The Use of Cone Beam CT(CBCT) in Differentiation of True from Mimicking Eagle's Syndrome

Differentiation of true from mimicking Eagle’s syndrome based on conventional radiography is difficult; however, cone beam computed tomography (CBCT) images can contribute to proper diagnosis of mimicking Eagle’s syndrome. The aim was to study radiological images of a 37-year old female patient (patient #1), with chronic cervicofacial pain who underwent radiological diagnosis with a conventional panoramic machine; another 75-year old male patient (patient #2), with chronic oropharyngeal pain, underwent a radiological diagnosis with the CBCT machine, with a field of a view of 16 × 12 cm. Exposure factors were 120 kVp, 7 mA, with a 20 s exposure time of acquisition. The results show a panoramic image (patient #1) with a pathologically elongated styloid process 46 mm of length, which was surgically removed, releasing the patient from further pain episodes. CBCT acquisition (patient #2) showed an impacted left maxillary canine in the edentulous maxilla and a peculiar elongation of both stylohyoid complexes as impressive, “collar-like”, bilateral, elongated, multiple segmented, calcified stylohyoid complexes, without pressure on the vital neurovascular neck structures, mimicking true Eagle’s syndrome. The impacted maxillary canine was surgically extracted with a subsequent resolution of pain episodes and the cessation of neurological complaints. The conclusions suggest that the use of CBCT images can contribute to differentiating mimicking from true Eagle’s syndrome, which has been rarely reported in the literature.

Eagle's syndrome mimicking dental pain: A case report with a novel surgical approach

PAIN in the craniofacial and neck region can be both intriguing and equally frustrating for the surgeon. This is principally because there is a multitude of related pain syndromes in this region, many of which are lacking in physical signs. Diagnosis then becomes even more dependent on an accurate description of the pain in terms of character, localization, duration, radiation, relieving and exacerbating factors. Familiarity and identification of a more obscure causative factor in a particular case lends itself not only to liberate the patient but also an increased awareness of the practitioner for the need to consider the coinciding minute diagnostic points of otolaryngology, ophthalmology and rhinology besides dentistry and oral surgery. The characteristic elongation of a styloid process may explain some occasions of pharyngeal, ear pain and sometimes headache, which have defied exhaustive diagnostic studies. A large spectrum of signs and symptoms has been mentioned in various reports of Eagle's syndrome. Diagnosis can be made with careful clinical evaluation and confirmed with radiographs showing an elongated styloid process or calcification of the stylohyoid complex. Styloidectomy is the procedural choice for Eagle's syndrome having high success rate. In our case, the intraoral approach for styloidectomy was not the routine one, for which the post-operative outcome was exceptionally good without any complications.

Evaluation of the relationship between stylohyoid complex morphology and maxillary/mandibular position using cone beam computed tomography

BACKGROUND

The aim of this study was to examine the morphologic features of the stylohyoid complex (SHC) and its relation to maxillomandibular position using three-dimensional cone beam computed tomography (CBCT) images.

MATERIALS AND METHODS

CBCT images from 157 individuals (74 females, 83 males) were analysed in this study. SHC length, width, and sagittal and transverse angles were measured. The subjects were grouped as skeletal class I, II, and III in order to determine the relative positions of the maxilla and mandible in the sagittal plane and as hypodivergent, normodivergent, and hyperdivergent according to the vertical rotation of the mandible in relation to the skull base. Mann-Whitney U and Kruskal-Wallis H tests were used for statistical analysis.

RESULTS

Mean SHC length was 23.56 ± 8.05 mm on the right side and 22.0 ± 6.51 mm on the left; mean SHC width was 3.31 ± 1.40 mm on the right and 2.93 ± 1.30 mm on the left. Mean sagittal angle was 27.43 ± 6.75° on the right side, 27.70 ± 6.51° on the left; mean transverse angle was 70.39 ± 4.59° on the right side and 71.79 ± 4.99° on the left. The only significant difference based on skeletal classification was greater SHC length among males compared to females in the class III group (p < 0.05).

CONCLUSIONS

No significant relationship was observed between SHC morphology and position of the maxilla or mandible. However, the gender difference observed among class III subjects suggests that SHC morphology may be affected by craniofacial morphology. Maxillofacial surgeons should investigate this anatomical landmark variation before surgical interventions involving this region, such as temporomandibular joint procedures.