Elongated Styloid Process Research Articles

Prevalence and Characteristics of Eagle's Syndrome in a Syrian Population: A Cross-Sectional Descriptive Study.

Objectives Elongation of the styloid process causes different symptoms with varying degrees of severity in some people. This elongation can be detected haply during routine reading of panoramic X-ray. The aim of this study is to determine the prevalence rate of Eagle's syndrome among a population from Damascus, Syria, and to evaluate the accompanying clinical symptoms. Methods This is a descriptive epidemiological study including 3,962 patients who attended one of the many dental clinics of educational and/or healthcare institutions in Damascus. All digital panoramic radiographs were reviewed, and the styloid processes were measured and assessed for elongation. Patients with styloid process of more than 3 cm in length were contacted and their consents were obtained to participate in the study to assess the presence of clinical symptoms. Results Radiographic elongation of the styloid process was found in 179 out of the 3,962 assessed dental records (prevalence rate was 4.5%). Length ranged from 30 to 90 mm, with an average of 55.9 mm. Of the patients with elongated styloid process, 10.2% had undergone tonsillectomy. All patients who underwent tonsil surgeries were symptomatic with at least three of the studied symptoms. Symptoms included peri-orbital pain (40.9%), orbital pain (35.2%), neck and shoulders pain (52.3%), ipsilateral headache (58%), earache (30.7%), tinnitus (37.5%), articular clicking (29.5%), throat pain (31.8%), globus sensation (22.7%), and dysphagia (21.6%). Conclusions The prevalence of Eagle's syndrome according to this study was 4.5%. Patients who had undergone tonsillectomy were more likely to be more symptomatic. The most common symptom was severe headache (migraine) on the same side of styloid elongation. Panoramic radiography is a low-cost means that can be helpful in the diagnosis of vague pain and symptoms caused by Eagle's syndrome in the head and neck regions.

Chronically misdiagnosed Eagle's syndrome, treated through transoral styloidectomy: a rare case report.

A 39-year-old man who is a farmer and a driver was presented with complaints of ongoing, excruciating discomfort in the back of his left ear. Before the exam, he took a variety of drugs, various drugs 2 years without receiving a definitive diagnosis. Axial, coronal, and sagittal computed tomography scans of both petrous bones were analyzed, and the results showed aberrant styloid process elongation and calcification of the stylohyoid ligament. ES, shares many symptoms with other regional illnesses. Physicians frequently misdiagnose cases of ES and treat them without providing a conclusive diagnosis or treatment. ES diagnosis can be difficult for otolaryngologists and primary care providers due to its similarity with other regional illnesses. However, surgical intervention can result in consistent and significant symptomatic improvement when correctly diagnosed. The case presented in the report was successfully diagnosed as ES and treated surgically through transoral approach styloidectomy.

Eagle’s Syndrome: a Systematic Review

<b>Introduction:</b> Eagle’s syndrome (ES) is a rare condition characterized by an elongated styloid process or a calcified stylohyoid ligament. It manifests itself with many symptoms related to anatomical involvement and caused by compression of regional structures, such as temporomandibular disorders, ear pathologies, and facial pain.</br></br> <b>Material and methods:</b> Major online medical databases, including PubMed, Embase, Scopus, and Web of Science were searched to gather all studies regarding symptoms, diagnosis, treatment, coexistence with other diseases and anatomical aspects of the ES.</br></br> <b>Results:</b> A total of 56 studies were included in this systematic review and divided into 5 categories: (1) anatomy and prevalence (n = 19); (2) symptoms (n = 9); (3) diagnosis (n = 8); (4) treatment (n = 20); (5) coexistence with other diseases (n = 5).</br></br> <b>Conclusion:</b> Considering the prevalence of ES and its nonspecific symptoms, it can often lead to misdiagnosis. Hence, all physicians and dentists shall include the ES in the differential diagnosis of cervicofacial and pharyngeal pain.

