A 38-year-old female presents with a 2.5-year history of right-sided throat pain radiating to the ear, aggravated by head turning, yawning, and swallowing. She also reports intermittent facial pain (VAS 7/10), odynophagia, foreign body sensation, and occasional vertigo. There is no history of fever, weight loss, or trauma. Her past history includes tonsillectomy at age 22 and controlled hypothyroidism.
She underwent root canal treatment for dental pain without relief and was later treated for migraine, also without improvement. On examination, there is right submandibular tenderness, and pain is elicited on transoral palpation of the right tonsillar fossa (positive styloid palpation test). Neck movement is restricted on the right side. Imaging reveals an elongated right styloid process measuring 42 mm with medial deviation toward the tonsillar fossa.
