Eagle's syndrome: A review of the literature

Abstract

Eagle's syndrome represents symptoms brought on by compression of regional structures by elongation of the styloid process or ossification of the stylohyoid or stylomandibular ligaments. Watt Eagle described it for the first time in 1937, dividing it into two subtypes: the "classic syndrome" and the "stylo-carotid artery syndrome." Many theories have been put forth regarding its pathogenesis. Depending on the underlying pathogenetic mechanism and the anatomical structures compressed or irritated by the styloid process, symptoms vary greatly, ranging from cervicofacial pain to cerebral ischemia. The syndrome generally follows tonsillectomy or trauma. Diagnosis is confirmed by radiological findings. Palpation of the styloid process in the tonsillar fossa and infiltration with anesthesia are also used in making the diagnosis. The treatment is primarily surgical; however, some conservative treatments have also been used. The current literature on Eagle's syndrome is reviewed, highlighting its often underestimated frequency and its clinical importance.

Eagle syndrome presented with neurological symptoms

“…On neurological examination, left central facial paralysis and left hemiparesia were found. Eagle syndrome is a rare clinical entity and described as an elongated styloid process or mineralization of the stylohyoid or stylomandibular ligaments that causes cervical and facial pain, sensation of foreign body lodged in the pharynx, dysphagia and odynophagia (7,10,19). The normal length of the adult styloid in an adult is thought to be approximately 2.5 cm while an elongated styloid is considered >3 cm.…”

Eagle’s Syndrome: Results of Surgical Treatment

“…The incidence varies by report. Review of literature reveals wide range of reported incidence styloid elongation from 3% to as high as 28% with most of these people being asymptomatic [4]. Incidental findings have increased with increasing radiograph use.…”

“…It is possibly an anatomic variant vs. post traumatic calcification. Some have reported association with posttonsillectomy patients; it is suggested to be related to granulation tissue and scar formation around the bone trapping nearby nerves [4]. Symptoms depend not only on length, but also width and projection of the styloid [4,5].…”

“…Two surgical approaches have been widely accepted, the transcervical (extra oral) approach and a transpharyngeal (intraoral) approach. Most literature reports that 80-90% of surgical patients will have decreased symptoms and complication rates are low [4][5][6].…”

“…Muscular and ligamentous attachments to the styloid process were dissected off of the bone. The styloid was then shortened to an appropriate length and the wound closed in layer fashion [4][5][6].…”