Eagle syndrome
(Redirected from Eagle's 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
- Elongated styloid process which causes neck and facial pain tinnitus and otalgia;
- Elongated styloid process syndrome;
- 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
Can you help answer any of these frequently asked questions on Eagle syndrome?
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