Elongated styloid process (Eagle's syndrome): A clinical study

doi:10.1053/joms.2002.29814

Journal of Oral and Maxillofacial Surgery

Volume 60, Issue 2, February 2002, Pages 171-175

https://doi.org/10.1053/joms.2002.29814 Get rights and content

Abstract

Purpose: Elongated styloid process can be a source of craniofacial and cervical pain and remains a diagnostic challenge to many. The aim of the study was to determine the symptomatology and various criteria for the diagnosis of an elongated styloid process and its management. Patients and Methods: Our clinical study consisted of 58 patients with elongated styloid process who had symptoms of vague cervicofacial pain and presented to our department during a period of 10 years. Special emphasis is given to palpation of the tonsillar fossa, lidocaine infiltration test, and orthopantomography. Results: Minimal complications and zero incidence of deep neck infection were noted. Conclusions: All of the patients were managed surgically through the intraoral approach, which was found to be a safe procedure. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:171-175, 2002

Section snippets

Patients and methods

Our study was a retrospective review of 58 patients with ESP and encompassed a period of 10 years. The chief symptoms were vague nagging pharyngeal pain, cervicofacial pain, foreign body sensation in the throat, pain on swallowing, pain on changing head position, and pain radiating to the temporomandibular joint or to the upper limb and otalgia (Table 1).Both men and women of varying ages were included in the study. None of the patients had had a tonsillectomy.

All of the patients were screened

Results

Of the 58 patients with ESP in our study, 14 were men and 44 were women; the male/female ratio of 1:3 shows a female preponderance. Patient age ranged from 18 to 67 years, with maximum incidence in the 30s and 40s. Fifty patients (86.2%) presented with unilateral symptoms and 8 patients (13.8%) presented with bilateral symptoms, although ESP was bilaterally palpable in 46 patients. Only 8 of these 46 patients had bilateral symptoms, whereas 38 had unilateral symptoms.

The chief symptoms were

Discussion

The styloid process is a slender, osseous projection derived from the second branchial arch, or Reichert's cartilage. The normal length of the styloid process ranges from 2 to 4.77 cm; most are less than 3 cm.2, 4 The exact cause of elongation of the styloid process is not clear. The painful symptoms may be related to previous trauma with fracture of the styloid process or to previous tonsillectomy.⁷ Other theories that have been proposed include 1) congenital elongation, 2) partial or complete

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Cited by (179)

