Orofacial pain and stylohyoid complex syndrome

Dear Editor,\udIn the introduction of the manuscript entitled\ud‘nigrostriatal dopaminergic depletion produces orofacial\udstatic mechanical allodynia’ (W. Dieb et al. Eur J Pain.\ud2015 April 21) the authors suggest that nigrostriatal dopamine\uddepletion could cause atypical facial pain. The purpose\udof this letter is to underline that the stylohyoid\udcomplex syndrome (SHCS) induces a part of orofacial pain\udthat should not be confused, as often is the case, with the\udatypical idiopathic orofacial pain and Dopamine depletion.\udThe term orofacial pain refers to pain that originates\udfrom hard and soft tissues of the head and neck. It may\udalso originate from the central nervous system or it can\udexpress a psychological disorder. A classification of orofacial\udpain considers the origin and the onset of pain: dental,\udoropharyngeal–laryngeal mucosal, neurovascular and atypical\udidiopathic. SHCS is a rare disease which is not well\udknown. Unfortunately, it is underestimated and is\udmisdiagnosed as atypical idiopathic orofacial pain.\udEagle described two clinical groups: (1) Classical syndrome,\udwhich occurs after trauma or tonsillectomy and\udpresents chronic neck pain, odynophagia, otalgia, dysphagia\udand foreign body sensation; (2) Carotid artery Syndrome,\udwhich occurs without trauma or tonsillectomy as\udwell as in cases in which the Stylohyoid process (SP) compresses\udthe carotid artery segments and perivascular sympathetic\udfibres (Eagle, 1949).\udTo make this clear, the SHCS can be represented as follows