Classic Eagle’s Syndrome: Styloidectomy via the Transcervical Approach

Eagle’s syndrome was first described by Watt Eagle in 1937, as a syndrome of vague orofacial and cervical pain. He reported two variants, classic styloid and stylocarotid artery syndrome. Eagle’s syndrome is a non-perceived and underdiagnosed clinical condition of the head and neck. This anomalous entity presents with neck pain, globus sensation, difficulty in turning the head, dysphagia, odynophagia and various other symptoms occurring as a result of irritation to the nearby structures. The surgical management of Eagle’s syndrome consists of two major approaches: the transoral and the transcervical approaches. We report a case of classic bilateral elongated styloid process syndrome, treated with transcervical styloidectomy for painful left elongated styloid process. This gave permanent relief to the patient. The transcervical surgical approach for resection of elongated styloid process in patients with Eagle’s syndrome appears to be safe and effective, although the risk for transient marginal mandibular nerve weakness is notable.

Download Full-text

Elongated styloid process - a cause for cervical pain

National Journal of Clinical Anatomy ◽

10.1055/s-0039-3401759 ◽

2014 ◽

Vol 03 (03) ◽

pp. 159-161

Author(s):

S. Sumathi ◽

T. Sivakami

Keyword(s):

Close Relation ◽

Chronic Neck Pain ◽

Styloid Process ◽

Clinical Implications ◽

Cervical Pain ◽

Eagle’S Syndrome ◽

Process Measures ◽

Normal Length ◽

Elongated Styloid Process ◽

Neurovascular Structures

AbstractThe normal length of the styloid process is 20-25 mms. A diagnosis of Eagle's syndrome is made when the styloid process measures more than 30 mms.The symptomatology associated with an elongated styloid process is called Eagle's syndrome. Abnormal elongation of styloid process causes compression of important neurovascular structures situated in close relation to it resulting in chronic neck pain, referred pain to the ear, jaw and orbit, and globus hystericus. We report here two cases of elongated styloid processes found during our routine osteology demonstrations. The etiopathogenesis and clinical implications of an elongated styloid process are discussed.

Download Full-text

Elongated Styloid Process and Eagle's Syndrome

Cephalalgia ◽

10.1046/j.1468-2982.1995.015002080.x ◽

1995 ◽

Vol 15 (2) ◽

pp. 80-93 ◽

Cited By ~ 61

Author(s):

L Montalbetti ◽

D Ferrandi ◽

P Pergami ◽

F Savoldi

Keyword(s):

Head And Neck ◽

Neck Region ◽

Styloid Process ◽

Eagle’S Syndrome ◽

Head And Neck Region ◽

Elongated Styloid Process ◽

First Case ◽

Pharyngeal Region ◽

Cranial Neuralgias ◽

International Headache Classification

A controversial entity, Eagle's syndrome, is reviewed. After an anatomical description of the maxillo-vertebro-pharyngeal region we summarize the causative, diagnostic and therapeutic aspects of the syndrome. Two different conditions are often reported as Eagle's syndrome: one characterized by dysphagia and unilateral pharyngeal pain radiating to the ear and worsened by swallowing; the other characterized by pain in the head and neck region due to compression of the neurovascular structure by an elongated styloid process. The latter also includes typical cranial neuralgias (such as glossopharyngeal neuralgia) and carotidynia. We believe that the term “Eagle's syndrome” is legitimate only in the first case and in those “atypical” painful head and neck conditions related to an elongated styloid process and relieved by styloidectomy. We believe Eagle's syndrome deserves consideration in the International Headache Classification.

Download Full-text

Clinicoradiologic Evaluation of Eagle’s Syndrome and its Management

Kathmandu University Medical Journal ◽

10.3126/kumj.v11i4.12527 ◽

2015 ◽

Vol 11 (4) ◽

pp. 305-309 ◽

Cited By ~ 5

Author(s):

M Pokharel ◽

S Karki ◽

I Shrestha ◽

BL Shrestha ◽

K Khanal ◽

...

