Eagle syndrome

  • Mladen Gasparini Oddelek za kirurgijo oddelek, Splošna bolnišnica Izola
  • Primož Praček Oddelek za kirurgijo oddelek, Splošna bolnišnica Izola
  • Jani Muha Oddelek za kirurgijo oddelek, Splošna bolnišnica Izola
  • Uroš Tomić Oddelek za kirurgijo oddelek, Splošna bolnišnica Izola
Keywords: eagle syndrome, styloid process, computed tomography

Abstract

Background: In the present article we present the characteristics of Eagle syndrome, which is an often overlooked cause of chronic pain in the neck and head. The syndrome is caused by the compression of an elongated styloid process on the adjacent cranial nerves or the carotid arteries. Since there are disparate data in the literature regarding the proportion of people with an elongated styloid process, we conducted a survey to determine the percentage of patients with an elongated styloid process in a group of subjects who underwent computed tomographic imaging of the neck vessels in our institution.

Methods: We analyzed the images of 104 patients who were referred to our institution for computed tomographic angiography of the neck between the years 2014 and 2016. With the help of a software measurement tool, we determined the length of the styloid processes and compared the length of the processes on both sides and in both genders. Patients with an elongated styloid process were reviewed for any symptoms of Eagle syndrome.

Results: The average age of the reviewed patients was 67.1 years. Both genders were equally represented (51 % men and 49 % women). The average length of the styloid process was 23.8 (7.0) mm, with 23 patients (22.1 %) having a styloid process longer than 30 mm. In one third of those patients the styloid process was elongated bilaterally. There were no differences in the average length of the styloid process between men and women and between the left and the right side. Among patients with an elongated styloid process, only one (4.3 %) had symptoms attributable to the Eagle syndrome.

Conclusions: Eagle syndrome should be suspected in a patient with repetitive, dull pain in the throat and neck, which worsens during speaking, chewing or swallowing. The diagnosis is confirmed by computed tomography which could demonstrate an elongated styloid process and exclude other causes for neck pain. With regard to the results of our study, an elongated styloid process is found in a relatively high percentage of patients but the condition is only rarely symptomatic.

Downloads

Download data is not yet available.

References

Al Weteid AS, Miloro M. Transoral endoscopic-assisted styloidectomy: How should Eagle syndrome be managed surgically? International Journal of Oral and Maxillofacial Surgery. 2015;44(9):1181–7.

Baddour HM, Anear JT, Tilson AB. Eagles syndrome report of case. Br J Oral Surg. 1978;36:486–91.

Krennmair G, Piehslinger E. Te Incidence and Influence of Abnormal Styloid Conditions on the Etiology of Craniomandibular Functional Disorders. CRANIO®. 1999;17(4):247–53.

Moffat DA, Ramsden RT, Shaw HJ. The styloid process syndrome: etiological factors and surgical management. J Laryngol Otol;1977:91:279–94.

Piagkou M, Anagnostopoulou S, Kouladouros K, Piagkos G. Eagle’s syndrome: A review of the literature. Clinical Anatomy. 2009;22(5):545–58.

Montalbetti L, Ferrandi D, Pergami P, Savoldi F. Elongated styloid process and Eagle’s syndrome. Cephalalgia. 1995;15(2):80–93.

Eagle WW. Elongated Styloid Process: Symptoms and Treatment. Archives of Otolaryngology–Head and Neck Surgery. 1958;67(2):172–6.

Monsour PA, Young WG. Variability of the styloid process and stylohyoid ligament in panoramic radiographs. Oral Surgery, Oral Medicine, Oral Pathology. 1986;61(5):522–6.

Zuber M, Meder JF, Mas JL. Carotid artery dissection due to elongated styloid process. Neurology. 1999;53(8):1886–7.

Koivumäki A, Marinescu-Gava M, Järnstedt J, Sándor GK, Wolff J. Trauma induced eagle syndrome. International Journal of Oral and Maxillofacial Surgery. 2012;41(3):350–3.

