Provoked Eagle syndrome after dental procedure: A review of the literature

Abstract

Eagle syndrome is an uncommon condition caused by an elongated ossified styloid process. The majority of individuals with an elongated ossified styloid process are asymptomatic. Therefore, this condition is diagnosed based on clinical presentation, with radiologic imaging serving to confirm the diagnosis. The styloid process is considered elongated if measuring greater than 3 cm, but there is little correlation between length of the styloid process and severity of symptoms. This syndrome was originally described in post-tonsillectomy patients, but has since been seen in other clinical settings. We present a case of Eagle syndrome that became symptomatic after a dental procedure (wisdom teeth removal). A literature review performed with focus on various etiologies of Eagle syndrome diagnosis found a previously published case of Eagle syndrome presenting as pain of dental origin; however, no case reports of symptoms arising in a patient post-dental procedure were found in our search.

A Prolonged Time to Diagnosis Due to Misdiagnoses: A Case Report of an Atypical Presentation of Eagle Syndrome

“…Eagle described 2 subtypes of the syndrome: the classic syndrome and the stylocarotid syndrome, depending on which structures are involved [ 3 ]. The most frequent symptoms reported are severe throat, facial and/or ear pain, and are usually exacerbated by head rotation, swallowing, yawning, or chewing [ 1 , 2 ]. Other symptoms reported also include foreign-body sensation in the pharynx, odynophagia, pharyngeal paresthesia, dysphagia, dysphonia, vertigo, syncope, and hearing problems [ 1 , 2 , 5 ].…”

“…The most frequent symptoms reported are severe throat, facial and/or ear pain, and are usually exacerbated by head rotation, swallowing, yawning, or chewing [ 1 , 2 ]. Other symptoms reported also include foreign-body sensation in the pharynx, odynophagia, pharyngeal paresthesia, dysphagia, dysphonia, vertigo, syncope, and hearing problems [ 1 , 2 , 5 ]. Rare instances of cerebral ischemia, carotid artery dissection, and even sudden death attributed to an elongated SP have been reported [ 2 , 6 – 9 ].…”

“…Other symptoms reported also include foreign-body sensation in the pharynx, odynophagia, pharyngeal paresthesia, dysphagia, dysphonia, vertigo, syncope, and hearing problems [ 1 , 2 , 5 ]. Rare instances of cerebral ischemia, carotid artery dissection, and even sudden death attributed to an elongated SP have been reported [ 2 , 6 – 9 ]. Recently, a third variant of Eagle syndrome, the styloidogenic jugular compression syndrome, has been identified [ 4 , 10 ].…”

“…The elongation of the SP classically occurs after a traumatic event such as the fracture of the SP, a minor trauma of the neck, or after tonsillectomy [ 1 , 2 ]. The incidence of elongated SP is thought to be between 4% and 15% of the population [ 3 , 13 , 14 ].…”

Styloid process elongation in a sample of Lebanese population: a consideration for the prevention of Eagle syndrome

“…Similarly, compression of dural spaces and of the internal jugular vein in so-called “Eagle-jugular syndrome” can ultimately lead to altered cerebral perfusion, with increased intra-cranial pressure and risk of cerebral hemorrhage [ 18 , 19 ]. This places additional clinical implication for the dental professional: special care must be taken during dental treatment to avoid positioning the patient in postures that cause further compression of any of these vital structures and decrease risk of aforementioned complications, such as head rotation and wide mouth opening [ 20 , 21 ].…”