Eagle's syndrome with neck discomfort: A report of three cases
2023, Radiology Case Reports
Eagle's syndrome, or ES, is associated with the elongation of the styloid process and partial or complete mineralization of the stylohyoid ligament. Clinically, the symptoms of ES are characterized by sore throat, neck pain radiating to the ear, dysphagia, and a foreign body sensation when swallowing, resulting from disruption of the neck or pharyngeal region. This report describes 3 male patients (40, 60, and 43 years old) with neck discomfort. These patients were inadvertently diagnosed with ES using multidetector computer tomography and 3-dimensional volumetric computed tomography (MDCT-3D CT). The length of the left styloid process in the first case was 42 mm. In the second case, the size of the right styloid process was 53 mm. In the last case, the length of the right styloid process was 41 mm, while the left side was 43 mm. This syndrome should always be suspected when pain is unilateral and unresponsive to analgesics, mainly in women. Diagnosis requires appropriate examination through radiological examination, special techniques, and experiences. We aim to present and re-emphasize the consideration of a differential diagnosis of ES for diagnosticians.
Nummular and Side-locked Headaches for the Otolaryngologist
2022, Otolaryngologic Clinics of North America
Eagle syndrome: Toward a clinical delimitation
2021, Neurologia
El dolor orofacial y cervical es un motivo de consulta frecuente, y puede deberse a múltiples procesos patológicos. Entre ellos se encuentra el síndrome de Eagle, entidad muy infrecuente cuyo origen se atribuye a una osificación del ligamento estilohioideo o una elongación de la apófisis estiloides. Presentamos una serie de cinco pacientes con dicho diagnóstico.
Se describen las características demográficas y clínicas de cinco pacientes atendidos en la Unidad de Cefaleas de dos hospitales terciarios por un cuadro compatible con síndrome de Eagle, y su respuesta a distintos tratamientos.
Se trata de tres varones y dos mujeres de entre 24 y 51 años, con dolor de localización predominante en un oído y la región amigdalina ipsilateral, de cualidad sorda y de gran intensidad. En todos ellos el patrón temporal era crónico y continuo, con exacerbaciones desencadenadas por la deglución. Cuatro pacientes habían realizado múltiples consultas en servicios de otorrinolaringología, y uno de ellos había recibido tratamiento antibiótico ante la sospecha de tubaritis. En todos los casos la palpación de la fosa amigdalina resultó dolorosa. En tres de los pacientes se demostró elongación de la apófisis estiloides y/o calcificación del ligamento estilohioideo mediante tomografía computarizada. Cuatro mejoraron con tratamiento neuromodulador (duloxetina, gabapentina, pregabalina) y solo uno precisó cirugía con escisión de la apófisis estiloides.
El síndrome de Eagle es una causa de dolor craneofacial poco frecuente y posiblemente infradiagnosticada. Aportamos cinco nuevos casos que permiten delimitar tanto la semiología como los posibles tratamientos.
Orofacial and cervical pain are a frequent reason for neurology consultations and may be due to multiple pathological processes. These include Eagle syndrome (ES), a very rare entity whose origin is attributed to calcification of the stylohyoid ligament or elongation of the temporal styloid process. We present a series of five patients diagnosed with ES.
We describe the demographic and clinical characteristics and response to treatment of 5 patients who attended the headache units of two tertiary hospitals for symptoms compatible with Eagle syndrome.
The patients were three men and two women aged between 24 and 51, presenting dull, intense pain, predominantly in the inner ear and the ipsilateral tonsillar fossa. All patients had chronic, continuous pain in the temporal region, with exacerbations triggered by swallowing. Four patients had previously consulted several specialists at otorhinolaryngology departments; one had been prescribed antibiotics for suspected Eustachian tube inflammation. In all cases, the palpation of the tonsillar fossa was painful. Computed tomography scans revealed an elongation of the styloid process and/or calcification of the stylohyoid ligament in three patients. Four patients improved with neuromodulatory therapy (duloxetine, gabapentin, pregabalin) and only one required surgical excision of the styloid process.
Eagle syndrome is a rare and possibly underdiagnosed cause of craniofacial pain. We present five new cases that exemplify both the symptoms and the potential treatments of this entity.
Dural Arteriovenous Fistula Formation as Eagle Jugular Syndrome: A Case Report and Literature Review
2020, World Neurosurgery
An elongated styloid process can less frequently lead to symptomatic compression of the internal jugular vein (IJV). We present the first case of dural arteriovenous fistula (DAVF) in association with compressed IJV by an elongated styloid process.
A 77-year-old woman presented with pulsating tinnitus. DAVF at the right hypoglossal canal was diagnosed, and she underwent transvenous embolization. The shunt flow was reduced, and the symptom disappeared after transvenous embolization. However, 2 years and 8 months later, retrograde sinus drainage from the residual shunt was asymptomatically found on magnetic resonance imaging, and angiography revealed progression of IJV stenosis caused by an elongated styloid process. Subsequently, she underwent a second transvenous embolization, and the arteriovenous shunt was almost completely obliterated.
The present case suggests that venous hypertension by compressed IJV can induce the development of DAVF. It is helpful for the diagnosis and treatment of DAVF to keep in mind the possibility of IJV stenosis owing to an elongated styloid process.
Eagle's syndrome, elongated styloid process and new evidence for pre-manipulative precautions for potential cervical arterial dysfunction
2020, Musculoskeletal Science and Practice
Safety with upper cervical interventions is a frequently discussed and updated concern for physical therapists, chiropractors and osteopaths. IFOMPT developed the framework for safety assessment of the cervical spine, and this topic has been discussed in-depth with past masterclasses characterizing carotid artery dissection and cervical arterial dysfunction. Our masterclass will expand on this information with knowledge of specific anatomical anomalies found to produce Eagle's syndrome, and cause carotid artery dissection, stroke and even death.
Eagle's syndrome is an underdiagnosed, multi-mechanism symptom assortment produced by provocation of the sensitive carotid space structures by styloid process anomalies. As the styloid traverses between the internal and external carotid arteries, provocation of the vessels and periarterial sympathetic nerve fibers can lead to various neural, vascular and autonomic symptoms. Eagle's syndrome commonly presents as neck, facial and jaw pain, headache and arm paresthesias; problems physical therapists frequently evaluate and treat.
This masterclass aims to outline the safety concerns, assessment and management of patients with Eagle's syndrome and styloid anomalies. By providing evidence of this common anomaly found in almost one-third of the population, hypothesis generation and clinical reasoning with patients presenting with head and neck symptoms can improve.
Including styloid anomalies as potential hypotheses for patients with head and neck complaints can assist therapists in safe practice and expedite referral. The authors recommend updating the IFOMPT framework to incorporate Eagle's syndrome, a comprehensive autonomic assessment, and palpation of the stylohyoid complex to avoid potentially serious complications from conceivably hazardous interventions.
Safety and efficacy of dynamic catheter-directed cerebral digital subtraction angiography for diagnosis of bowhunter syndrome spectrum disorders: A systematic review of the literature
2024, Interventional Neuroradiology

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^☆: *Professor of ENT and Chief of ENT Department and Honorary Medical Officer, Government Wenlock District Hospital.

^☆☆: †Professor, Head of the ENT Department and Director of Postgraduate Studies.

^★: ‡Resident in ENT.

^★★: §Resident in ENT.

^♢: ∥Resident in ENT.

^♢♢: Address correspondence and reprint requests to Dr Prasad: 1st Floor, Nethravathi Building, Balmatta, Mangalore 575001, Karnataka State, India; e-mail: [email protected]

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Clinical ArticlesElongated styloid process (Eagle's syndrome): A clinical study☆,☆☆,★,★★,♢,♢♢

Abstract

Section snippets

Patients and methods

Results

Discussion

Oral Surg Oral Med Oral Pathol

J Prosthet Dent

The styloid process syndrome: Aetiological factors and surgical management

J Laryngol Otol

Styloid process variation: Radiologic and clinic study

Arch Otolaryngol

Elongated styloid process syndrome: Intraoral versus external approach for styloid surgery

Laryngoscopy

Clinical Articles
Elongated styloid process (Eagle's syndrome): A clinical study☆,☆☆,★,★★,♢,♢♢