Abstract: Objective To investigate the surgical methods and clinical effects of tonsil-sparing styloid process truncation assisted by endoscopy via an oral approach. Methods We retrospectively analyzed the clinical data of 36 patients with styloid process syndrome(65 sides), the data included the main complaints, course of disease, misdiagnosis, length of the styloid process, and the degree of tonsil enlargement. Results Among the 36 patients, 7 had a unilateral styloid process, 29 had bilateral styloid processes, and 65 had styloid processes. The main complaints were pharyngeal foreign body sensation in 27, neck and shoulder pain or discomfort in 12, sore throat and pain associated with swallowing in 11, dry throat and cough in 7, facial pain in 1, and ear pain in 3 patients. The duration of illness ranged from 20 days to 3 years, with an average of 10 months. Of the misdiagnoses, twenty were pharyngitis, four were gastroesophageal reflux, two were thyroid disease, one was cervical spondylosis, and one was upper respiratory tract infection. The misdiagnosis ratio was 77.8%. Among the 36 patients, 14 had no tonsil hypertrophy, 20 had first-degree enlargement, and 2 had second-degree enlargement. None of the patients had a history of chronic tonsillitis or a tonsil mass. The average length of the preoperative styloid process is(4.38±0.78)cm; the longest is 7.89cm. The average length of the truncated styloid process is(2.09±0.93)cm. The duration of surgery was(67.08±28.4)min, and the blood loss during surgery was(8.42±5.58)mL. In six patients, seven side styloid processes were fractured externally due to the deep position or difficulty of separation. After postoperative follow-up for more than 3 months, 27 cases had resolved symptoms, 4 cases had symptom relief, 4 cases had no change in symptoms. One case was lost to follow-up. Conclusion Tonsil-sparing styloidectomy assisted by the endoscopic transoral approach preserves normal tonsils, with less surgical trauma, less pain, faster recovery, less bleeding, and good surgical results. It is effective for treating styloid process syndrome, which is a safe and minimally invasive surgical method.

Key words: Endoscopy-assisted, Without tonsillectomy, Styloid process syndrome, Eagle syndrome, Intraoral removal of the elongated styloid process