Murthy PSN, Hazarika P, Mathai M, Kumar A, Kamath MP. Elongated styloid process: An overview. International Journal of Oral and Maxillofacial Surgery. 1990;19(4):230–1.

Moon C-S, Lee B-S, Kwon Y-D, Choi B-J, Lee J-W, Lee H-W, et al. Eagle’s syndrome: a case report. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2014;40(1):43.

Chuang WC, Short JH, McKinney AM. Reversible lef hemispheric ischemia secondary to carotid compression in Eagle syndrome: surgical and CT angiographic correlation. Am J Neuroradiol. 2007;28(1):143–5.

Ceylan A, Köybaşioğlu A, Çelenk F, Yilmaz O, Uslu S. Surgical Treatment of Elongated Styloid Process: Experience of 61 Cases. Skull Base. 2008;18(05):289–95.

Pierrakou ED. Eagle’s syndrome. Review of the literature and a case report. Ann Dent. 1990;49(1):30–3

Rechtweg JS, Wax MK. Eagle’s syndrome: A review. American Journal of Otolaryngology. 1998;19(5):316–21.

Prasad KC, Kamath MP, Reddy KJM, Raju K, Agarwal S. Elongated styloid process (Eagle’s syndrome): A clinical study. Journal of Oral and Maxillofacial Surgery. 2002;60(2):171–5.

Eagle WW. Symptomatic elongated styloid process Report of Two Cases of Styloid Process-Carotid Artery Syndrome with Operation. Archives of Otolaryngology–Head and Neck Surgery. 1949;49(5):490–503.

Raser JM, Mullen MT, Kasner SE, Cucchiara BL, Messe SR. Cervical carotid artery dissection is associated with styloid process length. Neurology. 2011;77(23):2061–6.

Bafaqeeh SA. Eagle syndrome: classic and carotid artery types. J Otolaryngol. 2000;29(2):88–94.

More CB, Asrani MK. Eagle’s Syndrome: Report of Tree Cases. Indian Journal of Otolaryngology and Head & Neck Surgery. 2011;63(4):396–9.

Langlais RP, Miles DA, Van Dis ML. Elongated and mineralized stylohyoid ligament complex: A proposed classification and report of a case of Eagle’s syndrome. Oral Surgery, Oral Medicine, Oral Pathology. 1986;61(5):527–32.

Nayak DR, Pujary K, Aggarwal M, Punnoose SE, Chaly VA. Role of three-dimensional computed tomography reconstruction in the management of elongated styloid process: a preliminary study. The Journal of Laryngology & Otology. 2007;121(04).

Chrcanovic BR, Custódio ALN, de Oliveira DRF. An intraoral surgical approach to the styloid process in Eagle’s syndrome. Oral and Maxillofacial Surgery. 2009;13(3):145–51.

Chase DC, Zarmen A, Bigelow WC, McCoy JM. Eagle’s syndrome: A comparison of intraoral versus extraoral surgical approaches. Oral Surgery, Oral Medicine, Oral Pathology. 1986;62(6):625–9.

Moon C-S, Lee B-S, Kwon Y-D, Choi B-J, Lee J-W, Lee H-W, et al. Eagle’s syndrome: a case report. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2014;40(1):43.

Mortellaro C, Biancucci P, Picciolo G, Vercellino V. Eagle’s Syndrome: Importance of A Corrected Diagnosis and Adequate Surgical Treatment. Journal of Craniofacial Surgery. 2002;13(6):755–8.

Torres AC, Guerrero JS, Silva HC. A Modified Transoral Approach for Carotid Artery Type Eagle Syndrome. Annals of Otology, Rhinology & Laryngology. 2014;123(12):831–4.

Camarda AJ, Deschamps C, Forest D. I. Stylohyoid chain ossifcation: A discussion of etiology. Oral Surgery, Oral Medicine, Oral Pathology. 1989;67(5):508–14.

