Elongated Styloid Process Research Articles

Etio‐histomorphogenesis of styloid enlargement—A novel and extensive light microscopic analysis of 10 cases of Eagle’s syndrome

AbstractAim & ObjectivesTo carry out detailed light microscopic analysis of excised specimen of elongated styloid processes (ESPs) from patients suffering from Eagle's syndrome (ES). To thus gain a clear and precise insight into the aetiology, origin, development and progression of styloid enlargement, and to accurately hypothesize the underlying histopathological mechanisms bringing about their thickening and elongation.Study Design & SettingThis 3‐year study was conducted in 10 patients of ES, who were treated by transoral styloidectomy. The excised ESPs were subjected to a systematic and comprehensive histological analysis of sections from their base, mid and apical thirds.Material & MethodsImaging and diagnostic workup, operative procedure, postsurgical protocols and regimen, tissue processing and analysis of excised specimen were the same in all patients.ResultsImmature woven bone trabeculae and dystrophic calcifications were found within fibrocollagenous mesenchymal condensations of the stylohyoid ligament (SL) at the apical region of the ESPs, and in the tendinous insertions of the styloid group of muscles into the ESPs, indicative of their osseous metaplasia as a form of reactive response.ConclusionRepetitive stress, traction or traumatic stimuli brought to bear upon the apices and lateral surfaces of styloid processes via tendinous insertions of the SL and styloid group of muscles, as a result of neck and hyoid movements, are likely to serve as triggering factors, stimulating an osseous metaplasia of connective cells within these mesenchymal structures as well as in the periosteal fibrous tissue, into osteoblasts and osteocytes. This reactive response is followed by osteogenesis and laying down of woven bone at these sites, resulting in increase in length and circumference of the SPs and their attendant, associated clinical sequelae.

Internal carotid artery dissection due to Eagle syndrome: Case report and review of literatures

AbstractEagle syndrome is a rare condition induced by an elongated styloid process. A 51‐year‐old man became aware of weakness and numbness of the right upper extremity. Magnetic resonance images and angiography revealed fresh multiple infarctions in the left cerebrum, and stenosis and dilatation of the left internal carotid artery. Angiography, cone‐beam computed tomography, and contrast‐enhanced computed tomography demonstrated dissection of the left internal carotid artery and an elongated styloid process close to the internal carotid artery. These findings indicated that cerebral infarction due to internal carotid artery dissection resulted from mechanical compression by an elongated styloid process. The patient was treated by carotid artery stenting on the 7th day. His symptoms induced by cerebral infarction gradually improved. Follow‐up MRI on the 29th day showed patency of the left internal carotid artery. Although the incidence of internal carotid artery dissection due to Eagle syndrome is low, the possibility of this rare condition should be taken into consideration as an etiology of cerebral infarction.

Improvement of methods of diagnosis the hypertrophy of the styloid process of the temporal bone and stylohyoid syndrome in an outpatient and polyclinic conditions using functional tests

The Eagle's syndrome is a disease is caused by irritation of the nervous, vascular and muscular structures the surround the subcutaneous process of the temporal bone. A syndrome manifested by chronic pain at the deep part of the lateral region of the face, which irradiates in to the root of the tongue, pharynx and ear, dysphagia, symptoms of disorders of the circulation of the brain. Symptoms of Eagle’s syndrome are founding various otolaryngological, dental, neurological diseases. Aim: due to the lack of information on the development and course of the stylohyoid syndrome, conservative treatment and the complexity of diagnosis, the anatomical features of the hypertrophied styloid process, their length and angles of deviation and the need for local impact on the process, the stylohyoid ligament and the neurovascular bundle, to varying degrees presenting to the styloid process, it becomes necessary to develop the most effective and simple method for diagnosis a hypertrophied styloid process and to optimize the need for CT examination with contrasting of the great vessels of the neck and performing functional tests. Materials and methods: Over the past 9 years, we examined and treated 184 patients. The appeals were random, with no specific focus. Of these, there were 133 women (72.3%), men – 51 (27.7%); age – from 25 to 70 years old: 25-30 years old – 15 people (8.1%), 30-45 years old – 116 (63%), 45-60 years old – 38 (20.6%), 60-70 years old – 15 (8.1%); the duration of the disease is from 1 to 10-15 years. Our work was aimed at improving and simplifying the diagnosis of the hypertrophied styloid process during the initial treatment of the patient in an outpatient and polyclinic conditions using functional tests, determining the need to refer patients to CT examination to visualize the relationship of the elongated styloid process with the main vessels of the neck, the possibility of pressure of the append age on the vessels and nerves of the neck, both at rest and in the movement of the head and neck, the development of impaired blood circulation in the brain due to impaired blood flow through the arteries and impaired out flow through the veins, and the development of corresponding symptoms in addition to those described in the literature. Due to the difficulty of diagnosing hypertrophy of the styloid process of the temporal bone in an outpatient and polyclinic conditions and the lack of awareness of practical otolaryngologists about this problem, we proposed a scheme for examining patients with suspicion of this problem.

