Eagle Syndrome Research Articles

Expression of Concern: Eagle Syndrome: A Rare Cause of Stroke in a Young Patient.

Expression of Concern: Eagle Syndrome: A Rare Cause of Stroke in a Young Patient.

EAGLE SYNDROME: ETIOLOGY, DIAGNOSIS AND TREATMENT. A LITERATURE REVIEW AND PRESENTATION OF CASES

Objectives: The aim of this poster presentation is to review the etiology, diagnostic process and management of Eagle syndrome. In addition, some cases diagnosed with Eagle syndrome are discussed. Materials and Methods: Searches were conducted in Google Scholar, PubMed and Science Direct databases. Only English language results were reviewed. The following key words were used: “Eagle Syndrome” and “stylohyoid syndrome”. Typical cases will be presented. Results: Eagle Syndrome is a rare clinical condition (4–8 per 10,000 people) that presents with a variety of symptoms. It was first described by Eagle in 1937. It is more common in females than males (2:1 ratio) and in ages mainly greater than 50 years. Eagle syndrome is characterised by elongation of the styloid processes and/or stylohyoid ligament calcification, unilaterally or bilaterally. Due to its atypical symptoms, it is easy to be misdiagnosed. Common symptoms are: facial and neck pain, otalgia or temporomandibular joint pain, dysphagia/odynophagia, foreign body sensation. Other conditions related with Eagle syndrome are: ischemic attacks, carotid artery dissection and Horner’s syndrome. The patient’s history, physical examination and imaging are essential for management of this condition. Three-dimensional reconstructive computed tomographic (CT) scan remains the gold standard for diagnosis, as is shown in our case . Eagle syndrome is commonly treated either with conservative methods (e.g. analgesics, anticonvulsants, local injections) or surgically (intraoral or extraoral approach). Conclusion: Eagle syndrome is rare and difficult to diagnose. Various specialists are involved in its management. Proper diagnosis and treatment are significant due to its potentially serious complications. Surgical treatment is more definitive and provides long lasting relief.

ORAL PRESENTATION: Eagle Syndrome: The Forgotten Entity

Elongated styloid process or Eagle syndrome is a rare condition presenting with a wide range of symptoms including throat pain, foreign body sensation, neck pain and ear pain. Establishing a diagnosis requires a high index of suspicion and understanding of this entity by the physician. Computed tomography (CT) is the gold standard to diagnose Eagle syndrome. Conservative medical treatment with analgesics, oral steroids and anticonvulsants are offered in patients who refused surgery. The mainstay of treatment is surgical resection via intraoral or cervical approaches. We describe a rare case of bilateral Eagle syndrome in a 46-year-old female who was presented with chronic foreign body sensation in the throat but aggravated following fish bone ingestion. Flexible nasopharyngolaryngoscopy (FNPLS) and cervical x-ray did not reveal any foreign body and the patient was treated conservatively. Incidentally, a cervical x-ray also revealed an elongated styloid process bilaterally. Upon follow-up, the patient was still symptomatic. Thus, a CT scan with contrast of the neck was requested, which reported no foreign body, but the presence of bilateral elongated styloid process suggesting Eagle Syndrome. The patient was subjected to transoral endoscopic assisted bilateral styloidectomy following tonsillectomy. There was a complete resolution of the symptoms postoperatively. This approach is recommended to avoid external scarring and minimize postoperative pain. Eagle syndrome is diagnosed based on a combination of physical examination and radiological findings. The treatment options may vary based on the severity of symptoms.International Journal of Human and Health Sciences Supplementary Issue: 2022 Page: S14

Evaluating the relation between the elongated styloid process and the ponticulus posticus using cone-beam computed tomography.

