Transoral, retromolar, para-tonsillar approach to the styloid process in 6 patients with Eagle’s syndrome

K. Scheller,C. Scheller,AW. Eckert

doi:10.4317/medoral.18749

K. Scheller, C. Scheller + Show 1 more

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https://doi.org/10.4317/medoral.18749

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Abstract

Objectives: Eagle’s syndrome is caused by an elongated or mineralised styloid process and characterised by facial and pharyngeal pain, odynophagia and dysphagia. Diagnosis is based on clinical findings. However radiologic imaging, like panoramic radiograph, helps to confirm the diagnosis. There are different treatments of the Eagle’s syndrome. Anti-inflammatory medication (carbamazepime, corticosteroids) and/or surgical interventions are established. The aim of the different surgical techniques is to resect the elongated styloid process near the skull base. Study Design: A transoral, retromolar, para-tonsillar approach was performed to expose and resect the elongated calcified styloid process in a consecutive series of six patients. The use of different angled ring curettes, generally used in hypophysis surgery, facilitated the preparation of the styloid process through the surrounding tissue to the skull base, without a compromise to the surrounding tissue. Clinical examinations were performed pre- and postoperatively (3 month and after 1 year after surgery) in all patients. Results: No intra- or postoperative complications were observed. The hypophysis ring curettes facilitated the preparation of the styloid process to the skull base. Conclusions: The transoral, retromolar, para-tonsillar approach is a secure and fast method to resect an elongated symptomatic styloid process. Side effects of the classical transoral trans-tonsillar approach did not occur. Key words:Retromolar, para-tonsillar approach, Eagle syndrome, clinical features.

Highlights

Eagle’s syndrome was first described in 1937 by Eagle and refers to a rare constellation of neuropathic and vascular occlusive symptoms caused by a pathologic elongation of the styloid process and/or styloid chain [1]
The surgical procedure to resect the elongated symptomatic styloid process was performed by a transoral, retromolar, para-tonsillar approach between 01/2008 – 1/2009 in our department. -Clinical evaluation Most patients’ complained about an ipsilateral pharyngeal foreign body sensation, a dysphagia and a painful limitation of neck mobility to the affected side (Table 1)
Painful trismus, vertigo were less specific and less common. -Radiographic imaging In all patients the length of the symptomatic and nonsymptomatic styloid process was analysed by a digital, conventional panoramic radiograph (Orthophos Plus DS, Sirona, Wels, Austria)

Summary

Introduction

Eagle’s syndrome was first described in 1937 by Eagle and refers to a rare constellation of neuropathic and vascular occlusive symptoms caused by a pathologic elongation of the styloid process and/or styloid chain [1]. Two major procedures of the surgical treatment of Eagle’s syndrome are known and controversially discussed: the extraoral cervical or retroauricular approach and the classical transoral approach through the fossa tonsillaris [15,17,18,19,20]. Both have some considerable advantages and disadvantages and should be performed individually in respect to the patient’s circumstances and the surgeon’s experience

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