Keyword(s):

Ct Scan ◽

Styloid Process ◽

History Taking ◽

3D Ct ◽

Ct Reconstruction ◽

Eagle’S Syndrome ◽

Elongated Styloid Process ◽

Intraoral Approach ◽

3D Ct Scan ◽

Significant Difference

Background Eagle’s syndrome (Elongated styloid process) is often misdiagnosed due to its vague symptomatology. The diagnosis relies on detail history taking, palpation of styloid process in tonsillar fossa and imaging modalities.Objective To assess the length and medial angulation of elongated styloid process with the help of three dimensional computed tomography (3D CT) scan and to describe our clinical and surgical experience with patients suffering from Eagle’s syndrome.Method Prospective, analytical study conducted from August 2011 to August 2012 among 39 patients with Eagle’s syndrome. Detailed history taking, clinical examination and 3D CT scan was performed. Length and medial angulation was calculated. Patients with styloid process length longer than 2.50 cm underwent surgical excision via intraoral approach. Medial angulation of styloid process on both sides was correlated with each other using rank correlation coefficient. Wilcoxon Signed Rank test was applied to test significant difference between pre-operative and post-operative symptoms scores.Result Significant positive correlation was found between the medial angulation of styloid process on right side and left side (? =0.81, p<0.001). Significant difference was also observed between pre and post-operative symptoms scores (z=-5.16, p<0.001) .Conclusion Possibility of Eagle’s syndrome should always be considered while examining patients with vague neck pain. 3D CT reconstruction is a gold standard investigation which helps in studying the relation of styloid process with surrounding structures along with accurate measurement of its length and medial angulation.Kathmandu Univ Med J 2013; 11(4): 305-309

Download Full-text

Styloid process elongation and calcification in subjects with tmd: clinical and radiographic aspects

Brazilian Dental Journal ◽

10.1590/s0103-64402012000400023 ◽

2012 ◽

Vol 23 (4) ◽

pp. 443-450 ◽

Cited By ~ 20

Author(s):

Kelly Machado de Andrade ◽

Carolina Almeida Rodrigues ◽

Plauto C. Aranha Watanabe ◽

Marcelo Oliveira Mazzetto

Keyword(s):

Orofacial Pain ◽

Panoramic Radiograph ◽

Styloid Process ◽

Eagle’S Syndrome ◽

Linear Measurements ◽

Panoramic Radiographs ◽

Elongated Styloid Process ◽

Cephalometric Radiograph ◽

Lateral Cephalometric Radiograph ◽

Process Length

Knowledge of the Eagle's syndrome shows that its symptoms can be very easily confused with other types of craniomandibular disorders, especially temporomandibular disorders (TMD). The aim of this study was to find a possible correlation between the presence of TMD and elongation of the styloid process as well relate to presence of calcification of the stilohyoid chain. Fifty patients with TMD, confirmed from the RDC/TMD, were examined clinically and radiographically. Radiographic documentation consisted of digital panoramic radiograph and digital lateral cephalometric radiograph. Radiocef software (Radiomemory) was used for the analysis of radiographs by means of specific cephalometric tracing and linear measurements of the styloid process. Each radiograph was traced and measured three times with intervals of 1 month to spread the error. Statistical analysis was performed by Pearson's test (p=0.001) using Biostat 4.0 statistical software. Result showed an incidence of 76% elongation of the styloid process in the sample. There was a correlation between the bilateral measures taken in panoramic radiographs (?<0.001) and also for measures of styloid process length carried out in different panoramic radiographs and lateral cephalometric radiographs (?<0.001). It was concluded that there is prevalence of elongated styloid process in patients with TMD. However, no relationship was found between measurements on the stylohyoid chain and symptoms of headache, orofacial pain, tinnitus and vertigo.

