Eagle’s Syndrome: Presentation, Diagnosis, and Management
Objective: To study the presentation, diagnosis, and treatment options in Eagle’s Syndrome in a tertiary care hospital.
Material and Methods: The study was conducted at the ENT department of District Headquarter Hospital, Rawalpindi from 1st January 2016 to 31st March 2019. All the patients who presented in outpatient (OPD) of the ENT department with pain around the ear and throat and diagnosed as a case of Eagle’s syndrome were included in the study. All the data of gender, age, CT scan findings, pain score, and management were noted on a predesigned proforma. Percentages and frequencies were calculated for all the data by using SPSS 21 version.
Results: A total of 12 patients were included in the study, with 5 (42%) females and 7 (58%) males. The patient’s age range was from 24 to 68 years. Sharp, sudden onset, nerve-like pain was the major symptom in all cases. The length of the styloid process in 6 patients was between 3-4 cm and in 6 patients between 4-5 cm on a 3-dimensional computerized tomography scan. 100% of patients were managed surgically. In Group A (50%) styloidectomy was done after tonsillectomy while in other Group B (50%) patients styloidectomy was done by tonsil sparing technique. The relief of pain was a little better in patients of Group B.
Conclusion: Sudden onset, sharp, shooting pain in the jaw area, around-ear, and in the throat with no other co-morbid should be investigated for Eagle’s syndrome. 3 dimensional CT scan is the best modality to see the length of the styloid process. Styloidectomy with tonsil sparing technique is a little better than tonsillectomy and gives early and permanent relief from this painful condition.
2. Mahan PE. TMJ Disorders and Orofacial Pain. The role of dentistry in a multidisciplinary diagnostic approach. https://doi.org/10.1259/dmfr/13389903
3. Hoffmann E, Räder C, Fuhrmann H, Maurer P. Styloid–carotid artery syndrome treated surgically with Piezosurgery: a case report and literature review. Journal of Cranio-Maxillofacial Surgery. 2013 Mar 1;41(2):162-6. https://doi.org/10.1016/j.jcms.2012.07.004
4. Saccomanno S, Greco F, De Corso E, Lucidi D, Deli R, D’addona A, Paludetti G. Eagle’s Syndrome, from clinical presentation to diagnosis and surgical treatment: a case report. Acta Otorhinolaryngologica Italica. 2018 Apr;38(2):166. DOI: 10.14639/0392-100X-1479
5. Sakhdari S, Saberi S, Shamshiri AR. Prevalence and Pattern of Styloid Process Elongation and Calcification on Digital Panoramic Radiographs in an Iranian Population. Journal of Islamic Dental Association of Iran. 2018 Apr 10;30(2):44-51. DOI: 10.30699/JIsdreir.30.2.44
6. Abuhaimed AK, Alvarez R, Menezes RG. Anatomy, Head and Neck, Styloid Process. StatPearls [Internet]. 2020 Jun 1.
7. Okur A et al. Is there a relationship between symptoms of patients and tomographic characteristics of styloid process? Surg Radiol Anat. 2014. 36(7):627-32. DOI: 10.1007/s00276-013-1213-2.
8. Bouzaidi K et al. Eagle’s syndrome. Acta Radiol Short Rep. 2013. 2(5):1-4. DOI: 10.1177/2047981613495676.
9. Monsour PA, Young WG. Variability of the styloid process and stylohyoid ligament in panoramic radiographs Oral Surg Oral Med Oral Pathol. 1986. 61(5):522-6. DOI: 10.1016/0030-4220(86)90399-3.
10. Balcioglu HA, Kilic C, Akyol M, Ozan H, Kokten G. Length of the styloid process and anatomical implications for Eagle’s syndrome. Folia morphologica. 2009;68(4):265-70.
11. Eagle W. Elongated styloid process: Further observation and a new syndrome. Arch Otolaryngol. 1948. 47:630-40. DOI: 10.1001/archotol.1948.00690030654006.
12. Eagle W. Elongated styloid process. Report of two cases. Arch Otolaryngol. 1937. 25:584-87. DOI: 10.1001/archotol.1937.00650010656008.
13. Lentini A. Gli aspetti clinici e radiologici delle anomalle dell’apparato stilo-joideo Radiol Med. 1975. 61(4):337-64. DOI: PASCAL7650145277.
14. Epifanio G. Processi stiloidei lunghi e ossificazione della catena stiloidea. Rad Prat. 1962. 12:127-32.
15. Bruno G et al. Elongated styloid process: an epidemiological study on digital panoramic radiographs. J Clin Exp Dent. 2017. 9(12):1446-52. DOI: 10.4317/jced.54370.
16. Kumar P et al. Sudden death due to Eagle syndrome: a case report. Am J Forensic Med Pathol. 2013. 34(3): 231-33. DOI: 10.1097/PAF.0b013e3182a186e1.
17. Naik SM, Naik SS. Tonsillo-styloidectomy for Eagle syndrome. A review of 15 cases in KVG medical college Sullia. Oman Med J. 2011. 26920:122-6. DOI: 10.5001/omj.20011.30.
18. Maru YK et al. Stylalgia and its surgical management by intra oral route clinical experience of 332 cases. Indian Journal of Otolaryngology and Head and Neck Surgery. 2003. 55(2):87-90. DOI: 10.1007/BF02974610.
19. Yavuz H et al. Angulation of the styloid process in Eagle syndrome. Eur Arch Otorhinolaryngol. 2008. 265:139-6. DOI: 10.1007/s00405-008-0686-9.
20. Singh R, Galagali JR. Tonsillostyloidectomy for Eagle syndrome. A study of 20 cases. Int J Otorhinolaryngol Head Neck Surg. 2016. 2(1):22-5. DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20160064.
21. Balbuena L Jr et al. Eagle syndrome. South Med J. 1997. 90(3):331-4. DOI: 10.1097/00007611-1997003000-00014.
22. Camarda AJ et al. Stylohyoid chain ossification. A discussion of etiology. Oral Surg Oral Med Oral Pathol. 1989. 67(5):508-14. DOI: 10.1016/0030-4220(89)90264-8.
23. Piagkou M et al. Eagle syndrome. A review of the literature. Clin Anat. 2009. 22(5):545-58. DOI: 10.1002/ca.20804.
24. Frommer J. Anatomic variations in the stylohyoid chaing and their possible clinical significance. Oral Surg Oral Med Oral Pathol. 1974. 38(5):659-67. DOI: https://doi.org/10.1016/0030-4220(74)90382-X.
25. Nayak DR et al. Role of three dimensional computed tomography reconstruction in the management of elongated styloid process. A preliminary study. J Laryngol Otol. 2007. 121(4):349-53. DOI: 10.1017/S0022215106003276.
26. Schroeder WA Jr. Traumatic Eagles syndrome. Otolaryngol Head Neck Surg. 1991. 104(3):371-4. DOI: 10.1177/019459989110400314.
27. Glogoff MR, Baum SM, Cheifetz I. Diagnosis and treatment of Eagles syndrome. J Oral Surg. 1981. 39(12):941-4. PMID: 6948095.
28. Martin TJ, Friedland DR, Merati AL. Trascervical resection of the styloid process in Eagle syndrome. Ear Nose Throat J. 2008. 87(7):399-401. PMID: 18633935.
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