Elongated Styloid Process in Panoramic Radiographs

AbstractThe aim of this study is to evaluate the prevalence of the elongated styloid process in panoramic radiographic exams, in a subpopulation of northern Brazil in relation to age, sex and side. 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 tip of the process. The data were analyzed using chi-square tests and variance analysis with a 5% significance level. Approximately 30% of the elongated styloid process was observed in patients between 18 to 35 years. Of the styloid processes that measured more than 30 mm (elongated), 764 styloid processes (81%) showed Type I elongation pattern, 97 styloid processes (10%) showed Type II calcification patterns, and 85 styloid processes (9%) showed Type III calcification patterns. The prevalence of the elongated styloid process was high, and no statistically significant correlation was found between the presence of the elongated styloid process and the variables studied.Keywords: Bone Lengthening. Osteogenesis. Radiography, Panoramic. ResumoO objetivo deste estudo é avaliar a prevalência do processo estilóide alongado em exames radiográficos panorâmicos, em uma subpopulação do norte do Brasil em relação à idade, sexo e lado. Radiografias panorâmicas foram selecionadas, e tamanho aparente do processo estilóide foi medido a partir do ponto em que o estilóide deixa a placa timpânica até a ponta do processo. Os dados foram analisados por meio de testes qui-quadrado e análise de variância com nível de significância de 5%. Aproximadamente 73% do processo estilóide alongado foi observado em pacientes entre 18 e 53 anos (p <0,05). Dos processos estilóides que mediram mais de 30 mm (alongados), 543 processos estiloide (82,9%) mostraram padrão de alongamento do Tipo I, 33 processos estiloide (5,03%) mostraram padrões de calcificação do Tipo II, e 79 processos estilóide (12,06%) mostraram padrões de calcificação do Tipo III. A prevalência do processo estilóide alongado foi alta e não foi encontrada correlação estatisticamente significante entre a presença do processo estilóide alongado e as variáveis estudadas.Palavras-chave: Alongamento Ósseo. Osteogênese. Radiografia Panorâmica.

The Comparison of Styloid Processes in the Edentulous and the Posterior Dentate Patients Using Panoramic Radiography

Introduction: The aim of this study was to evaluate the length of styloid processes of edentulous and posterior dentate patients retrospectively using digital panoramic radiography. Methods: This study was carried out in southwestern of eastern Anatolia region Turkish population. In this study, 100 styloid processes of each of edentulous and posterior dentate patients were measured on digital panoramic radiographs. Styloid process longer than 30 mm was evaluated as an elongated styloid process. Recording of data was performed based on gender, side and groups, Chi-square and Mann Whitney U test were conducted for statistical analysis. Results: Styloid process length was not found to be statistically significant between edentulous (24.9±6.66) and posterior dentate (25.75±5.64) groups (p˃0.05). The frequencies of Elongated styloid processes were not statistically different between genders, side or groups (p˃0.05). Conclusion: Being edentulous was not an important factor for the length of the styloid process and the likelihood of symptoms that might develop.

Neurosurgical management of vascular compression presenting as visual symptoms secondary to elongated styloid processes (Eagle syndrome)

Background Eagle syndrome (ES) was first described in 1937, to characterize elongation of the styloid process. It is rarely encountered by neurosurgeons but does present the potential for vascular sequelae and neurological complications. Demonstrative cases We discuss three patients with uncommon presentations of neurovascular compromise with uncommon symptomatology, secondary to ES. Their management ranged from retrospective diagnoses following self-limited events, antiplatelet therapy, and endovascular and surgical interventions. Discussion While traumatic fractures, chiropractic manipulation, and history of prior neck surgery have been implicated as the etiologies for ES, congenital cases are common. The styloid process intimately interplays with adjacent neurovascular and nervous structures; its elongation can cause symptoms in 10% of patients. Conclusion Awareness of this potentially dangerous but rare disease – more commonly seen by our otolaryngology colleagues – may help reduce diagnostic delays when an elongated styloid process is the cause, as surgery may be required.