Ponticlus posticus (PP) as a one of the cervical vertebra variations brings about symptoms similar to Eagle syndrome. This study aimed to determine the relationship between elongated styloid process (ESP) and PP in a group of Iranian patients using cone-beam computed tomography (CBCT) images. The CBCT images of 349 patients (118 males and 231 females; mean age: 32.53 ± 14.143) were involved in this study. The atlas vertebra was investigated for the presence and classification of PP (partial or complete) in sagittal views. Also, the styloid process was evaluated for the presence of ESP in reconstructed panoramic and three-dimensional images. Data were analysed using Mann-Whitney test, Fisher's exact test, and Chi-square test to assess the relationship between the presence of PP and ESP with regard to age and gender. Ponticulus posticus was observed in 24.5% of patients with ESP and 31.98% of patients without ESP. There was no significant relationship between the presence of PP and ESP (p = 0.198). Twenty-five patients with ESP showed PP; cases of ESP with either side and opposite side PP were 7.84% and 1.96%, respectively. Cases of bilateral ESP and PP were predominant (14.70%). The mean age of patients with bilateral ESP and PP was higher than others. There was no significant difference between males and females (p = 0.456). Considering the prevalence and characteristics of PP in the case and control groups, there was no significant relationship between PP and ESP.

What you need to know about: arterial cerebrovascular syndromes caused by static or dynamic musculoskeletal compression.

Compressive syndromes of the cervical arteries caused by musculoskeletal structures include bow hunter's syndrome, beauty parlour stroke syndrome, carotid compression by the hyoid bone, carotid compression by the digastric muscle and Eagle syndrome. They are a rare but increasingly recognised group of syndromes, so a high level of suspicion is needed so the diagnosis is not missed. The diagnosis is typically based on a combination of clinical history and advanced imaging investigations. Compression of the arteries may be static (only provoked by compression) or dynamic (exaggerated by movement), and this should be considered when selecting imaging studies. Symptoms resulting from vertebrobasilar insufficiency or ischaemia of areas supplied by the internal carotid artery are caused by compression of the vertebral artery and the internal carotid artery respectively. Surgical procedures are the preferred treatment for most of these syndromes.

Vascular compression syndromes: a pictorial review.

Vascular compression syndromes include a group of rare vascular changes due to extrinsic compression of veins or arteries by surrounding structures. These pathologies are often underestimated due to their rarity, clinicians’ poor level of knowledge, and the non-specificity of their symptoms. The best known are Eagle syndrome, thoracic outlet syndrome, nutcracker syndrome, May-Thurner syndrome, Dunbar syndrome, and popliteal entrapment syndrome. This work summarizes the main ultrasonographic characteristics, symptoms, and treatments of choice for these syndromes. Knowledge of these conditions’ characteristic signs is essential for the differential diagnosis. Failure to diagnose these rare diseases can expose patients to serious complications and risks to their health.

Transcervical styloidectomy for Eagle syndrome.

We demonstrate a safe and effective surgical technique for the operative management of Eagle syndrome, also known as stylohyoid syndrome, via transcervical styloidectomy. Fifteen patients who presented to our institution for surgical management of Eagle syndrome were included. A detailed video shows the operative techniques used to perform styloidectomy via a transcervical approach. The procedure was well tolerated without complications, and all patients were discharged on postoperative day one. Thirteen patients (87%) endorsed significant improvement or complete resolution of their presenting complaint(s), most commonly throat and neck pain/discomfort (53%), otalgia (47%), and/or tinnitus (40%). The transcervical approach for styloidectomy provides an alternative for operative access that overcomes the limitations associated with the transoral approach. It enables better exposure of the operative field, a more efficient procedure, and, in the senior author's experience, results in decreased postoperative pain, trismus, and length of hospital stay.

Eagle's Syndrome.

Eagle's Syndrome.

Eagle’s syndrome (Elongated styloid process) an unrecognized rare cause of neck pain: A case illustration

Eagle syndrome is a rare condition characterized by an abnormally elongated styloid process with or without abnormal direction and/or ossification of the styloid ligament. 45-year-old men with the complaint of left-sided neck pain below the ear for 3 years. The diagnosis of cervical arthrosis was made and physiotherapy was advised for 2 years. Three-dimensional Computed tomography scan revealed bilateral elongated styloid processes: both styloid processes were found to be longer than normal. No vascular compression was documented. Surgery was advised but the patient has refused. The management was conservative with non-steroid analgesics and antalgics. These symptoms are not specific because the symptoms related to this condition can be confused with those attributed to a wide variety of disorders including facial neuralgias, oral, otologic, and spinal diseases. Diagnosis is made with appropriate radiological examination specially cranial 3D CT scan. The treatment of Eagle's syndrome is primarily surgical. The styloid process can be shortened through an intraoral or external approach. Neurosurgeons, Otolaryngologists, and dental surgeons should be aware of the existence and incidence of this clinical entity, which is associated with reduced quality of life.

