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Taneja S, Chand S, Dhar S. Stylalgia and Styloidectomy: A Review. J Maxillofac Oral Surg 2023; 22:60-66. [PMID: 36703673 PMCID: PMC9871118 DOI: 10.1007/s12663-022-01720-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/31/2022] [Indexed: 01/29/2023] Open
Abstract
Stylalgia also referred to as Eagle's or stylohyoid syndrome (first described by Watt Eagle) is a constellation of signs secondary to an elongated styloid process or due to mineralization of the stylohyoid or stylomandibular ligament or the posterior belly of the digastric muscle (Malik et al. in Iran J Otorhinolaryngol 30(6): 101, 2018). The Eagle's syndrome includes symptoms ranging from stylalgia (i.e., pain in the tonsillar fossa, pharyngeal or hyoid region) to foreign-body sensation in the throat, cervicofacial pain, otalgia or even increased salivation or giddiness. Diagnosis is primarily based on symptomatology, physical examination and radiographic investigations and should not be missed. However, palpation of tonsillar fossa with radiological demonstration of the elongated styloid process confirms the diagnosis. Surgical treatment by tonsillo-styloidectomy produces satisfactory results in stylalgia. (Malik et al. in Iran J Otorhinolaryngol 30(6):101, 2018).
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Affiliation(s)
- Saumya Taneja
- Department of Pedodontics and Preventive Dentistry, Inderprastha Dental College, Ghaziabad, Uttar Pradesh India
| | - Sharad Chand
- Department of Dentistry, Government Medical College, Banda, Uttar Pradesh India
| | - Shishir Dhar
- Department of Dentistry, GSVM, Medical College, Kanpur, Uttar Pradesh India
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Kumar PS, Singh DK, Gupta SK, Raina S, Prasad BK. Of Eagle's Syndrome and Finding Some Clarity on Its Management. Indian J Otolaryngol Head Neck Surg 2022; 74:2184-2189. [PMID: 36452859 PMCID: PMC9702270 DOI: 10.1007/s12070-020-02079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022] Open
Abstract
Eagle's Syndrome is a much discussed yet controversial and debatable diagnosis of exclusion which is treated by many specialities with often unsatisfactory results. Due to entrapment/impingement on surrounding neurovascular structures by elongated styloid process patient may present with multitude of symptoms. Treatment is controversial and opinions are divided on choice of conservative and surgical management. Aim was to study outcomes of conservative and surgical modalities of treatment of Eagle's Syndrome and bring some clarity on management, what to offer, to whom and when. This prospective observational descriptive study included 15 patients of Eagle's Syndrome, 7 were treated with conservative method and 8 underwent resection of styloid process with intraoral approach. With objectives in mind to study efficacy of both management modalities, pain visual analogue scale (VAS) scores were recorded pre-intervention, post-intervention and during follow up on 1, 3 and 6 months and compared. Conservative management resulted in up to 70% reduction in pain VAS scores till 3 months of therapy (mean pre-intervention score being 3.71, 3 months-1, 6 months-1.29), while surgical modality resulted in nearly 99% reduction in mean pain VAS scores up to 3 months and even improved after 6 months (mean pre-intervention score being 6.75, 3 months-0.5, 6 months-0.13). With this we can conclude that conservative management provide satisfactory short-term (up to 3 months) results but recurrences are known, while surgical resection of elongated styloid process gives better long-term results (6 months and beyond).
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Affiliation(s)
- Prem Shankar Kumar
- Department of ENT & HNS, Command Hospital (Eastern Command), Kolkata, West Bengal 700027 India
| | - D. K. Singh
- Department of ENT & HNS, Command Hospital (Eastern Command), Kolkata, West Bengal 700027 India
| | - Salil Kumar Gupta
- Department of ENT & HNS, Command Hospital (Eastern Command), Kolkata, West Bengal 700027 India
| | - Sheetal Raina
- Department of ENT & HNS, Command Hospital (Eastern Command), Kolkata, West Bengal 700027 India
| | - B. K. Prasad
- Department of ENT & HNS, Command Hospital (Eastern Command), Kolkata, West Bengal 700027 India
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González-García N, Porta-Etessam J, García-Azorín D. Eagle syndrome: toward a clinical delimitation. Neurologia (Engl Ed) 2021; 36:412-7. [PMID: 34238523 DOI: 10.1016/j.nrleng.2018.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/01/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Orofacial and cervical pain are a frequent reason for neurology consultations and may be due to multiple pathological processes. These include Eagle syndrome (ES), a very rare entity whose origin is attributed to calcification of the stylohyoid ligament or elongation of the temporal styloid process. We present a series of five patients diagnosed with ES. METHODS We describe the demographic and clinical characteristics and response to treatment of 5 patients who attended the headache units of 2 tertiary hospitals for symptoms compatible with Eagle syndrome. RESULTS The patients were 3 men and 2 women aged between 24 and 51, presenting dull, intense pain, predominantly in the inner ear and the ipsilateral tonsillar fossa. All patients had chronic, continuous pain in the temporal region, with exacerbations triggered by swallowing. Four patients had previously consulted several specialists at otorhinolaryngology departments; one had been prescribed antibiotics for suspected Eustachian tube inflammation. In all cases, the palpation of the tonsillar fossa was painful. Computed tomography scans revealed an elongation of the styloid process and/or calcification of the stylohyoid ligament in 3 patients. Four patients improved with neuromodulatory therapy (duloxetine, gabapentin, pregabalin) and only one required surgical excision of the styloid process. CONCLUSIONS Eagle syndrome is a rare and possibly underdiagnosed cause of craniofacial pain. We present 5 new cases that exemplify both the symptoms and the potential treatments of this entity.