Download Full-text

The involvement of the styloid process in head and neck pain-a preliminary study

Journal of Oral Rehabilitation ◽

10.1046/j.1365-2842.2000.00515.x ◽

2000 ◽

Vol 27 (4) ◽

pp. 275-287 ◽

Cited By ~ 28

Author(s):

P. Palesy ◽

G. M. Murray ◽

J. De Boever ◽

I. Klineberg

Keyword(s):

Neck Pain ◽

Head And Neck ◽

Styloid Process ◽

Preliminary Study

Download Full-text

An intraoral surgical approach to the styloid process in Eagle’s syndrome

Oral and Maxillofacial Surgery ◽

10.1007/s10006-009-0164-6 ◽

2009 ◽

Vol 13 (3) ◽

pp. 145-151 ◽

Cited By ~ 26

Author(s):

Bruno Ramos Chrcanovic ◽

Antônio Luís Neto Custódio ◽

Davidson Rodarte Felix de Oliveira

Keyword(s):

Surgical Approach ◽

Styloid Process ◽

Eagle’S Syndrome

Download Full-text

Elongated styloid process in a dry human skull and its relation to the Eagle’s Syndrome: case report and biometrical assessment

Research Society and Development ◽

10.33448/rsd-v9i9.8374 ◽

2020 ◽

Vol 9 (9) ◽

pp. e961998374

Author(s):

Jaiurte Gomes Martins da Silva ◽

Glícia Maria de Oliveira ◽

Ewerton Fylipe de Araújo Silva ◽

Adriane Barbosa Fernandes Silva ◽

Edla Vitória Santos Pereira ◽

...

Keyword(s):

Case Report ◽

Styloid Process ◽

Eagle’S Syndrome ◽

Human Skull ◽

Elongated Styloid Process ◽

Female Individual ◽

Total Length ◽

Anatomical Basis ◽

The Right

The purpose of the present study was to report a case of an elongated styloid process in a dry human skull and present its biometrical values. The styloid processes of the skull from an 80-year-old Brazilian female individual were inspected and 10 measures were performed bilaterally. Despite small differences between the right and left styloid processes regarding the antero-posterior and lateral-medial widths on the three thirds measured, one must highlight the considerable differences showed on the total length of the styloid process (left side: 65.94; right side: 28.90) and on the length of the sheath of the styloid process, which was of 30.01mm on the left side and it was not acquired on the right side because of its small dimensions. The paper discusses its findings from an anatomical and clinical perspectives, providing anatomical basis for a better understanding of the Eagle’s syndrome.

Download Full-text

Modified Craniocervical Approach for Resection of the Styloid Process in Patients with Eagle's Syndrome

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-3400297 ◽

2019 ◽

Author(s):

Felipe Constanzo ◽

Ricardo Ramina ◽

Mauricio Coelho Neto

Keyword(s):

Facial Nerve ◽

Medical Center ◽

Demographic Data ◽

Styloid Process ◽

Jugular Foramen ◽

Eagle’S Syndrome ◽

Transcervical Approach ◽

Marginal Mandibular Branch ◽

Mean Size ◽

Mandibular Branch

Abstract Objectives Surgical treatment of Eagle's syndrome remains the mainstay of treatment. Palsy of the marginal mandibular branch of the facial nerve is the most significant complication encountered in transcervical resections, due to direct compression during the approach. We proposed a modification of the craniocervical approach to the jugular foramen to resect the styloid process avoiding the marginal mandibular branch and subsequent palsy. Design Preset study is a single-center retrospective cohort study. Setting The research was conducted at a tertiary medical center. Participants From November 2008 to October 2018, 12 patients with Eagle's syndrome underwent treatment using our modified approach. Main Outcome Measures Demographic data, type of Eagle's syndrome, symptomatic side, size of the styloid process, clinical outcomes, and complications were analyzed. Results Mean size of the styloid processes was of 3.34 cm on the operated side (2.3–4.7 cm) and 2.98 cm on the other (2–4.2 cm). Intraoperative facial nerve irritation occurred in one case. Resection of the entire styloid process was achieved in all cases. Eight cases experienced complete improvement, three cases had a partial response, and one case failed to improve. There were no cases of recurrence. Two patients presented transient postoperative auricular paresthesia. There were no cases of mandibular branch palsy, nor any other complications in our series. Conclusions Our modified transcervical approach is effective in avoiding the marginal mandibular branch of the facial nerve, avoiding postoperative palsy.

