Eagle syndrome

Eagle syndrome

Definition

Eagle syndrome is a recurrent pain in the middle part of the throat (oropharynx) and face.

Cause

Eagle syndrome is due to a calcified stylohyoid ligament or an elongated styloid process.

Styloid process

The styloid process is a pointed part of the temporal bone that serves as an anchor point for several muscles associated with the tongue and larynx.

Other names

1. Elongated styloid process which causes neck and facial pain tinnitus and otalgia;
2. Elongated styloid process syndrome;
3. Styloid-stylohyoid syndrome;

Signs and symptoms

• "Classic Eagle syndrome" is typically seen in patients after throat trauma or tonsillectomy
• Symptoms include dull and persistent throat pain that may radiate to the ear and worsen with rotation of the head.
• Other symptoms may include difficulty swallowing, feeling of something stuck in the throat, tinnitus, and neck or facial pain.
• A second form of Eagle syndrome unrelated to tonsillectomy causes compression of the vessel that carries blood to the brain, neck, and face (carotid artery) which cause headache and dizziness

Diagnosis

• Diagnosis is is made with clinical presentation and imaging studies.
• The classic form of "Eagle syndrome" presents as unilateral neck pain, sore throat or tinnitus.
• Sometimes the tip of the styloid process is palpable in the back of the throat.
• The diagnosis of the vascular type is more difficult and requires an expert opinion.
• One should have a high level of suspicion when neurological symptoms occur upon head rotation.
• Symptoms tend to be worsened on bimanual palpation of the styloid through the tonsillar bed.
• They may be relieved by infiltration of lidocaine into the tonsillar bed.
• Because of the proximity of several large vascular structures in this area this procedure should not be considered to be risk free.
• Imaging is important and is diagnostic.
• Visualizing the styloid process on a CT scan with 3D reconstruction is the suggested imaging technique.
• The enlarged styloid may be visible on an orthopantogram or a lateral soft tissue X ray of the neck.

Treatment

• The mainstay treatment for Eagle syndrome is surgery to shorten the styloid process called styloidectomy.

Surgery

• Traditionally, this surgery has been done using either an intraoral (through the mouth) or extraoral (through the neck) approach.
• The intraoral approach usually requires tonsillectomy, and access to the styloid process is limited.
• There is also risk of injury to major vessels.
• However, this method reportedly is safe, more simple, and an external scar is avoided.
• The extraoral approach may provide better exposure of the process and its surrounding structures.
• However, this approach results in a scar, requires going through connective tissue and may carry an increased risk of trauma to surrounding structures.
• In recent years, more minimally-invasive techniques have been used for head and neck surgery.

Endoscopic assisted surgery

• Some patients with Eagle syndrome have undergone an endoscope-assisted surgery.

Medical management

• Medical management of Eagle syndrome may include the use of pain and anti-inflammatory medications, antidepressants, and/or steroids for pain.
• The overall success rate for treatment (medical or surgical) is about 80%.

Epidemiology

• Approximately 4% of the general population have an elongated styloid process, and of these about 4% give rise to the symptoms of Eagle syndrome.
• The incidence of stylohyoid syndrome may be about 0.16%.
• Patients with this syndrome tend to be between 30 and 50 years of age but it has been recorded in teenagers and in patients > 75 years old.
• It is more common in women, with a male:female ratio ~ 1:2.

History

The condition was first described by American otorhinolaryngologist Watt Weems Eagle in 1937.

Gallery

• Radiograph, lateral view showing elongated stylohyoid process and stylohyoid ligament ossification

• 

  Radiograph, lateral view showing joint-like formation in ossified stylohyoid ligament

• CT scan, coronal section showing bilateral extended styloid process and stylohyoid ligament ossification (incidental finding)

• 3D-reconstructed CT scan showing bilateral stylohyoid ligament ossification

• 3D reconstructed CT scan showing elongated styloid process (right side)

FAQS

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• Does Eagle syndrome go away?
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• Does Eagle syndrome cause ear pain?
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• Which nerve is affected by Eagle's syndrome?
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• Is Eagle syndrome congenital?
• How risky is a Styloidectomy?
• What are calcified ligaments?

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