|Year : 2015 | Volume
| Issue : 1 | Page : 59-61
Trans-oral extratonsillar styloidectomy for treatment of Eagle's syndrome
Satnam Singh1, Kamaljit Kaur2, Akshat Gupta1, Gyan R Sahu1
1 Department of Oral and Maxillofacial Surgery, PGIMER, Chandigarh, India
2 Pedodontic and Preventive Dentistry, Rayat Bahara Dental College, Kharar, Punjab, India
|Date of Web Publication||30-Jul-2015|
Dr. Satnam Singh
EX SR PGIMER, CHC Khera, Fatehgarh Sahib, Punjab
Source of Support: None, Conflict of Interest: None
Eagle's syndrome, also known as an elongated styloid process, is a condition that may be the source of craniofacial and cervical pain. It is infrequently reported but is probably more common than generally considered. The symptoms related to Eagle's syndrome can be confused with those attributed to a wide variety of facial neuralgias and/or oral, dental, and temporomandibular joint diseases. Surgical treatment is considered as the best option to remove the styloid process to its normal limit through extraoral or intraoral techniques. We are reporting a case and reviewed the recent literature of trans-oral extratonsillar approach without tonsillectomy and advantage such as simple, time-saving, and without any extra oral scar.
Keywords: Chewing problem, elongated styloid, intraoral surgery, pain
|How to cite this article:|
Singh S, Kaur K, Gupta A, Sahu GR. Trans-oral extratonsillar styloidectomy for treatment of Eagle's syndrome. Saint Int Dent J 2015;1:59-61
|How to cite this URL:|
Singh S, Kaur K, Gupta A, Sahu GR. Trans-oral extratonsillar styloidectomy for treatment of Eagle's syndrome. Saint Int Dent J [serial online] 2015 [cited 2020 Jan 27];1:59-61. Available from: http://www.sidj.org/text.asp?2015/1/1/59/161814
Elongation of the styloid process has been implicated previously in pain syndromes of the craniofacial and cervical regions and is frequently misdiagnosed. In 1937, Eagle first described a case of pain associated to elongation of the styloid process.  He described that any styloid process longer that 25 mm is considered to be responsible for the syndrome.  A "long'' styloid process is defined as more than 4 cm. The incidence of the elongated styloid process has been reported to be between 1.4-30% cases.  Diagnosis can usually be made on physical examination by digital palpation of the styloid process in the tonsillar fossa and radiographically (panoramic radiograph, computed tomography scan, magnetic resonance imaging), etc.  The vagueness of symptoms and the infrequent clinical observations are often misleading, so the correct diagnosis is most important. Dentists and oral surgeon have an important role to play in the diagnosis of Eagle's syndrome, as the presenting symptoms in most cases lead patients to them. The purpose of this article was to discuss a trans-oral extratonsillar approach for removal of a styloid process for Eagle's syndrome.
| Case Report|| |
A 52-year-old patient was referred from Orthopedic Department to Oral and Maxillofacial Surgery with a chief complaint of pain on bending of his neck toward right side and radiated toward retromolar area and palpation of some foreign body in oropharyngeal region extraorally, there was no any swelling and mouth opening of the patient was normal. Intraoral examination reveals no any carious and impacted tooth, no periodontitis, no tonsillitis, on intra-oral palpation deep in the neck a sharp pointed styloid process was palpated. Orthopantamogram (OPG) was advised which shows an enlarged styloid process in the right side as a comparison to the left side [Figure 1]. It was diagnosed as Eagle's syndrome and surgical removal of styloid process intra-orally through extratonsillar approach without tonsillectomy under general anesthesia was planned because of its palpability. Under general anesthesia, the tip of the process was palpalpated, and a small nick was given on the mucosa up to the bone, then soft tissue and ligament were retracted, and it was dissected up to maximum length [Figure 2]. With the help of bone roenger, it was cut and removed [Figure 3]. The wound was left open to prevent any hematoma formation. After 2 weeks patient reported the department with the improvement of his symptoms. There was no postoperative infection or weakness of any nerve and sensory disturbances. Postoperative OPG was taken which showed a reduction of the styloid process [Figure 4]. After 6 months of follow-up, there was complete remission of symptoms.