A CLINICAL STUDY OF THE PATIENTS WITH STYLOID NEURALGIA

INTRODUCTION Eagle syndrome is a rare disorder produced on by the styloid process lengthening or the stylohyoid ligament being calcified. Eagle syndrome patients frequently experience dysphagia, dysphonia, cough, voice changes, otalgia, sore throat, face pain, a feeling of a foreign body, headache, vertigo, and neck pain. When a patient experiences unilateral idiopathic pain, especially in adult women, and the pain is not relieved by analgesics, Eagle's syndrome should always be taken into account. For symptoms that are not identifiable, patients see multiple doctors with varied outcomes. MATERIAL & METHOD This study was performed as a retrospective study in Asian institute of medical sciences on 68 patients with elongated styloid process between January 2022 to October 2022 with symptoms of throat pain, otalgia, foreign body sensation in throat and neck pain.In these situations, a multidisciplinary approach and early radiological evaluation, particularly an x-ray of the styloid process, are necessary. CONCLUSION This study was conducted to establish a correct diagnosis, determine the underlying reason of the patient's ambiguous symptoms, and evaluate the effectiveness of gabapentin and carbamezapine. Keywords: Styloid Neuralgia, Styalgia, styloid process

Elongated styloid syndrome mimicking temporomandibular joint disorders: a case report and short literature review.

Elongated styloid syndrome (ESS) can present with myriad symptoms that mimic common features of orofacial pain, such as temporomandibular joint disorders (TMJDs), often causing a challenge and delay in diagnosis. We report the case of a 52-year-old male with a three-year history of non-painful clicking during jaw movement initially diagnosed as TMJD-related internal derangement. The patient presented with a history of annoying jaw sounds for three years, described as a popping sound without bilateral clicking or crepitation. Tinnitus and progressive hearing loss were observed in the right ear, and a hearing aid was recommended by an otolaryngologist. The patient was initially diagnosed with TMJD and managed accordingly; nevertheless, his symptoms persisted. Imaging revealed prominent bilateral styloid process elongation that exceeded the recognized cut-off level of >30 mm for elongation. The patient was informed of his diagnosis and its treatment but opted only for further swallowing and auditory assessments of his ear and nose symptoms. Clinicians should consider including ESS as a differential diagnosis in patients presenting with non-specific chronic orofacial symptoms for timely diagnosis and favorable clinical outcomes.

Eagle jugular syndrome presenting with intracranial hypertension - Diagnosis and illustration of pathophysiology by multi-modality imaging.

Eagle jugular syndrome is an uncommon condition caused by compression of an elongated styloid process onto the internal jugular vein. Its presentation is non-specific but may represent in severe clinical consequences including venous thrombosis and intracranial haemorrhage. Thorough understanding of local anatomy is important in understanding the pathogenesis and establishing the diagnosis. Our case reported here illustrates the use of multimodality imaging, including dynamic Computer tomography manoeuvre, in identifying the site of obstruction and guidance towards successful surgical treatment.

Evaluation of Stylohyoid Ligament Calcifications in the Central Anatolian Region

This study aims to determine the prevalence of the elongated styloid process (ESP) on panoramic radiographs in a Turkish subpopulation and to investigate the relationship between SP lengths and the age and gender of individuals. Digital panoramic radiographs of 1000 patients who applied to Necmettin Erbakan University, Faculty of Dentistry, Dentomaxillofacial Radiology Clinic for the first examination between January 2020 and January 2022 were obtained from the database and examined. Individuals were evaluated by dividing them into three groups according to their age SP lengths were measured on both sides, and those greater than 30 mm were contemplated elongated. The data were evaluated in the SPSS V.21 program. In 1000 evaluated patients, ESP of >30 mm was detected in 304 individuals. It was determined that SP length did not differ according to age groups, gender, and systemic disease (p<0.05). Panoramic radiographs are useful, economical, and easily reachable diagnostic equipment in the diagnosis of symptomatic or asymptomatic ESP. Furthermore, it would be more useful to evaluate the prevalence of ESP with larger sample groups and advanced imaging methods.

