APRIL 12, 2023

Eagle Syndrome: Elongation of styloid process or ossification of stylohyoid ligament

  • Presenting Symptoms: Unilateral tonsillar pain, retromandibular pain, odynophagia, referred otalgia, focal tenderness to palpation

  • Epidemiology: 

    • F>M

    • > 30 years of age

    • Usually unilateral

  • Etiology: Hypothesized to be related to focal trauma (tonsillectomy), endocrine disorders, or end-stage renal disease (ESRD)

  • Pathophysiology: Long styloid process or ossified stylohyoid ligament that causes mechanical irritation of surrounding nerves

  • Diagnosis: CT with 3D reconstruction (preferred modality), X-ray

  • Treatment: 

    • Conservative

      • Analgesia

      • Anticonvulsants

      • Transpharyngeal steroid or lidocaine injection

      • Topical heat

      • Avoid manual fracture; does not usually relieve symptoms

    • Surgical

      • Styloidectomy or styloid reduction —> gold standard of treatment

      • Either intraoral or externally  

        • Caution to avoid CN VII damage

        • Significant risk of failure (~20%)

 

 

      

Badhey A, Jategaonkar A, Anglin Kovacs AJ, Kadakia S, De Deyn PP, Ducic Y, Schantz S, Shin E. Eagle syndrome: A comprehensive review. Clin Neurol Neurosurg. 2017 Aug;159:34-38. 

 

Elmas F, Shrestha BL. Eagle's Syndrome. N Engl J Med. 2017 Sep 28;377(13):e18. 


Further Reading:

General

Related Anatomy

Work Up

Treatment
 

Written by: Graham Pingree

EDUCATIONAL PEARL