An elongated styloid process or a calcified stylohyoid ligament may cause dysphagia or craniofacial and cervical pain. Palpation and radiography confirm the diagnosis provided that it is considered. The only effective treatment is surgery. Eleven patients undergoing surgery for elongated styloids or calcified ligaments are reported. In all cases the symptoms disappeared or were relieved. An evaluation of the external versus the transoral approach is presented. The authors recommend the external one, as it provides adequate anatomical exposure of the styloid process and its relationship to the structures of the parapharyngeal space.