Management of eagle syndrome.

Eagle syndrome is a challenging clinical presentation with important potential complications. It can be misdiagnosed due to lack of awareness; this review provides information in terms of diagnosis and management of eagle syndrome. The importance of early diagnosis of this rare disease is preventing the delay in clinical-surgical treatment. As there is not a universally accepted cut-off for styloid process length, the diagnosis should be confirmed by length of process greater than one-third of the length of mandibular ramus in addition to other clinical symptoms and signs. There are both surgical and pharmacological treatment options for these patients. Eagle syndrome is a rare clinical condition and its diagnosis is made by physical examination and radiography. When it is suspected by physical examination, definitive diagnosis is confirmed by computed tomography scans of the skull, as the gold standard. Location, degree of elongation of styloid process, and severity and reproducibility of symptoms are important factors in deciding the most appropriate approach. Surgery is frequently the treatment of choice in Eagle syndrome patients. With proper diagnosis and treatment, the prognosis is favourable and recurrence is uncommon.

Elongated Styloid Process Can be Made Responsible for Recurrent Embolic Stroke Only if Eagle Syndrome is Present

With interest we read the article by Xu et al. on a 59 year-old male with recurrent episode of left hemispheric, embolic stroke [1]. Elongated styloid process (ESP) and carotid web pocket were identified as causes of recurrent stroke [1]. After resection of the ESP and resection of the carotid web, the patient became asymptomatic during a 6 months follow-up [1]. The study is excellent but has limitations that are cause of concerns and should be discussed. The main limitation of the study is that alternative causes of embolic stroke were not entirely ruled out. We should know whether there were any indications for alternative causes of embolic stroke, such as heart failure, atrial fibrillation, Takotsubo syndrome. noncompaction, endocarditis, valve abnormalities, or myocarditis. Missing in this respect are echocardiography and ultrasound of vertebral arteries. As long as all these alternative sources of embolism were not adequately ruled out, ESP and carotid web pocket cannot be made responsible for recurrent stroke with certainty. There is also no mention of inflammatory parameters, blood coagulation parameters, platelet counts, troponin values, and pro brain-natriuretic peptide (proBNP). A strong argument against the ESP as the cause of recurrent stroke is that ESP presumably existed already for a long time. No explanation is provided why it became symptomatic just at age 58 years. Where there ever any sudden neurological deficits recognised during previous years (>1.5 years before)? Another argument against ESP as the cause of recurrent stroke is that the index patient did not present with typical Eagle syndrome also referred as stylohyoid syndrome, styloid syndrome, or styloid–carotid artery syndrome [2]. Eagle syndrome is clinically characterised by orofacial and cervical pain often triggered by neck movements, by dysphagia, facial palsy, slurred speech, and vertigo [2]. Eagle syndrome can be associated with ankyloting spondylitis [3], which should have been ruled out in the index patient. The diffusion weighted imaging (DWI) lesions shown in figure 1 panel A do not explain right-sided weakness of the upper limb and amaurosis. The precentral lesions are too small and not directly in the area of the cortical upper limb representation to explain limb weakness. Regarding unilateral amaurosis, we should know whether ophthalmologists ever documented occlusion of the central retinal artery. Amaurosis triggered by head flexion suggests that each time the head is flexed embolization into the left central retinal artery occurs, which is rather unlikely. Clamping of the carotid artery by head flexion is unlikely since no cerebral symptoms with head flexion were reported [1]. Another argument against amaurosis as a manifestation of ESP is that no such cases have been previously reported. Overall, the interesting study has limitations that call the results and their interpretation into question. Addressing these issues would strengthen the conclusions and could improve the status of the study. Before attributing recurrent embolic stroke to ESP and carotid web, it is crucial to adequately rule out all alternative causes of embolic stroke. Recurrent unilateral amaurosis triggered by head flexion cannot be easily explained by ESP.