Elongated styloid process syndrome with prolongation of the superior cornu of the thyroid cartilage: A case report

IntroductionElongated styloid process syndrome represents a group of symptoms, such as recurrent throat pain and neck pain, caused by elongation of the styloid process. We report a case of elongated styloid process syndrome with prolongation of the superior cornu of the thyroid cartilage.Case presentationA 50-year-old man was referred to our clinic with the chief complaint of discomfort on the right side of his neck. He had no history of any disease. Extraoral findings indicated pain during neck rotation. Computed tomography showed prolongation of the styloid process beyond the mandibular plane and close to the hyoid. Moreover, prolongation of the superior cornu of the thyroid cartilage was detected. The discomfort during rotation of the neck was due to the stimulation by the styloid process. Styloid resection was performed using the extraoral approach under general anesthesia.ConclusionDiscomfort in the neck was resolved after operation.

Varied presentations of a mineralized styloid process in oral submucous fibrosis patients visualized on digital panoramic radiographs

Oral Submucous Fibrosis (OSMF) is a widely prevalent, premalignant condition which adversely affects the quality of life of an individual and can warrant stringent surgical regimen for its treatment. An Elongated Styloid Process (ESP), if coexisting, can invariably impair the post-surgical mandatory physiotherapy necessary to maintain the mouth-opening achieved intraoperatively. To evaluate digital Orthopantomograms (OPGs) of patients having OSMF and to observe presentations of various combinations of calcification types and patterns of ESP in them. Patients with clinically diagnosed OSMF (Grade III and IV according to Khanna and Andrade 1995) were advised a digital OPG to measure and observe the ESP using the C.S. Imaging Software 7.0.3.The digitized OPGs were converted into KODAK large format prints and then ESP was measured starting from the point where it is visualized to leave the tympanic plate extending upto its tip and its myriad of combinations of calcification patterns were recorded by a single observer.The presence of unilateral and bilateral elongation along with the type and pattern of calcification was effectively noted using the C.S. Imaging Software 7.0.3. Visualization of various unique, varying patterns of ESP was noted. Sixteen such different radiological presentations were shown, captured through digital OPGs. An undetected ESP can prove to be detrimental for a patient who is recently treated for OSMF as it hinders efficient postoperative mouth opening exercises. This can easily be prevented by a simple maneuver of identifying the ESP on a digital OPG using computer aided software. The presence of assorted radiographic patterns in patients having OSMF indicate that extensive research should be directed to identify and categorize such patterns which do not conform to the past methods of classification. This study hints towards the existence of a scope to study the factors responsible for the occurrence of the varied combinations of calcification and thickness of the ESP and their clinical relevance.

Asymptomatic Complete Occlusion of Extracranial Internal Carotid Artery: A Case Report

This article reports on head-and-neck computed tomography angiography imaging findings and data of ultrasound examination of the extracranial carotid and vertebral arteries of 69-year-old patient with unilateral asymptomatic complete occlusion of extracranial internal carotid artery (ICA) in combination with unusually elongated styloid processes of temporal bone. The aim of the study was to specify the collateral pathways blood supply to the brain and to assess the possible clinical significance of an abnormally elongated styloid pro cess. Adequate cerebral blood flow was provided by anastomoses between the arteries at the base of the brain. This can explain the asymptomatic unilateral complete occlusion of the extracranial ICA. Occlusion of the artery was not associated with the presence of a 5.5 cm styloid process. Computed tomography angiography is a highly informative method for visualizing the individual morphological variants to clarify their clinical significance.

A Rare Case of Eagle Syndrome Associated with Tonsil Hypertrophy: Case Report with Literature Review

Eagle’s syndrome, or stylohyoid complex syndrome, is a rare facial pain syndrome characterised by latero-cervical pain radiating to the face, pharyngeal pain increased by swallowing, linked to an abnormal enlargement of the styloid or calcification of the stylo-hyoid ligament. The incidence of the presentation is about 4 to 8 per 10,000 individuals. The establishment of the diagnosis is a challenge in itself as we need to differentiate it from the neuralgias of cranial nerve such as glossopharyngeal neuralgia and superior laryngeal neuralgias. The surgical management of the Eagle syndrome consists in the shortening of the elongated styloid process, with the surgical access by intra oral or cervical. We report a case of a 28-yearold men admitted to our otorhinolaryngology department with sharp neck pain and a sensation of having a foreign body in the throat. Physical examination found bilateral tonsilar hypertrophia, with palpation of a solid immobile structure. CT scan with 3D reconstruction revealed elongated styloid processes with ossification of the left stylo-hyoid ligament. The patient was treated by tonsillectomy with excision of styloid processes by intra oral approach.