Bertossi D, Albanese M, Chiarini L, Corega C, Mortellaro C, Nocini P. Eagle Syndrome Surgical Treatment With Piezosurgery. Journal of Craniofacial Surgery. 2014;25(3):811–3.

Tian L, Dou G, Zhang Y, Zong C, Chen Y, Guo Y. Application of surgical navigation in styloidectomy for treating Eagle’s syndrome. Terapeutics and Clinical Risk Management. 2016:575.

Ogura T, Mineharu Y, Todo K, Kohara N, Sakai N. Carotid Artery Dissection Caused by an Elongated Styloid Process: Tree Case Reports and Review of the Literature. NMC Case Report Journal. 2015;2(1):21–5.

Fusco DJ, Asteraki S, Spetzler RF. Eagle’s syndrome: embryology, anatomy, and clinical management. Acta Neurochirurgica. 2012;154(7):1119–26.

Eagle WW. ELONGATED STYLOID PROCESSES: Report of Two Cases. Archives of Otolaryngology–Head and Neck Surgery. 1937;25(5):584–7.

İlgüy D, İlgüy M, Fişekçioğlu E, Dölekoğlu S. Assessment of the Stylohyoid Complex with Cone Beam Computed Tomography. Iranian Journal of Radiology. 2012;10(1):21–6.

Ramadan SU, Gokharman D, Tunçbilek I, Kacar M, Koşar P, Kosar U. Assessment of the stylohoid chain by 3D-CT. Surgical and Radiologic Anatomy. 2007;29(7):583–8.

Başekim CÇ, Mutlu H, Güngör A, Şilit E, Pekkafali Z, Kutlay M, et al. Evaluation of styloid process by three-dimensional computed tomography. European Radiology. 2004;15(1):134–9.

Yilmaz MT, Akin D, Cicekcibasi AE, Kabakci ADA, Seker M, Sakarya ME. Morphometric Analysis of Styloid Process Using Multidetector Computed Tomography. Journal of Craniofacial Surgery. 2015;26(5):e438-e43.

Correll RW, Jensen JL, Taylor JB, Rhyne RR. Mineralization of the stylohyoid-stylomandibular ligament complex. Oral Surgery, Oral Medicine, Oral Pathology. 1979;48(4):286–91.

Kaufman SM, Elzay RP, Irish EF. Styloid Process Variation: Radiologic and Clinical Study. Archives of Otolaryngology–Head and Neck Surgery. 1970;91(5):460–3.

Öztunç H, Evlice B, Tatli U, Evlice A. Cone-beam computed tomographic evaluation of styloid process: a retrospective study of 208 patients with orofacial pain. Head & Face Medicine. 2014;10(1).

Gözil R, Yener N, Çalgüner E, Araç M, Tunç E, Bahcelioğlu M. Morphological characteristics of styloid process evaluated by computerized axial tomography. Annals of Anatomy–Anatomischer Anzeiger. 2001;183(6):527–35.

Ekici F, Tekbas G, Hamidi C, Onder H, Goya C, Cetincakmak MG, et al. Te distribution of stylohyoid chain anatomic variations by age groups and gender: an analysis using MDCT. European Archives of Oto-Rhino-Laryngology. 2012;270(5):1715–20.

Keur JJ, Campbell JPS, McCarthy JF, Ralph WJ. The clinical significance of the elongated styloid process. Oral Surgery, Oral Medicine, Oral Pathology. 1986;61(4):399-404.

Published
2017-06-05
How to Cite
1.
Gasparini M, Praček P, Muha J, Tomić U. Eagle syndrome. TEST ZdravVestn [Internet]. 5Jun.2017 [cited 27Apr.2024];86. Available from: http://vestnik-dev.szd.si/index.php/ZdravVest/article/view/1894
Section
Original article