A rare case of Carotid Dissection seen in Vascular Eagle Syndrome (P3-5.024)

<h3>Objective:</h3> NA <h3>Background:</h3> Vascular eagle syndrome occurs when an elongated styloid process causes impingement to a carotid artery. Four percent of the general population have an elongated styloid process; only four percent are symptomatic. Clinical manifestations occur due to angulation in the middle or end of the styloid, in which turning the head might compress the carotid artery or even tear the vessel itself. Some manifestations include syncope from irritation of the sympathetic plexus, restriction in blood flow, transient ischemic attack, and carotid dissection. <h3>Design/Methods:</h3> NA <h3>Results:</h3> This is an 82-year-old man who presented due to sudden onset of left-sided hemiparesis, urinary incontinence, and aphasia upon awakening. His medical history was significant for recent atrial fibrillation with a pacemaker (not on anticoagulation), hypertension, and hyperlipidemia. Neurological examination revealed left pronator drift, hemisensory neglect on simultaneous tactile stimulation, and a positive left plantar reflex. Computed tomography angiogram (CTA) head and neck revealed a short segment nonflow-limiting dissection of the right mid-cervical internal carotid artery. Magnetic resonance imaging (MRI) of the brain showed multiple areas of cortical and subcortical hyperintense diffusion and T2 foci involving the right frontoparietal and insular cortex most consistent with late acute infarct. Further review showed an elongated styloid process impinging on the right carotid artery. Due to this patient’s age and risk factors, he was not a candidate for surgical intervention. He was started on a heparin drip and bridged to warfarin for secondary stroke prevention for both extracranial cervical dissection and concurrent atrial fibrillation. Stent placement at a later date would be considered if he failed medical therapy. <h3>Conclusions:</h3> An elongated styloid process should be considered in an atraumatic, symptomatic cervical dissection presenting with ischemic infarcts. There is limited data regarding management of vascular eagle syndrome and should be studied further to compare medical management versus surgical intervention. <b>Disclosure:</b> Dr. Kokikian has nothing to disclose. Dr. Ly has nothing to disclose. Dr. Al-Khoury has nothing to disclose.

BILATERAL EAGLE'S SYNDROME IN LUMBAR SPONDYLOSIS – A CASE REPORT AND REVIEW

There are Published case studies involving diffuse idiopathic skeletal hyperostosis (DISH) along with symptomatic ossification of the stylohyoid ligament, or “Eagle syndrome,” are rare. Coincidence of the Eagle syndrome and diffuse idiopathic skeletal hyperostosis can very rarely result with compression of the hypopharynx. The three-dimensional volume-rendered air-specific Multidetector computed tomography MDCT image is accurately used to show the relationship between the Oro-hypopharyngeal air column and the elongated styloid processes. The authors here described a very rare case of hypopharyngeal airway compression and nagging pharyngeal pain secondary to cervical osteophytes in a patient with coincidence of Eagle syndrome and diffuse idiopathic skeletal hyperostosis. A known case of ankylosing spondylosis under treatment since last three years with degenerative changes in the cervical spine was taken up for removal of styloid process under General anesthesia. Follow up was done for one year and it was uneventful.

Eagle Syndrome with Internal Carotid Artery Compression causing Recurred Syncope: A Case Report.

We herein report a 54-year-old man with eagle syndrome who presented with repeated episodes of syncope, especially after moving his head to a downward position. Computed tomography with contrast revealed a bilateral elongated styloid process. The left internal carotid artery was obviously compressed by the left elongated styloid processes. A transcranial Doppler examination detected a significantly decreased blood flow velocity in the left middle cerebral artery when the patient slightly lowered his head position. After surgery, the positional cerebral blood flow alteration disappeared. No further similar syncope episodes have been reported to date.

Differences in the Osseous Ultrastructure in 2 Differing Etiologies of Eagle Syndrome. A Micro-CT Study.

