In Ernest syndrome, what ligament is affected?

• A. Stylohyoid ligament
• B. Stylomandibular ligament
• C. Sphenomandibular ligament
• D. Temporomandibular ligament

Answer: (B)

Ernest syndrome involves calcification of an extrinsic ligament that restricts jaw movement. The ligament affected is the stylomandibular ligament, which extends from the styloid process to the angle of the mandible and normally acts as a passive restraint to excessive mandibular motion. When it ossifies, it becomes a rigid band that limits opening and protrusion, producing pain and reduced mouth opening characteristic of this condition. The stylohyoid ligament is associated with Eagle syndrome, the sphenomandibular ligament is a separate extrinsic ligament with different clinical associations, and the temporomandibular ligament is the main intra-articular ligament of the TMJ, not the ligament classically linked to Ernest syndrome.