www.journalomp.org pISSN 2288-9272 eISSN 2383-8493 J Oral Med Pain 2018;43(3):77-83 https://doi.org/10.14476/jomp.2018.43.3.77 The Association of Ponticulus Posticus & Elongated Styloid Process with Headaches Shivani Sharma 1 , Rakesh Nagaraju 2 , Shweta Sharma 3 1 Department of Oral Medicine and Radiology, Army Dental Corps, New Delhi, India 2 Department of Oral Medicine and Radiology, M. S. Ramaiah Dental College and Hospital, Karnataka, India 3 Department of Opthalmology, Government Medical College, Jammu, Jammu & Kashmir, India Received February 8, 2018 Revised March 15, 2018 Accepted March 23, 2018 Purpose: The present study was designed to investigate the association of ponticulus posticus (PP) and elongated styloid process (ESP) with headaches. Methods: Analysis of head and neck cone beam computed tomography samples from the ar- chives of the Department of Oral Radiology was done for the presence of partial or complete PP and ESP length, type, thickness, mediolateral angulation, anterioposterior angulation (hori- zontal & vertical), lateral or medial curvature. This was followed by personal & telephonic questionnaires to the subjects for the evaluation of the presence of headaches & other associ- ated symptoms. Results: Among 134 subjects, 62 subjects (46.3%) presented with headache and 72 subjects (53.7%) did not have any headache. On further analysing the total 62 subjects with headache, it was found out that 31 subjects (50.0%) of them had ESP and PP both, 16 subjects (25.8%) had only ESP, and 15 subjects (24.2%) had only PP. A strong association was present between headache and presence of PP & ESP individually and together. Conclusions: All health care professionals dealing with the head and neck pain disorders should also consider the presence of ESP & PP during diagnosis and treatment. Key Words: Cone beam computed tomography; Elongated styloid process; Headache; Ponticu- lus posticus; Surveys and questionnaires Correspondence to: Shivani Sharma Department of Oral Medicine and Radiology, Army Dental Corps, New Delhi 110011, India Tel: +91-94-1918-7170 Fax: +91-11-2619-2356 E-mail: [email protected]Original Article JOMP Journal of Oral Medicine and Pain Copyright Ⓒ 2018 Korean Academy of Orofacial Pain and Oral Medicine. All rights reserved. CC This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. INTRODUCTION Headaches are highly prevalent and disabling disorders throughout the world but are largely not diagnosed and treated properly. World Health Organisation’s recent re- search on the leading causes of disabling conditions lists headache as 12th for women and 19th for men worldwide. 1) The fact that the data of the prevalence of headache disor- ders has been gathered predominantly from the high-in- come countries leaving vast geographical areas of underde- veloped and developing countries including India leads to a lack of knowledge of the prevalence and burden attribut- able to headache disorders among such a large population. 2) Minority of people with headache disorders are profession- ally diagnosed, about 50% of people are estimated to be primarily self-treating worldwide. 3) The primary headache disorders account for approximately 95% of all headache complaints. Headache also occurs as a typical symptom of a range of other health conditions, called ‘secondary headaches’. 4) The ponticulus posticus (PP) is a bridge of bone some- times found on the atlas vertebra surrounding various ner- vous and vascular structures and is generally regarded as a simple anatomical variant. It can have varied presentations namely complete, incomplete, unilateral or bilateral. The prevalence of PP has been reported to be 5.14%-37.83% in
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www.journalomp.org
pISSN 2288-9272 eISSN 2383-8493
J Oral Med Pain 2018;43(3):77-83
https://doi.org/10.14476/jomp.2018.43.3.77
The Association of Ponticulus Posticus & Elongated Styloid Process with Headaches
Shivani Sharma1, Rakesh Nagaraju2, Shweta Sharma3
1Department of Oral Medicine and Radiology, Army Dental Corps, New Delhi, India
2Department of Oral Medicine and Radiology, M. S. Ramaiah Dental College and Hospital, Karnataka, India 3Department of Opthalmology, Government Medical College, Jammu, Jammu & Kashmir, India
Received February 8, 2018
Revised March 15, 2018
Accepted March 23, 2018
Purpose: The present study was designed to investigate the association of ponticulus posticus (PP) and elongated styloid process (ESP) with headaches.
Methods: Analysis of head and neck cone beam computed tomography samples from the ar-chives of the Department of Oral Radiology was done for the presence of partial or complete PP and ESP length, type, thickness, mediolateral angulation, anterioposterior angulation (hori-zontal & vertical), lateral or medial curvature. This was followed by personal & telephonic questionnaires to the subjects for the evaluation of the presence of headaches & other associ-ated symptoms.
Results: Among 134 subjects, 62 subjects (46.3%) presented with headache and 72 subjects (53.7%) did not have any headache. On further analysing the total 62 subjects with headache, it was found out that 31 subjects (50.0%) of them had ESP and PP both, 16 subjects (25.8%) had only ESP, and 15 subjects (24.2%) had only PP. A strong association was present between headache and presence of PP & ESP individually and together.
Conclusions: All health care professionals dealing with the head and neck pain disorders should also consider the presence of ESP & PP during diagnosis and treatment.
Copyright Ⓒ 2018 Korean Academy of Orofacial Pain and Oral Medicine. All rights reserved.
CC This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
INTRODUCTION
Headaches are highly prevalent and disabling disorders
throughout the world but are largely not diagnosed and
treated properly. World Health Organisation’s recent re-
search on the leading causes of disabling conditions lists
headache as 12th for women and 19th for men worldwide.1)
The fact that the data of the prevalence of headache disor-
ders has been gathered predominantly from the high-in-
come countries leaving vast geographical areas of underde-
veloped and developing countries including India leads to
a lack of knowledge of the prevalence and burden attribut-
able to headache disorders among such a large population.2)
Minority of people with headache disorders are profession-
ally diagnosed, about 50% of people are estimated to be
primarily self-treating worldwide.3) The primary headache
disorders account for approximately 95% of all headache
complaints. Headache also occurs as a typical symptom
of a range of other health conditions, called ‘secondary
headaches’.4)
The ponticulus posticus (PP) is a bridge of bone some-
times found on the atlas vertebra surrounding various ner-
vous and vascular structures and is generally regarded as a
simple anatomical variant. It can have varied presentations
namely complete, incomplete, unilateral or bilateral. The
prevalence of PP has been reported to be 5.14%-37.83% in
78 J Oral Med Pain Vol. 43 No. 3, September 2018
www.journalomp.org
the western population.5) Among Indian population, com-
plete PP was found in 4.3% of the subjects with a male
(5.33%) predominance over female (3.76%).6) Due to the
compression of the structures passing through the foramen,
symptoms such as cervical migraine, neurosensory-type
tions, analgesics, anticonvulsants, antidepressants, and lo-
cal infiltrations with steroids or anesthetic agents.30) Patients
who fail to get relief from medical therapy may benefit
from surgical removal of the elongated portion of the SP.29)
In conclusion, headache is one of the most common dis-
orders worldwide causing substantial levels of disability and
lost productivity through missed workdays. Health care for
headache needs to be improved by education. According to
our study, there is a positive association of headache with
PP & ESP. Therefore, ESP & PP could be major etiologic
factors responsible for headaches and should be taken into
consideration while diagnosing and managing headache
disorders. The clinicians, radiologists, surgeons, dentists and
chiropractors, should be aware of these anatomical varia-
tions and their various clinical features. We recommend
further research to determine the type of headaches associ-
ated with ESP and PP.
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article
was reported.
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