Eagle syndrome is a rare disease caused by an elongated styloid process (type I) or ossified stylohyoid ligament (type II) and causes a heterogeneous symptom complex, ranging from pain in the throat and neck to neurological symptoms and neurovascular entrapment. The 2 different types present differing shapes and ultrastructures and cause different symptoms. This study aimed to distinguish the 2 types by investigating the structures by micro-computed tomography. Micro-computed tomography was performed and evaluated in n=10 resected styloid processes from patients diagnosed with Eagle syndrome. The tissues were measured for their shape, ratio of soft tissue and bone amounts, bone volume, and ultrastructure, and compared within the groups. The shapes of the different types were different and the ultrastructure differed between the 2 groups, with an absence of trabecular architecture in type II. The area of bone to nonbone tissues in type I samples was significantly higher compared with type II ( P =0.007). Alike these results, the bone volume and bone-to-soft tissue ratio were significantly higher in type I compared with type II ( P =0.009). The findings suggest that both the popular theories (hyperplasia and metaplasia) may be probable but each solely valid for 1 type of Eagle. Type I may derive from bone hyperplasia with cancellous bone formation and rather high bone density in the elongated styloid process. Type II most likely originates from ligament metaplasia into bone without a compact structure.

Elongated Styloid Process (Eagle's Syndrome): A Case Report

Elongated Styloid Process (Eagle's Syndrome): A Case Report

A study on calcification, variability of the stylo-mandibular ligament, or styloid process with regard to clinical parameters among United Arab Emirates population

Aim: The styloid process (SP) is often considered elongated when it is longer than 33 mm. The aim of this study is to assess the prevalence of the elongated styloid process (ESP) among dental patients and the role of dental pathology as a possible etiological factor. Materials and Methods: In total, 2000 consecutive panoramic radiographs of normal people were retrieved from the College of Dentistry, Ajman University, Ajman, UAE, during the 2-year study period. Two calibrated observers evaluated the radiographs to minimize interobserver bias and error. A caliper was used to measure the length (in millimeters of the ESPs directly on the radiographs from the caudal margin of the tympanic plate to the tip of the SP). The ESP was considered present when the measurements were ≥30 mm. Results: This study indicates that the prevalence of the ESP was about 6.9% among the patients who attended the dental school clinic. Of the 2000 panoramic radiographs reviewed, ESP could be measured in 100 cases at least on one side. There was a significant difference between distributions on the left and right sides. The distribution also depends significantly on age and gender. The incidence of related symptoms was higher than that reported in previous studies. Conclusions: The incidence of ESP among dental patients was estimated to be 6.9%, more prevalent among the elderly compared to the young people and bilateral. Odds ratio (OR) in favor of developing ESP in males is 2.378 times more than that in females. In contrast, the OR in favor of having unilateral ESP in males is less than that in females by 0.284.

A Retrospective Cone-Beam Computed Tomography Study of the Calcification Pattern, Prevalence, and Morphology of the Elongated Styloid Process

Introduction: A styloid process (SP) is considered extended if it is longer than 30 millimeters (mm), which falls between the typical range of 20 and 30 mm. Eagle’s syndrome (ES), a disease associated with the styloid process elongation (SPE), was originally recognized by otorhinolaryngologist “Watt Weems Eagle” in 1937. Aims: The calcification pattern, prevalence, and morphology of the SPE in a hospital-based population in Bhubaneswar were all objectively assessed in the study using cone-beam computed tomography (CBCT). Methods and Material: Radiographic records of 1027 patients have been recovered arbitrarily from the authentic records and assessed. The length of the SP was estimated and characterized by their morphology and calcification design. The collected data were analyzed using Statistical Package for the Social Sciences version 25 software. It was deemed statistically significant if the P value ≤ 0.05. Results: It was seen that 25.8% of the males had the presence of elongation as compared to 30.1% of females, which is 153 males out of 440, and 131 females out of 304 showed elongated SP. Conclusion: The SPE could be a coincidental radiography perception without symptoms. In this study, a substitute for CT or all panoramic radiographs for the estimation and assessment of the SP is the CBCT approach.

