Bilateral elongated styloid process in an Early Middle Age individual from the south-east of Spain: elongation, angulation, and clinical implications

Elongated styloid processes (>30 mm), medial-lateral angulation, and calcification/ossification of the stylohyoid ligament are key factors to consider when diagnosing Eagle syndrome. This case, presented within a historical context, aims to provide data on the prevalence, morphological variations, and clinical significance of this condition over time, thereby bridging the fields of paleopathology and modern clinical practice. An adult male (identified as T.26) with bilateral elongation of the stylohyoid complex was analysed. Dated to the 6^th7^th centuries CE from the necropolis of Cabezo Del Molino, Rojales, Alicante, Spain. Computed tomography (CT) was employed to study the elongated styloid processes and their paleopathological implications. The tomographic images enabled the measurement of the length of both styloid processes, as well as the medial-lateral angle. In this case, both stylohyoid complexes exceeded 30 mm in length, exhibited medial thickening, and showed partial calcification/ossification of the stylohyoid ligament. This irregular attachment between the styloid process and the ligament, combined with medial-lateral angulation (MLA), may contribute to clinical symptoms such as loss of vision and stroke, and could even lead to arterial dissection. Medial-lateral angulation of the styloid process, rather than its length alone, should be considered a potential cause of pathological symptoms. It should be noted that preservation of styloid processes in osteoarchaeological contexts is rare, and it is even rarer when it involves the elongation of both stylohyoid complexes.