SOME of the obscure, as well as common, pharyngeal pains, painful deglutition and referred otalgia may be traced to an elongated styloid process.1 It is of interest that these symptoms are usually found only after tonsillectomy. I now hope to establish that the elongated styloid process may also cause facial pain and headache, even when tonsillectomy has not been performed, owing to impingement of the process on a carotid artery. Thus, there exist two distinct syndromes referable to the styloid process; these syndromes present groups of symptoms which differ in their anatomic locations. The classic, and commoner, syndrome usually relates all symptoms to the pharynx and the ear, but occasionally an atypical group of symptoms may be referred to the hypopharynx and the upper part of the esophagus.1f The second syndrome, which I shall designate as the styloid process–carotid artery syndrome, presents symptoms related to the pattern of