Traumatic Events and Eagle Syndrome: Is There Any Correlation? A Systematic Review

Background: Eagle syndrome occurs when elongated styloid process or ossification of the stylohyoid ligament interfere with the surrounding anatomical structures giving rise to various symptoms. Watt W. Eagle identified two types: stylo-hyoid classic syndrome and stylo-carotid artery syndrome. The aim of this systematic review of the literature is to evaluate correlations between Eagle syndrome and traumatic events or teeth extractions. Methods: out of 294 articles, the final study allowed the identification of 13 studies focusing on traumatic events. Out of 342 articles, the final study allowed the analysis of two studies regarding extractive dental events. Results: 13 articles showed correlations between the onset of symptoms in Eagle syndrome and traumatic events and highlighted two possibilities: traumatic event could fracture the already elongated styloid process or calcified stylohyoid ligament; trauma itself triggers the pathophysiological mechanisms that lead to lengthening of styloid process or calcification of stylohyoid ligament and therefore the typical symptoms. The only two case reports concerning Eagle syndrome symptoms after extractive dental events describe the onset of classic type. Conclusions: The analyzed articles confirm correlation between traumatic event and onset of typical symptoms of Eagle syndrome. There is not enough literature linking extractive dental events to Eagle syndrome. Trial registration: CRD42020185176.

Elongated Styloid Process- An Unusual Finding- A Case Study

Styloid process is approximately 2.5 cm to 3cm in length and its tip is located lateral to tonsillar fossa between external and internal carotid arteries. Elongation of Styloid process or calcification of stylohyoid ligament leads to Eagle syndrome which causes excruciating throat pain, facial pain, dysphagia, or foreign body sensation. It may be present unilaterally or bilaterally with an overall prevalence of 4% in adults out of which 0.16% are symptomatic with symptoms.

Familial occurrence of skeletal developmental anomalies as a reflection of biological relationships in a genealogically documented Central European sample (19th to 20th centuries).

Skeletal developmental anomalies (SDA) are a subject of constant interest across scientific disciplines, but still mostly as isolates and curiosities. The aim of this study was to find out to what extent the occurrence of SDA reflects documented biological relationships. The skeletal remains of 34 individuals with known genealogical data were available, members of one family over four generations (19th to 20th centuries, Bohemia, Czech Republic), including some inbred individuals. The occurrence of 89 SDA was assessed on the basis of scopic morphological evaluation and X-ray and CT examinations. The degree of similarity between individuals was calculated using a "similarity coefficient" (SC). A linear model was used to test the relationship between positive values of the SC and the relatedness of biologically related individuals. Simultaneously, based on population frequencies of the evaluated anomalies, those that could be considered familial were recorded. A statistically significant relationship between morphological similarity and the biological distance between individuals was found. The greatest similarity was found among close relatives such as parents and children, siblings, or grandparents and grandchildren. The effect of increased consanguinity on the occurrence of anomalies was not confirmed, however. Seventeen SDA shared by closely related individuals were found in the sample, supporting the documented family relationships among them. Eleven of these were selected as possibly familial, but only five were statistically significant: an elongated styloid process, a cervical block vertebrae (arch, facet joints), hamate hamulus aplasia, anteater nose sign, and incomplete fusion of the S1spinous process. There were also 28 cases of individual occurrences of 17 different SDA, without connection to the documented relationships between individuals.

Prevalence of Radiographic Anomalies and Abnormalities on Panoramic Films in the Pakistani Population

OBJECTIVES: Orthopantomogram (OPG) is a dental radiograph that captures the maxillofacial region in a single image for quick assessment of the dental arches and their surrounding structures. It can be used for treatment planning and analysis of jaw-related pathologies. Prior studies have demonstrated geographical variations in radiographic anomalies and pathologies, our purpose was to establish baseline statistics for the Pakistani population, so the Pakistani dentists are able to distinguish between anomalies and pathologies and provide appropriate care when needed. METHODOLOGY: A cross-sectional study design was used to analyze de-identified 2411 OPGs taken for routine dental care at the dental clinics of Riphah International University. These were broadly classified according to site. Data was documented on SPSS version 22 and presented as frequencies. RESULTS: From a total of 2,411 OPGs, 2326 met the inclusion criteria. The mean age of the patients was 29.06±17.99 years. Our findings included pneumatization of the maxillary sinus in 9.8%, pathological findings in the sinus in 3.9%, deflected nasal septum in 7.5%, alveolar bone loss in 32.7%, elongated styloid process in 12.1%, pathological finding associated with maxillary bone in 1.4% and mandibular bone in 2.1%. CONCLUSIONS: Our results were somewhat unique when compared with studies from other geographical locations. We established baseline statistics about the common anomalies and abnormalities noted in dental radiographs for the Pakistani population. KEY WORDS: Orthopantomogram, anomalies, mandible, maxilla