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Hajare P, Puneeth Nayak S, Deepthi B, Shashi Kumar T. Eagle's Syndrome: An Underdiagnosed Condition-Case Series in a Tertiary Care Hospital. Indian J Otolaryngol Head Neck Surg 2019; 71:949-952. [PMID: 31742100 DOI: 10.1007/s12070-019-01630-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/05/2019] [Indexed: 11/29/2022] Open
Abstract
To evaluate all the cases of chronic neck pain thoroughly to diagnose eagle's syndrome. Hospital based prospective study done in the department of otorhinolaryngology at our tertiary care hospital from January 2017 to December 2018. We selected 60 subjects in our study who presented to us with complaints of chronic neck pain associated with referred otalgia, along with aggravation of pain with neck movements, odynophagia, throat pain and foreign body sensation in the throat. After thorough clinical examination an orthopantomogram has been done which revealed elongated styloid process. Conservative management with carbamazepine was tried but only temporary relief was noticed in these patients. Hence intra oral tonsillo-styloidectomy was done and patients were followed up to 3 months. Out of 10 patients, 9 were female and 1 was male. 8 patients had bilateral elongated styloid process and 2 patients had unilateral elongation. Orthopantomogram revealed an average elongation of styloid process of 3.5-5 cm and the average length of the removed styloid process ranged from 0.6-3 cm. All patients showed significant improvement post operatively. Eagle's syndrome is not a rarity, but underdiagnosed and missed most of the times. Hence all cases of chronic neck pain should be evaluated thoroughly by taking complete history and proper clinical examination, along with radiological investigations.
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Affiliation(s)
- Priti Hajare
- Department of ENT and HNS, Jawaharlal Nehru Medical College, Belagavi, India
| | - S Puneeth Nayak
- Department of ENT and HNS, Jawaharlal Nehru Medical College, Belagavi, India
| | - B Deepthi
- Department of ENT and HNS, Jawaharlal Nehru Medical College, Belagavi, India
| | - T Shashi Kumar
- Department of ENT and HNS, Jawaharlal Nehru Medical College, Belagavi, India
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Scavone G, Caltabiano DC, Raciti MV, Calcagno MC, Pennisi M, Musumeci AG, Ettorre GC. Eagle's syndrome: a case report and CT pictorial review. Radiol Case Rep 2018; 14:141-145. [PMID: 30405864 PMCID: PMC6218696 DOI: 10.1016/j.radcr.2018.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/14/2018] [Accepted: 10/14/2018] [Indexed: 11/27/2022] Open
Abstract
Eagle's syndrome (ES) refers to symptomatic elongation of the ossified styloid process. A styloid process greater than 2.5 cm in length should be considered abnormal; however, an elongated styloid process is not sufficient for a diagnosis of ES; only an abnormal styloid process in association with symptoms can confirm the syndrome. In this case report, we discuss a 54-year-old man who has come to our attention with various symptoms: dysphagia to both solids and liquids, difficulty swallowing, neck pain, and a foreign body sensation during bilateral neck rotation and mouth opening. The diagnosis is performed radiologically because conventional radiographs have many potential disadvantages, whereas, computed tomography (CT) scans and reconstructions allow the length and angulation of the styloid process to be measured and the relationship between the elongated styloid processes and adjacent anatomical structures to be evaluated. Moreover, CT allows for differential diagnosis and provides detailed information needed for surgical planning.
