The styloid is located at the junction of the bottom surface of the temporal bone's petrosal part and the mastoid process. It is slender and cylindrical, emerging from the front and inner sides of the stylomastoid foramen, and is attached to the stylopharyngeus, stylohyoid muscle, and stylohyoid ligaments as well as the stylomandibular ligament [8, 9]. Its root is similar to the facial nerve and stylomastoid artery emerging from the stylomastoid foramen, and the facial nerve runs on the posterolateral side of the styloid . The middle and lower segments of the styloid are adjacent to the accessory nerve, hypoglossal nerve, vagus nerve, glossopharyngeal nerve, internal carotid artery, external carotid artery and their branches. The tip is just at the bifurcation of the superficial temporal and maxillary arteries from the external carotid artery. The styloid itself has no important physiological function. According to skull measurement data, its normal average length is 2.5 cm. The abnormal shape, orientation or length of the styloid can stimulate and compress surrounding blood vessels and nerves, causing pharyngalgia, cervicodynia, pharyngeal foreign body sensation, carotid artery compression symptoms, etc., which is called styloid process syndrome (styloid syndrome) . Currently, styloid truncation is usually performed in clinical practice, generally including the transoropharyngeal tonsillar fossa approach and external cervical approach, each with its own advantages and disadvantages . Among them, the external cervical approach can completely expose styloid and surrounding tissues, which is convenient for surgical operation, whereas wounds caused by such an approach are large, increasing the risk of nerve damage and infection as well as postoperative scar repair and other problems. Although the transoropharyngeal tonsillar fossa approach can overcome the above shortcomings, it must remove patients' tonsils and has the disadvantages of an insufficient intraoperative visual field and difficult identification and protection of surrounding tissues. A truncated styloid is not long enough to cause difficulties in eating in the future, greatly reducing its therapeutic efficacy, which is difficult to popularize on a large scale . Thus, herein, we adopted a new surgical method of styloid incision truncation via percutaneous punching to treat styloid syndrome and clarified its therapeutic effect.
Medical research and clinical therapy revealed that the inflammatory response has a very direct relation to the functional recovery of patients' bodies [13, 14], and it is also a vital indicator affecting the recovery efficacy of patients' bodies after surgery, especially TNF-α, IL-6, and CRP, which are the main indicators in the actual treatment process. TNF-α is an inflammatory cytokine secreted by monocytes-macrophages . When the body is stimulated by surgery, it elevates the activity of phagocytes in the local environment of the peritoneal cavity and induces the formation of various cytokines. From a physiological point of view, such a process will directly affect the defense function of the body. IL-6, a substance with a variety of biological activities, can better facilitate the secretion of inflammatory cells. Thus, the IL-6 level is also closely related to the degree of tissue damage. CRP is an acute phase response protein whose function is to directly reflect the degree of inflammation in the body [16, 17].
In the current study, 24 h after the operation, TNF-α, CRP, and IL-6 levels in both groups presented elevation relative to those before the operation, with statistical significance. TNF-α, CRP, and IL-6 levels in the observation group presented depletion relative to those in the control group, with statistical significance. The main reason was that the surgical wound in the observation group was relatively smaller, and its impact on the patient’s body was not great; thus, the inflammation was milder, which was beneficial to the patient’s subsequent recovery. Additionally, surgical wounds not only affect the occurrence of inflammation, but also cause postoperative pain and complications . There were statistically significant differences between the two surgical procedures in terms of local pain, impact on speech, swallowing, operation time, and fever (complications) after the operation. Furthermore, the average length of styloid amputated by the external cervical approach was longer, the amount of bleeding was less through clinical observation, and hospital stays and hospitalization costs were also relatively low. This suggested that our styloid incision truncation via percutaneous punching can not only attenuate postoperative pain and complications of patients, but also reduce the difficulty of operation and save hospitalization costs of patients relative to traditional styloid truncation via an external cervical approach, which is conducive to hospital promotion.
In conclusion, styloid incision truncation via percutaneous punching in treating styloid syndrome not only has a good therapeutic effect, but also results in less trauma and fewer complications, conducive to the recovery of patients, with a simple operation, which is worthy of promotion in hospitals.