Elongated styloid process (Eagle's syndrome) as a cause of atypical craniocervical pain

Hernández, J.L.; Velasco, Jaime

doi:10.1136/bcr.2007.121020

Cited by 3 publications

(3 citation statements)

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“…38 There may pass several years before symptoms occur. 21,25,30,39 It is thought that these are caused by the ossified structure irritating the tissues around it, including the carotid artery and the cranial nerves VII, IX and X 10,17,19,28,29,33,[40][41][42] or by the gradual loss of elasticity of the surrounding soft-tissues that develops over the years. 8,29 The lack of elasticity could result in a more posterior position of the greater horn of the hyoid bone, displacing it closer to the neurovascular structures.…”

Section: Discussionmentioning

confidence: 99%

Complete Ossification of the Stylohyoid Chain as Cause of Eagle's Syndrome: A Very Rare Case Report

Guimarães¹,

Pozza²,

Castro³

et al. 2014

The Journal of Contemporary Dental Practice

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Section: Discussionmentioning

confidence: 99%

Complete Ossification of the Stylohyoid Chain as Cause of Eagle's Syndrome: A Very Rare Case Report

Guimarães¹,

Pozza²,

Castro³

et al. 2014

The Journal of Contemporary Dental Practice

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“…Pain is a variable feature and may be referred anywhere from the ipsilateral parietal bone to the pectoral region of the chest [3,19,33,40,49,51,60,64,66,70]. This pain is usually dull, constant, and nagging and is often aggravated by swallowing and yawning [50,68,84].…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Given the variation in the clinical presentation of classic-type Eagle's syndrome, the differential diagnosis is broad and includes glossopharyngeal neuralgia [76,78,79], occipital neuralgia [54], sphenopalatine neuralgia, temporomandibular disorders [17,26,43], dental infection, tonsillitis [2,27], mastoiditis [19,60], and migraine [33,50,54]. For the carotid type, vasculopathy and cardiac pathology should be considered [4,14,15,24,63,92].…”

Section: Diagnosismentioning

confidence: 99%

Eagle’s syndrome: embryology, anatomy, and clinical management

2012

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Background Eagle's syndrome refers to a rare constellation of neuropathic and vascular occlusive symptoms caused by pathologic elongation or angulation of the styloid process and styloid chain. First described in 1652 by Italian surgeon Piertro Marchetti, the clinical syndrome was definitively outlined by Watt Eagle in the late 1940s and early 1950s. Methods This article reviews how underlying embryologic and anatomic pathology predicts clinical symptomatology, diagnosis, and ultimately treatment of the syndrome. Results The length and direction of the styloid process and styloid chain are highly variable. This variability leads to a wide range of relationships between the chain and the neurovascular elements of the neck, including cranial nerves 5, 7, 9, and 10 and the internal carotid artery. In the classic type of Eagle's syndrome, compressive cranial neuropathy most commonly leads to the sensation of a foreign body in the throat, odynophagia, and dysphagia. In the carotid type, compression over the internal carotid artery can cause pain in the parietal region of the skull or in the superior periorbital region, among other symptoms. Conclusions Careful recording of the history of the present illness and review of systems is crucial to the diagnosis of Eagle's syndrome. After the clinical examination, the optimal imaging modality for styloid process pathology is spiral CT of the neck and skull base. Surgical interventions are considered only after noninvasive therapies have failed, the two most common being intraoral and external resection of the styloid process. Embryology and phylogenyThe embryologic history of the styloid process, stylohyoid ligament, and hyoid bone is a subject of debate. Revilla and Stuyt [69] suggest that the styloid process, stylohyoid ligament, and lesser cornu of the hyoid bone develop from endochondral ossification of Reichert's cartilage, the cartilaginous component of the second branchial arch. They assert that after 3 months of fetal life, Reichert's cartilage is disrupted and divided into five distinct components (from proximal to distal): tympanohyal, stylohyal, ceratohyal, hypohyal, and basyhyal [58,69]. The tympanohyal component contributes to the tympanic bone and the base of the styloid process. The stylohyal component contributes to the majority of the styloid process, and the hypohyal and basyhyal components contribute to the hyoid bone. In many animals the ceratohyal component ultimately becomes the epihyoid bone. In humans, Revilla and Stuyt [69] contend that it degenerates to form the stylohyoid ligament.In contrast, during their detailed description of Reichert's cartilage in 50 human embryos and fetuses, RodriguezVazquez et al. [72] suggested that the second branchial arch cartilage is formed in two distinct segments separated by mesenchymal tissue. The proximal and larger segment is continuous with the otic capsule and becomes the styloid process. The smaller and more distal component forms the