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Affiliation(s)
- Giovanni Scavone
- Department of diagnostic Radiology, Neuroradiology and interventional radiology, Hospital "Garibaldi", Piazza Santa Maria di Gesù, 5, Catania, CT 95124, Italy
| | - Daniele Carmelo Caltabiano
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico Vittorio-Emanuele", Via Santa Sofia, 78, Catania CT 95124, Italy
| | - Maria Vittoria Raciti
- Radiodiagnostic Unit, University I.R.C.C.S. Policlinico "San Matteo", Viale Camillo Golgi, 19, Pavia, PV 27100, Italy
| | - Maria Carla Calcagno
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico Vittorio-Emanuele", Via Santa Sofia, 78, Catania CT 95124, Italy
| | - Monica Pennisi
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico Vittorio-Emanuele", Via Santa Sofia, 78, Catania CT 95124, Italy
| | - Andrea Giovanni Musumeci
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico Vittorio-Emanuele", Via Santa Sofia, 78, Catania CT 95124, Italy
| | - Giovanni Carlo Ettorre
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico Vittorio-Emanuele", Via Santa Sofia, 78, Catania CT 95124, Italy
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González-García N, García-Azorín D, Porta-Etessam J. Eagle syndrome: Toward a clinical delimitation. Neurologia 2018. [PMID: 30032933 DOI: 10.1016/j.nrl.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES Orofacial and cervical pain are a frequent reason for neurology consultations and may be due to multiple pathological processes. These include Eagle syndrome (ES), a very rare entity whose origin is attributed to calcification of the stylohyoid ligament or elongation of the temporal styloid process. We present a series of five patients diagnosed with ES. MATERIAL AND METHODS We describe the demographic and clinical characteristics and response to treatment of 5 patients who attended the headache units of two tertiary hospitals for symptoms compatible with Eagle syndrome. RESULTS The patients were three men and two women aged between 24 and 51, presenting dull, intense pain, predominantly in the inner ear and the ipsilateral tonsillar fossa. All patients had chronic, continuous pain in the temporal region, with exacerbations triggered by swallowing. Four patients had previously consulted several specialists at otorhinolaryngology departments; one had been prescribed antibiotics for suspected Eustachian tube inflammation. In all cases, the palpation of the tonsillar fossa was painful. Computed tomography scans revealed an elongation of the styloid process and/or calcification of the stylohyoid ligament in three patients. Four patients improved with neuromodulatory therapy (duloxetine, gabapentin, pregabalin) and only one required surgical excision of the styloid process. CONCLUSIONS Eagle syndrome is a rare and possibly underdiagnosed cause of craniofacial pain. We present five new cases that exemplify both the symptoms and the potential treatments of this entity.
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Affiliation(s)
| | - D García-Azorín
- Hospital Clínico Universitario de Valladolid, Valladolid, España
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Singhania AA, Chauhan NV, George A, Rathwala K. Lidocine Infiltration Test: An Useful Test in the Prediction of Results of Styloidectomy for Eagle's Syndrome. Indian J Otolaryngol Head Neck Surg 2014; 65:20-3. [PMID: 24381913 DOI: 10.1007/s12070-012-0577-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 10/05/2012] [Indexed: 11/25/2022] Open
Abstract
Eagle's syndrome is caused by elongated styloid process. Its accepted treatment is styloidectomy. However more than one-fourths of patients undergoing styloidectomy do not experience relief. To find the utility of the lidocaine infiltration test to predict the results of styloidectomy in patients clinically diagnosed as having stylalgia. Twenty-six patients undergoing styloidectomy for Eagle's syndrome were included in the study. They were divided into two groups depending on their response to lidocaine infiltration in the tonsillar fossa. Patients were followed up till 3 months after styloidectomy and their pre operative visual analogue scale for pain was compared with the post operative VAS score. Majority of the patients were females and in the fifth decade of life. There were 18 patients in group I and eight patients in Group II. The groups were similar in terms of age and sex distribution and pre operative VAS score for pain. There was good corelation between post infiltration and post operative VAS scores. The test had 94.44 % sensitivity and 87.5 % specificity. The age and sex distribution and the failure rates in the present study were similar to that reported in other studies. There are many other reasons besides elongation which can cause the typical pain of stylalgia and some of them are not amenable to styloidectomy. The lidocaine infiltration test is an useful test to predict the results of styloidectomy for Eagle's syndrome.
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Affiliation(s)
- Ankit A Singhania
- Department of ENT, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Campus, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Nirali V Chauhan
- Department of ENT, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Campus, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Ajay George
- Department of ENT, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Campus, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Kayedjohar Rathwala
- Department of ENT, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Campus, Piparia, Waghodia, Vadodara, 391760 Gujarat India
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Kaur A, Singh A, Singal R, Gupta S. Is this way: self inflicted fracture of styloid process cures stylalgia. J Med Life 2013; 6:202-4. [PMID: 23904884 PMCID: PMC3725450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 04/18/2013] [Indexed: 11/18/2022] Open
Abstract
The treatment of stylalgia varies from region to region. The initial treatment for stylalgia is conservative and if not relieved, styloidectomy is advised. Styloid process fracture has also given favorable results in many patients. We are presenting a rare case of a 45-year-old man who accidentally fractured his own styloid process and got relieved of stylalgia. According to our research, this is probably the first case in the world. In this case report, the authors also discuss the clinical presentation, differential diagnosis of stylalgia and various lines of management for stylalgia.
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Affiliation(s)
- A Kaur
- Department of Physiology, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Ambala, India
| | - A Singh
- Department Of Otolaryngology (E.N.T) M. M. Institute of Medical Sciences and Research, Mullana, Ambala, India
| | - R Singal
- Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Ambala, India
| | - S Gupta
- Department of Radiodiagnosis and Imaging, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Ambala, India
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