP morphology on standardised PRs and to explore whether commonly cited length thresholds should be interpreted with caution in this imaging modality. MATERIALS AND METHODS: A retrospective analysis of 350 standardised PRs was performed. Bilateral measurements included SP length, width, angulation, distance to anatomical reference points, segmentation according to the Langlais classification, and calcification patterns. Data were stratified by sex and age (≥ 40 vs.