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Neurological phenotypes and treatment outcomes in Eagle syndrome: systematic review and meta-analysis

Hassani,

Grønlund,

Albrechtsen

et al. 2024

PeerJ

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Background Eagle syndrome is caused by an elongated styloid process affecting carotid arteries and cranial nerves. Pain, dysphagia, tinnitus, paresthesia (classic subtype), and neurovascular events (vascular subtype) may be triggered by head movements or arise spontaneously. However, Eagle syndrome remains underappreciated in the neurological community. We aimed to determine the most common neurological and non-neurological clinical presentations in patients with Eagle syndrome and to assess the clinical outcome post-surgical resection in comparison to non-surgical therapies. Methodology We conducted a systematic review of patient-level data on adults with Eagle syndrome, following PRISMA guidelines. We extracted data on demographics, presenting symptoms, neurological deficits, radiological findings, and treatments, including outcomes and complications, from studies in multiple indexing databases published between 2000 and 2023. The study protocol is registered with PROSPERO. Results In total, 285 studies met inclusion criteria, including 497 patients with Eagle syndrome (mean age 47.3 years; 49.8% female). Classical Eagle (370 patients, 74.5%) was more frequent than vascular Eagle syndrome (117 patients, 23.5%, p < 0.0001). Six patients (1.2%) presented with both variants and the subvariant for four patients (0.8%) was unknown. There was a male preponderance (70.1% male) in the vascular subtype. A history of tonsillectomy was more frequent in classic (48/153 cases) than in vascular (2/33 cases) Eagle syndrome (Odds Ratio 5.2, 95% CI [1.2–22.4]; p = 0.028). By contrast, cervical movements as trigger factors were more prevalent in vascular (12/33 cases) than in classic (7/153 cases) Eagle syndrome (Odds Ratio 7.95, 95% CI [2.9–21.7]; p = 0.0001). Headache and Horner syndrome were more frequent in vascular Eagle syndrome and dysphagia and neck pain more prominent in classic Eagle syndrome (all p < 0.01). Surgically treated patients achieved overall better outcomes than medically treated ones: Eighty-one (65.9%) of 123 medically treated patients experienced improvement or complete resolution, while the same applied to 313 (97.8%) of 320 surgical patients (Odds Ratio 1.49, 95% CI [1.1–2.0]; p = 0.016). Conclusions Eagle syndrome is underdiagnosed with potentially serious neurovascular complications, including ischemic stroke. Surgical treatment achieves better outcomes than conservative management. Although traditionally the domain of otorhinolaryngologist, neurologist should include this syndrome in differential diagnostic considerations because of the varied neurological presentations that are amenable to effective treatment.

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Elongated styloid process (Eagle's syndrome) as a cause of atypical craniocervical pain

Cited by 3 publications

References 2 publications

Complete Ossification of the Stylohyoid Chain as Cause of Eagle's Syndrome: A Very Rare Case Report

Complete Ossification of the Stylohyoid Chain as Cause of Eagle's Syndrome: A Very Rare Case Report

Eagle’s syndrome: embryology, anatomy, and clinical management

Neurological phenotypes and treatment outcomes in Eagle syndrome: systematic review and meta-analysis

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