A systematic review of the literature on stylohyoid syndrome treatment was performed according to PRISMA guidelines.

Three hundred and forty-nine articles were retrieved in the PubMed and Cochrane databases using the search-terms “stylohyoid syndrome” and synonyms. Articles documenting treatment and outcome with more than 1 month's follow-up were selected. Treatment-related complications and rate of cure, defined as disappearance of symptoms and/or of revelatory complication, were analyzed. Overall analysis was performed for series and a mixed logistic regression model for case reports.

Hundred and two articles (12 series, 90 case reports) were selected. The 12 series included 482 patients with pain syndrome managed by styloidectomy, with 84.2% and 73.7% cure rates for cervical and transoral approaches, respectively. There were no complications with the transoral approach, versus 1.2% transient facial paresis with the cervical approach. In the 90 case reports, 112 patients had pain syndrome (Group I) and 16 neurological deficit (Group II). Cure rate in Group I varied significantly (P=0.005; OR 8.33, 95% CI [2.12–32.81]) from 64.3% following medical treatment (antiepileptics, muscle relaxants, analgesics, per os and/or locally injected anti-inflammatory drugs) to 91.8% following styloidectomy, without any significant impact of surgical approach (P=0.1; OR 0.17, 95% CI [0.02–1.60]). In Group I, no complications occurred after medical treatment, versus 4.3% and 16.3% after transoral and cervical styloidectomy, respectively. In Group II, cure and complication rates were 87.5% and 6.2%, respectively. Due to the small sample size and heterogeneity of Group II, no statistical assessment of the contribution of styloidectomy to medical treatment (antiplatelet drugs, with or without stenting) was performed.

Styloidectomy appears to be the treatment of choice for stylohyoid syndrome. The surgical approach does not significantly influence the cure or complications rate.