Eagle’s Syndrome: A Case Report of a Bilateral Elongated Styloid Process

Eagle’s Syndrome: A Case Report of a Bilateral Elongated Styloid Process

A Case of Elongated Styloid Process That Presented with Intractable Sore Throat

A Case of Elongated Styloid Process That Presented with Intractable Sore Throat

Evaluation of Styloid Process Length using Multidetector Computed Tomography Scan in Indian Population: A Cross-sectional Study

Introduction: The length of the Styloid Process (SP) has been a subject of research since Eagle's case report on a syndrome characterised by symptoms related to a painful elongated SP. Various modalities including orthopantomogram, digital radiography, cadaveric measurements, and Multidetector Computerised Tomography (MDCT) scanning have been used to study SP length. The present study aims to determine the normal SP length in the Indian population, specifically among armed forces personnel, using MDCT scans. Aim: To measure the SP length in the Indian population using MDCT scans and establish a cut-off length to define elongation. Materials and Methods: A single centre cross-sectional study was conducted at the Department of Radiology, Command Hospital Pune, Maharashtra, India from January 2023 to March 2023. The SP length was measured in 402 patients referred for CT scans of the head and Paranasal Sinus (PNS), utilising 3D Multiplanar Reformation (MPR), curved reformat, and volume rendering techniques. The patients were divided into six age groups: Group I (&lt;20 years), Group II (21 to 30 years), Group III (31 to 40 years), Group IV (41 to 50 years), Group V (51-60 years), and Group VI (&gt;60 years). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) Version 28.0, and significance was set at p-value &lt;0.05. Results: Among the 402 patients, 210 were males, and 192 were females, with a mean age of 43.8±16.7 years. The mean SP length across all patients was 23.24±3.92 mm. The mean length was 23.74±4.50 mm on the right side and 22.74±3.72 mm on the left side, with no statistically significant difference between them (p-value=0.058). There was a significant gender difference, with males having a mean length of 23.67±4.12 mm and females 22.77±3.64 mm (p-value=0.011). The SP length increased significantly with age, demonstrating a notable difference between age groups. The upper limit of normal (90th percentile) ranged from 25.74 mm for patients &lt;20 years to 28.91 mm for patients &gt;60 years. Conclusion: A statistically significant difference in SP length was observed between genders, with a significant increase in length with age. In the Indian population, an SP length greater than 28 mm should be considered elongated.

Prevalence and Pattern of Stylohyoid Chain Complex on Panoramic Radiographs: A Retrospective Study

Objective: The elongated styloid process (SP) and calcified stylohyoid ligament can be evaluated radiologically and are associated with some symptoms and syndromes. This study aimed to define the incidence of different stylohyoid chain patterns and classify them.&#x0D; Methods: Digital panoramic radiographs of 1217 patients were included in the study. The styloid chain patterns were analyzed according to MacDonald-Jankowski’s study. Data analysis was performed using the IBM SPSS Statistics 21.0 (Statistical Package for Social Sciences) program. &#x0D; Descriptive values were analyzed by using descriptive statistics. The data were assessed by using Chi-squared tests. A probability level of less than .05 (p ˂ .05) was considered significant.&#x0D; Results: The prevalence of the stylohyoid chain complex patterns was higher for normal SP (86.5%), followed by elongated SP (7.1%), calcified stylohyoid ligament (2.2%), and absent stylohyoid chain (2.8%). Unclassified SP was detected in twenty individuals on the left (1.6%) and fourteen on the right (1.2%). In view of symmetry of the stylohyoid chain complex, 979 (80.4%) were symmetric, 238 (19.6%) were asymmetric and 14 (1.15%) of the asymmetrical ones were unilateral. There was no significant difference in gender for the type of stylohyoid chain complex pattern (p &gt; .05). There was statistically significant difference between the stylohyoid complex pattern and age groups for the right and left &#x0D; sides (p &lt; .05).&#x0D; Conclusion: The authors believe that this study provides additional information about the frequency of the elongated styloid process and provides valuable knowledge of the anatomical variations of the SP. Current findings should be correlated with clinical symptoms in future studies