I. Stylohyoid chain ossification: a discussion of etiology.

Not all patients with cervicopharyngeal pain related to the stylohyoid apparatus can be diagnosed as having Eagle's syndrome. An attempt is therefore made to classify these patients according to etiology. First, a diagnosis of Eagle's syndrome is applied to symptomatic patients in whom elongated, ossified styloid processes develop within a period of time posttraumatically. Second, a diagnosis of stylohyoid syndrome is applied to patients in whom elongated styloid processes and/or stylohyoid chain ossification develop early in life as an anatomic anomaly, and in whom symptoms later develop. Last, a diagnosis of pseudostylohyoid syndrome is applied to patients in whom, because of aging, a tendinosis at the junction of the stylohyoid ligament and the lesser horn of the hyoid bone develops. It is hoped that such a simplified classification may lead to a global understanding of the causes of such symptomatology, a more practical approach to treatment, and less confusion among the professions in regard to terminology.

II. Stylohyoid chain ossification: a discussion of etiology.

It has been estimated that between 2% and 4% of the general adult population has radiographic evidence of an ossification of the stylohyoid chain. In an effort to prove that this is also the case in children and adolescents, 150 panoramic radiographs were examined at the Department of Pedodontics of St. Justine's Hospital in Montreal, Quebec, Canada. A total of 300 styloid processes and stylohyoid chains were evaluated and measured radiographically. The patients' mean age was 11 years. The mean length of the styloid processes was 10 mm. Forty percent of the population without symptoms studied showed some evidence of stylohyoid ligament ossification. Sixty percent of these were males; 40% were females. It was also found that 65.6% had no history of cervicopharyngeal trauma on review of the medical and dental histories.

Mandibular infected buccal cyst: report of two cases.

Two cases of mandibular infected buccal cyst are presented. A thorough review of the literature reveals that this is a fairly new entity with the first cases reported by Stoneman and Worth in 1983.

The use of nuclear medicine in the diagnosis of Paget's disease of the mandible. Report of a case.

Traditionally, incisional bone biopsy has been required in order to establish and confirm a diagnosis of Paget's disease (Osteitis deformans) of the mandible and/or maxilla. This article presents a case report of a patient who refused such biopsy. The patient was referred with a three year history of intermittent mandibular pain, accompanied by occasional swelling of the adjacent soft tissues. Although several health professionals had been consulted, no diagnosis had been established. Furthermore, an incisional biopsy had apparently been performed in the area of the left mandible, as reported by the patient, with no conclusive results. On examination, the patient refused all proposed repeat biopsy, but did agree to a full laboratory workup which included: routine blood studies; nuclear medicine bone studies of total body regions including the head and neck, followed by sialography of the submandibular salivary glands. A definitive diagnosis of Paget's disease was reported on 99-m-MDP-technetium bone scans of the mandible. The patient was subsequently treated with the appropriate medication which resulted in a remission of the disease over the three year follow-up period. The histopathological diagnosis was never confirmed because of the patient's repeated refusal to be biopsied.

Immunocytochemical localization of gamma-carboxyglutamic acid-containing proteins (osteocalcin) in rat bone and dentin.

Gla-protein or osteocalcin is one of the most abundant noncollagenous matrix proteins found in bone and dentin. The present study describes, with high resolution, the intracellular and extracellular distribution of Gla-protein in alveolar bone and incisor dentin. Sections of tissues embedded in Lowicryl K4M were incubated with rabbit antibodies to rat dentin Gla-protein. The site of the specific antigen-antibody reaction was revealed by the protein A-gold complex. Labeling was detected over bone and dentin while fewer gold particles were present over prebone and predentin. Gold particles were also seen over the protein synthetic organelles (rough endoplasmic reticulum, Golgi apparatus) of osteoblasts and odontoblasts. These findings confirm, with improved resolution, previous light immunohistochemical studies, and offer the possibility to examine the secretory pathway of the protein.