11,17 ES is diagnosed by both physical and radiographical examination. The SP palpation in the tonsillar fossa is indicative of SPE which are not normally palpable. Palpation of the tip of the SP should exacerbate the symptoms associated with this sellckchem syndrome. If highly suspicious for ES, confirmation can be done by radiographical imaging.15 Generally, a PR rather than CT is used to detect if the SP is elongated.14 There are many vessels such as carotid arteries and nerves adjacent to the SP.1�C3 The signs and symptoms with this syndrome are due to the anatomic relationship between the SP and its surrounding structures.1,12 The symptoms can be confused with some disorders including a wide variety of facial neuralgias, oral, dental and, temporomandibular diseases.

Therefore, a detailed differential diagnosis for SPE should be done.18 The reported radiographic prevalence of the SPE varies from less than 2% to greater than 30% in the literature.6,9,19�C22 There are several reports investigating the SPE prevalence in Turkish population. Ilguy et al. evaluated the PRs of 860 subjects in terms of SPE. Of these patients, 32 patients (3.7%) had SPEs.6 In another study, the SPE prevalence on the PRs was investigated for the 900 adult patients with dental problems and the prevalence was 1.1%.22 Also, Bozk r et al. investigated the SPE prevalence in 200 edentulous patients who were over 50 years old. It was found that the SPE prevalence was 4%.20 As in our study, the length of SP and/or stylohyoid ligament, which are longer than 30 mm were considered to be SPE in all these Turkish reports.

6,22 According to our knowledge, the present study is the first report investigating the SPE prevalence and evaluating the subgroups in terms of this prevalence on PRs in Cappadocia region population. In the current study, the prevalence was 7.7%. In Turkey, there are many ethnic groups and regions. So, ethnic groups are changing according to the different regions. All the Turkish reports investigating SPE including our study were done in the different regions of Turkey. Therefore, regional factors including dietary factors and ethnicity may be important for the different SPE prevalances in these reports. There were statistical differences between 10�C19, 20�C29 age subgroups and 30�C39, 50�C59 age subgroups in terms of the SPE incidence, but not other subgroups.

Cilengitide Therefore, no relationship could be established between the SPE and increasing patient age as in Correll et al��s study.23 However, the patient abnormal distributions according to age subgroups was the limitation of this interpretation in the current report. As a result, SPEs found as incidental findings on PRs may be important clinically in not only patients with systemic diseases, but also normal population. Instead of many hypotheses and studies, the exact etiology of elongated SP is unknown. SPEs in the present study were detected by PRs in 7.7% of this population.