Styloid Process Elongation as an Incidental Finding in Adult Orthodontic Patients: Prevalence, Morphology and Diagnostic Implications from Panoramic Radiography

Background: The styloid process exhibits considerable anatomical variability, and its elongation is frequently identified as an incidental finding on panoramic radiographs. However, limited evidence exists regarding its prevalence and possible association with craniofacial skeletal characteristics in adult orthodontic patients. Therefore, the aim of this study was to evaluate the prevalence, morphological characteristics, mineralisation patterns, and possible association of styloid process elongation with skeletal class and facial pattern in an adult orthodontic population. Methods: A retrospective cross-sectional study was conducted on 340 adult orthodontic patients (130 males and 210 females; mean age: 51.55 ± 6.62 years). Panoramic radiographs were used to assess styloid process elongation, defined as ≥30 mm, as well as its morphology and mineralisation patterns according to the Langlais classification. Lateral cephalograms were analysed to determine skeletal class and facial pattern. Statistical analysis included descriptive and inferential methods, with significance set at p < 0.05. Results: Styloid process elongation was identified in 47.65% of patients. Elongated processes showed significantly greater length and side asymmetry (p = 0.001). The most frequent morphology was normal (Type IV), while complete mineralisation (Type D) predominated. No significant associations were found between elongation and age or sex. Furthermore, no statistically significant relationship was observed between elongation and skeletal class (p = 0.479) or facial pattern (p = 0.531). Only a small proportion of patients reported symptoms according to the available clinical records, with no clear association with styloid process elongation. Conclusions: Styloid process elongation is a common incidental finding in adult orthodontic patients and does not appear to be associated with skeletal class or facial pattern. Its recognition on panoramic radiographs may improve the differential diagnosis of orofacial and cervical symptoms.