Download Full-text

Own experience in the diagnosis and treatment of elongated styloid process syndrome

Otolaryngologia Polska ◽

10.5604/01.3001.0014.3666 ◽

2020 ◽

Vol 74 (6) ◽

pp. 1-5

Author(s):

Magdalena Wacławek ◽

Piotr Pietkiewicz ◽

Piotr Niewiadomski ◽

Jurek Olszewski

Keyword(s):

Treatment Time ◽

Correct Diagnosis ◽

Styloid Process ◽

The Body ◽

Eagle’S Syndrome ◽

Elongated Styloid Process ◽

Intraoral Approach ◽

Cosmetic Effect ◽

Male Patients ◽

Medical University

Introduction: The aim of the study was to present selected cases with Eagle’s syndrome diagnosed and treated at the Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics, Medical University of Lodz, in the years 2016–2020. Material and method: Five selected clinical cases with Eagle’s syndrome are presented, including three male patients and two female patients, aged 28 to 42 years. Results: The prevalence of Eagle’s syndrome was similar for both female and male patients. The carotid artery syndrome, which is characterized by: visual disturbances, unilateral pain located along cervical vessels, headache and migraine, was more common. Lack of proper diagnosis of Eagle’s syndrome often significantly delays the implementation of proper treatment and thus exposes patients to long-term struggle with pain. Our observations have shown that the time between the onset of symptoms and correct diagnosis in patients averaged about five years. 3D-CT scan is the gold standard for detecting Eagle’s syndrome. An intraoral approach was used in surgical treatment. Although this approach offers shorter treatment time and better cosmetic effect, there is also a greater risk of complications associated with limited visibility of the surgical field and infection. Conclusions: Although styloid syndrome usually occurs bilaterally, these patients reported unilateral symptoms. No correlations were found between the prevalence of Eagle’s syndrome and sex, the length of the styloid process or age, nor side of the body. The best healing effect is obtained by surgical correction/reduction of the elongated styloid process.

Download Full-text

Styloidectomy: our experience with intraoral approach

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20204639 ◽

2020 ◽

Vol 6 (11) ◽

pp. 2106

Author(s):

Purigali S. Maradesha ◽

Subash Chandrashekhar ◽

Samatha K. Jayaramaiah

Keyword(s):

Retrospective Study ◽

Local Anesthesia ◽

Styloid Process ◽

Study Group ◽

Eagle’S Syndrome ◽

Quick Recovery ◽

Elongated Styloid Process ◽

Intraoral Approach ◽

Symptom Complex ◽

Stylohyoid Ligament

Background: Eagle’s syndrome is a symptom complex arising due to elongated styloid process or calcification of stylohyoid ligament. Surgical treatment is regarded as the foremost option. The study aims to put forth our experience with intraoral approach to styloidectomy in 17 subjects.Methods: A retrospective study was conducted between January 2017 to December 2019. The study included 17 subjects with a diagnosis of elongated styloid process. All the subjects underwent styloidectomy by intraoral approach and were followed up.Results: In our study, the median age of the study group was 33.76 and out of 17 subjects 13 were female and 4 male. The procedure was done under local anesthesia in 13 subjects and under general anesthesia in 4 subjects. Styloidectomy by intraoral approach was done in all subjects among which 15 were bilateral and 2 unilateral. 88% of the subjects were symptom free by third week.Conclusions: The study suggests that styloidectomy by intraoral approach is minimally invasive and can be done under local anesthesia with an added advantage of quick recovery.

Download Full-text