|Figure 1: Preoperative orthopantamogram showing elongated styloid process|
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|Figure 4: Postoperative orthopantamogram after reduction of styloid process|
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| Discussion|| |
Elongation or mineralization of the stylohyoid process causes Eagle's syndrome, which is characterized by facial and pharyngeal pain, odynophagia, and dysphagia. Eagle first described this syndrome in 1937 as two distinct syndromes [Table 1].  Classic syndrome, which generally follows tonsillectomy, includes symptoms resembling the sensation of a foreign body lodged in the pharynx especially located in the tonsillar fossa, with pain radiated to the ipsilateral ear, accompanied, occasionally by dysphagia and painful swallowing (odynophagia), as much as facial and/or cervical pain like in our case. Rarely, the pain is very intense. Stylocarotid syndrome which did not correlated with a tonsillectomy. It arises whenever the stylohyoid apparatus compresses the internal and/or external carotid arteries, and especially the perivascular sympathetic. It is characterized by cervical pain arising when the internal carotid artery is compressed, provoked and aggravated by rotation, and compression of the neck and radiates to the areas vascularized by the ophthalmic artery with involvement of the supraorbital and parietal regions.  In contrast, if the external carotid artery is irritated, the pain radiates to the infraorbital region.  Conservative treatment options have included transpharyngeal injection of steroids and lignocaine, nonsteroidal anti-inflammatory drugs, diazepam, the application of heat, and transpharyngeal manipulation with manual fracturing of the styloid process. 
|Table 1: Recent published literature of trans-oral approach for Styloidectomy |
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The most satisfactory and effective treatment is surgical shortening or removal of the styloid process through either an intraoral or external approach (Boedts, 1978; Zhang et al., 1987, Chase et al., 1986, Beder et al., 2005, Chrcanovic et al., 2009).  The extraoral approach has the advantages of providing better visualization of the operative field, so if there is any vascular lesion, it is possible to resolve it without major problems. , However, there are some disadvantages, such as the complexity of the technique that demands longer operating time, and an external scar that is not cosmetically pleasing. , Intraoral approach has advantage that they can be done quickly and easy without extensive dissection and scar, but the disadvantage is that, there are poor visibility and chances to the injury to neurovascular bundles near the process and deep neck infections.  Roychowdhury recently described an intraoral extratonsillar approach without any Complication  . In our case extratonsillar, trans-oral approach was used without tonsillectomy to removed styloid process under general anesthesia without any complication. It is considered to be an easy, simple, and time-saving method that can be done under local and general anesthesia as a routine procedure as in our case too.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Eagle WW. Elongated styloid process; symptoms and treatment. AMA Arch Otolaryngol 1958;67:172-6.
Fini G, Gasparini G, Filippini F, Becelli R, Marcotullio D. The long styloid process syndrome or Eagle′s syndrome. J Craniomaxillofac Surg 2000;28:123-7.
Chrcanovic BR, Custódio AL, de Oliveira DR. An intraoral surgical approach to the styloid process in Eagle′s syndrome. Oral Maxillofac Surg 2009;13:145-51.
Buono U, Mangone GM, Michelotti A, Longo F, Califano L. Surgical approach to the stylohyoid process in Eagle′s syndrome. J Oral Maxillofac Surg 2005;63:714-6.
Beder E, Ozgursoy OB, Karatayli Ozgursoy S. Current diagnosis and transoral surgical treatment of Eagle′s syndrome. J Oral Maxillofac Surg 2005;63:1742-5.
Raychowdhury R. The extra-tonsillar approach to the styloid process. Br J Oral Maxillofac Surg 2011;49:e40-1.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]