Significance of styloidectomy in Eagle’s syndrome: an analysis

Mohanty, Sanjeev; Thirumaran, N. S.; Gopinath, Manoj; Bambha, Gaurav; Balakrishnan, Shalini

doi:10.1007/s12070-009-0079-4

Cited by 17 publications

(19 citation statements)

References 16 publications

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“…The two most common approaches described in the literature are intraoral resection of the styloid process and external resection of the styloid process. Each has its own risk-benefit profile [9,18,53].…”

Section: Treatmentmentioning

confidence: 99%

“…Muscular attachments are removed via subperiosteal dissection. The styloid process is then removed completely in a piecemeal fashion [10,11,53,83]. The operating surgeon must take care to expose and then to avoid the mandibular branch of the facial nerve in the superficial fascia as well as external carotid artery branches within the deep fascia.…”

Section: Treatmentmentioning

confidence: 99%

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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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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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

2012

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“…[10] Both of our cases were younger than the cases reported in literature. One case had unusually elongated styloid process of length 6.97 cm.…”

Section: Discussionmentioning

confidence: 82%

Unusually elongated styloid process: A report of two cases with literature review

Sharma

Ram

Kamal

2016

Ann Maxillofac Surg

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Eagle's syndrome is most often associated with an elongated styloid process or ossified stylohyoid ligament, which may result in cervicofacial pain. Since the symptoms are vague and nonspecific, patients with the Eagle's syndrome are difficult to diagnose. We here report two cases of Eagle's syndrome, one case with unusually elongated styloid process of size 6.97 cm, in whom imaging with computed tomography established the diagnosis and managed by local infiltration of lidocaine and steroid; in another case the length of styloid processes were 3.47 cm and 3 cm respectively and was managed surgically.

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“…En complément de la médication per os, des injections antalgiques à travers la fosse tonsillaire ou vers la petite corne de l'os hyoïde peuvent être effectuées [4,16]. Plusieurs solutions peuvent être injectées : des anesthé-siques locaux comme la lidocaïne ; des stéroïdes (cortisone ou hydrocortisone) avec ou sans anesthésique local comme la bupivacaïne [16,40] ou de l'impletol (un mélange de procaïne et de caféine) [17]. La fracture manuelle de l'élongation du processus styloïde par manipulation transpharyngée a aussi été proposée comme option non chirurgicale mais elle donne peu de résultats positifs [1,3,4,14,16].…”

Section: Thérapeutiqueunclassified

“…De plus, elle peut être à l'origine de dommages vasculaires ou nerveux et entraîner des récidives. L'application de chaleur sur les endroits douloureux ou la médecine chinoise sont des traitements cités dans la littéra-ture mais qui restent peu étudiés [16] [13], la résection doit concerner les deux processus styloïdes si ceux-ci sont allongés [4,16,22,40]. La voie intra-orale peut être réalisée sous anesthésie locale ou bien, le plus couramment, sous anesthésie générale [4,9].…”

Section: Thérapeutiqueunclassified

Prise en charge chirurgicale par voie endobuccale d’une patiente atteinte d’un syndrome d’Eagle : cas clinique et revue de la littérature

Bizet

Margottin

Lagarde

et al. 2016

Med Buccale Chir Buccale

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Résumé -Introduction :Le syndrome d'Eagle est un ensemble de symptômes cervicaux résultant de l'élongation du ligament stylohyoïdien puis de son ossification. De diagnostic souvent tardif, la prise en charge thérapeutique est liée à l'ampleur de la symptomatologie associée. Observation : Une patiente de 35 ans avait été adressée par son médecin généraliste pour des douleurs sous-angulomandibulaires postérieures et cervicales droites modérées depuis trois ans. La rotation de la tête était difficile et la flexion provoquait une sensation d'étouffement. L'examen clinique exobuccal révélait une tuméfaction de faible volume, parotidienne et sous-angulomandibulaire droite, ferme et douloureuse à la palpation. Une radiographie panoramique initiale était réalisée et révélait l'inclusion de la 18 et la présence de processus styloïdiens droit et gauche minéralisés, démesurément longs. Une imagerie complémentaire tomodensitométrique précisait l'élongation et la minéralisation bilatérale des ligaments stylohyoïdiens. L'accumulation de tous ces signes faisait suspecter un syndrome d'Eagle. Un traitement chirurgical, justifié par la symptomatologie douloureuse, avait été proposé en première intention. Une approche intra-orale avait été privilégiée sous anesthésie générale. Un an après l'intervention, la patiente rapportait une nette amélioration des symptômes initiaux. Discussion : Les caractéristiques principales et documentées du syndrome d'Eagle sont répertoriées et discutées à partir d'une revue de la littérature. Celles mises en évidence dans le cas clinique rapporté s'y superposent presque totalement. Conclusion : Le chirurgien oral et le chirurgien-dentiste doivent connaître le syndrome d'Eagle comme une cause de douleur cervico-faciale. Ils ont toute leur place dans le dépistage et la prise en charge des patients concernés par cette pathologie.Abstract -Oral approach for surgical treatment in a patient affected by Eagle syndrome : case report and review of the literature. Introduction: Eagle syndrome is defined as a set of cervical symptoms resulting from the styloid process elongation and then its mineralization. Most often diagnosed late, the therapeutic management is related to the extent of the associated symptoms. Observation: A 35-year-old female patient was referred by her doctor for persistent but moderate pains of the posterior right mandibular angle for the past 3 years. Head rotation was difficult and the flexion induced a sensation of suffocation. An extra-oral clinical exam revealed a weak swelling of the right parotidian and posterior mandibular area, which was firm and painful. An initial panoramic X-ray revealed impaction of the right upper wisdom tooth and elongated right and left styloid processes. A CT scan showed the extension of these mineralized processes. All these signs strongly suggested Eagle syndrome. Based on the painful symptoms, surgical management was proposed to the patient, by a seldom-used oral approach under general anesthesia. One year after, the patient reported a drastic improveme...

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Significance of styloidectomy in Eagle’s syndrome: an analysis

Cited by 17 publications

References 16 publications

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

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

Unusually elongated styloid process: A report of two cases with literature review

Prise en charge chirurgicale par voie endobuccale d’une patiente atteinte d’un syndrome d’Eagle : cas clinique et revue de la littérature

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