Eagle's syndrome (Elongated styloid process) an unrecognized rare cause of neck pain: A case illustration

Eagle's syndrome (Elongated styloid process) an unrecognized rare cause of neck pain: A case illustration

Asymptomatic right internal carotid artery pseudoaneurysm and Eagle's syndrome

A healthy 21-year-old man presented with a right neck palpable mass and calcifications diagnosed during a Panorex odontologic study. Computed tomography angiography imaging of the neck demonstrated a right common and internal carotid artery (ICA) pseudoaneurysm with irregular thrombus and calcifications causing severe right ICA stenosis (A, B). An elongated styloid process was identified adjacent to the pseudoaneurysm associated with ossification of the stylohyoid ligaments (C/Cover). A diagnosis of stylocarotid artery syndrome, a subtype of Eagle's syndrome, was considered and operative treatment recommended, given the pseudoaneurysm appearance with large thrombus and stenosis of the ICA.

Complications in intraoral versus external approach for surgical treatment of Eagle syndrome: A systematic review and meta-analysis

ABSTRACT Objective The surgical treatment of Eagle syndrome involves an intra- or extraoral approach. This systematic review set out to consolidate current knowledge on the prevalence of complications associated with intraoral and external approaches. Methods Seven main electronic and two gray literature databases were searched. Studies were blindly selected by two reviewers based on pre-defined eligibility criteria. Studies evaluating any type of complication in the treatment of Eagle syndrome were considered eligible. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for studies reporting prevalence data, case reports, and case series. The Comprehensive Meta-Analysis software (Software version 3.0 – Biostat, Englewood, NJ, USA) was used to perform all meta-analyses. Results Out of 1728 articles found on all databases, 36 were included for qualitative analysis. Twenty were included for quantitative analysis and meta-analysis. Conclusion In this study, the highest rate of complications was found in the intraoral approach.

Eagle's Syndrome.

Eagle's Syndrome.

An epidemiological study of elongation of styloid process in the saurashtra population: A retrospective radiographic digital orthopantomographic study

Introduction: The styloid process (SP) is a cylindrical bony structure emerging from the lower surface of the petrous temporal bone, its normal length is from 20 mm to 30 mm and those with more than 30 mm length are considered elongated. Calcification in stylohyoid ligament or calcification of SP is termed Eagle's syndrome. The aim of this study is to conduct an epidemiological survey of SP on digital orthopantomogram (OPG) in the Saurashtra population with an age range of 5–90 years. Materials and Methods: This is a retrospective study of 1088 OPG radiographs randomly selected from the database of 2019–2020 from the oral medicine and radiology department of our institute, which was taken on the OPG model CS 8100 Carestream digital panoramic system. Measurements of SP were done from the temporal bone to the tip. Those with more than 30 mm in length were considered to be elongated. The study sample was divided into four different age groups and was compared according to gender and sides. The Chi-square test and t-test were performed. Results: Elongated SP was noted in 354 (32.53%) out of 1088 subjects. Among age groups, subjects of more than 50 years showed a maximum number of elongated SPs. Conclusion: Subjects showing elongated SP and their mean length are increased with age, which indicates chronic development of calcification. No statistical significance was found in the elongation of SP in correlation with the cohort's gender and sides (bilateral or unilateral).

Evaluation Of Postoperative Symptom Relief With Styloidectomy Procedure For Eagle Syndrome: A Case Series From A National-Accredited Center

Evaluation Of Postoperative Symptom Relief With Styloidectomy Procedure For Eagle Syndrome: A Case Series From A National-Accredited Center

Intra-Oral Approach For Eagle Syndrome (Case Report)

Eagle syndrome occur due to calcification of the stylohyoid ligament or elongation of styloid process, which then produce a pain in the jaw, back of throat, base of the tongue, ears, neck and face as well as difficulty swallowing and sensation of having a foreign object in the throat. Classic eagle syndrome is present on only one side; however, it may be present on both sides.

Three-dimensional navigation in maxillofacial surgery - the way to minimize surgical stress and improve accuracy in fibula free flap and Eagles syndrome surgical procedures.

Surgical navigation with three-dimensional (3D) printing techniques presents two major advantages: First, from atechnical aspect, it facilitates orientation in target anatomical structures resulting in improvement of the accuracy of surgery. Moreover, it shortens the time of complex surgical interventions by preparing the exact position of customized autologous grafts with fixation devices. Second, from aclinical point of view, it also lessens the impact of surgical stress to adjacent tissues by decreasing the duration of surgery. Two maxillofacial procedures were evaluated in this study using 3D navigation and planning approach - resection of the styloid process due to Eaglessyndrome and microvascular mandibular reconstruction with the fibula free flap. All patients who underwent these procedures were divided into two groups (with or without 3D navigation). In the Eaglessyndrome group procedure independent t-test showed significant difference in the operating time between group 1 (M = 148; SD = 0) and group 2 (M = 78; SD = 4.24) t (1) = 13.472; P = 0.047. There was no significant difference in the duration of postoperative hospitalization (2 days), which was equal in all patient groups. Regarding the fibula free flap procedure, the independent t-test revealed significant difference in operating time with (M = 8: 40 : 25; SD = 0 : 58 : 07) and without 3D printing guides (M = 10 : 43 : 15; SD = 3 : 04 : 32) t (14)=2.133, P = 0.051. Similarly, there was no significant difference between groups (group 1 M = 15.5; SD = 0,71; group 2 M = 13; SD = 1,63) in the duration of postoperative hospitalization time t (4) =1,98; P = 0.119. In summary, reduction in operation time in Eaglessyndrome and in microvascular mandibular reconstruction with the fibula free flap group mitigates the surgical stress on target tissues enabling faster tissue healing and quicker recovery.

PROCESSO ESTILOIDE ALONGADO NAS RADIOGRAFIAS PANORÂMICAS EM UMA SUBPOPULAÇÃO

Styloid process elongation associated with symptoms such as cervicofacial pain, tinnitus and otalgia is called Eagle Syndrome. The objective of this study is to assess the presence of elongated styloid process through panoramic radiographs, in a subpopulation of the State of Para, Brazil, as to age and sex. Panoramic radiographs were selected and the apparent size of the styloid process was measured from the point where the styloid leaves the tympanic plate to the lower tip of the process. Data were analyzed by means of chi-square tests and the “t” test with a significance level of 5%. Forty-three percent of all elongated styloid processes were observed in patients aged between 18 and 35 years old. Of these styloid processes measuring more than 30 mm, there were 815 that showed a Type I elongation pattern, being 98 that showed a Type II calcification pattern and 92 showed a Type III calcification pattern. It is concluded that the Type I elongated styloid process was the most frequent, but no statistically significant correlation was found between the presence of the elongated styloid process and the studied variables.

The Eagle Has Landed: an unusual case of Eagle’s syndrome

Eagle’s syndrome refers to a group of characteristic symptoms affecting the oropharynx and neck that are caused by regional compression of structures due to a calcified stylohyoid ligament or an elongated styloid process. Of its two types, the former type is more common than the latter, but carotid artery dissection as a result of an elongated styloid is exceptionally rare. Following an extensive literature review, we present a case of carotid artery dissection causing multiple strokes secondary to direct compression from an elongated styloid process. Managed surgically through excision of the elongated styloid and post-operative rehabilitation, the patient recovered well and was discharged on anti-thrombotic medication, preventing further potentially detrimental attacks.

Eagle Syndrome Unmasked by Acute Parotitis

Eagle Syndrome is elongation of the styloid process or calcification of the stylohyoid ligament that causes chronic neck and throat pain often precipitated by turning the head and frequently requires surgical treatment. However, Eagle Syndrome can also present acutely due to infections of the head and neck. In these cases, treatment of the infection with antibiotics and steroids can resolve symptoms. We highlight a case in which the patient developed acute parotitis and the cervicofacial soft tissue edema from infection caused the patient to have symptomatic Eagle Syndrome with throat pain and dysphagia due to a previously asymptomatic ossified stylohyoid ligament. Including Eagle Syndrome as part of the differential resulted in a non-surgical treatment plan with full remission of the patient’s symptoms.