Elongated Styloid Process: Mapping the incidence in Greek population

Background: Styloid process (SP) is a needle shaped projection of the temporal bone, which lies in close proximity to several important anatomical structures of the head and neck. It attracts the attention of anatomists, otolaryngologists and head and neck surgeons, as an abnormally long SP is linked with a clinical condition known as Eagle Syndrome. There are numerous studies in the literature investigating morphometric characteristics of SP, including its length in different populations. The aim of this study is to investigate the incidence of SP elongation in Greek population and to construct an epidemiologic map showing the incidence of SP elongation across different regions of Greek territory. Materials and methods: Two hundred and nine skulls retrieved from cemeteries across Greece were meticulously examined. Ninety-four male skulls and one-hundred and fifteen females, all of Hellenic origin. SP length was measured from the lowest inner point of the surface between the SP and the stylomastoid foramen to its tip, utilizing a digital caliper and a steel wire. Data from this study were statistically analyzed and combined with data from other studies in Greek population in order to construct a detailed epidemiologic map. Results: The mean length was 27.26 ± 5.89 mm for the left and 27.84 ± 6.31 mm for the right SP. In males 36.4% of the left and 37.8% of the right SP were elongated. In females the incidence of SP elongation was 14.3% and 15.5% for left and right side respectively. Statistically significant association was observed between gender and SP length but not between age and SP length. Conclusion: This study enriches the literature by adding information about elongated SP incidence in Greek population. It reviews the existing studies about SP length in Greeks and presents an epidemiologic map showing the incidence of SP elongation across different regions in Greece. KEY WORDS: Skull, Eagle syndrome, Hellenic population, Elongated Styloid Process.

Bilateral elongated styloid processes: Eagle syndrome

A 40-year-old-woman presented to our outpatient clinic with a 6-month history of pain in her throat and a feeling that she had a foreign body in the submandibular region. She said the pain was pricking, intermittent, bilateral, non-radiating, aggravated by eating solid food, and moderate to severe in intensity. She reported no history of trauma or previous operations—specifically a tonsillectomy. The patient was previously fit and well and had no medical history.

Styloid Process: What Length Is Abnormal?

The length of the styloid process varies greatly in different populations and depends on ethnicity and geographical background. The elongated styloid process may be associated with Eagle’s syndrome. Therefore, the mean normal length of the styloid process in different population groups needs to be calculated and the upper cutoff limit for elongated styloid process should be found. The objective of the research was to evaluate the styloid process length in the Kashmiri population using multidetector computed tomography. Materials and Methods. We retrospectively evaluated 304 patients who underwent computed tomography of the head and paranasal sinuses, and the mean styloid process length was calculated on both sides. The mean of three measurements of styloid process length was taken. The study population was grouped as follows: Group I included patients at the age of 21-30 years; Group II comprised patients at the age of 31-40 years; Group III included 68 patients at the age of 41-50 years; Group IV comprised patients > 50 years old. Results. The mean length of the styloid process in the studied population varied from 20 to 51 mm (mean 31.3 ± 4.5 mm). There was no significant difference in the length on both sides (p=0.835). The mean length of the styloid process was 30.1 ± 4.2 mm in females and 32.3 ± 4.8 mm in males (p< 0.034). The lengths of the styloid process in different age groups were as follows: in Group I - 30.9 ± 4.4 mm; in Group II - 31.2 ± 4.8 mm; in Group III - 31.6 ± 4.3 mm; in Group IV - 31.5 ± 4.5 mm. Conclusions. The mean length of the styloid process in our population was higher as compared to many other ethnic groups. The styloid process in males was longer. The elongated styloid process on computed tomography scan should not be labeled as Eagle’s syndrome unless clinical symptoms are present.

Histopathological Analysis of Elongated Styloid Processes: A New Light on Etiopathogenesis of Eagle's Syndrome.

There exists paucity in recorded literature on the detailed microscopic appearance of elongated styloid processes (ESPs) in patients with Eagle's syndrome (ES). Although literature is replete with numerous conflicting and inconclusive theories, the exact cause, mechanism of origin, development and progression of styloid apparatus enlargement remains unclear and ambiguous. To carry out detailed histopathogical examination of excised specimen of ESPs in a patient with ES, with the objective to determine its precise etiomorphogenesis, and to analyse the role of possible triggering factors. Light microscopic examination was carried out of the base, mid- and apical thirds of transorally excised ESPs in a 45-year-old patient with ES. Woven bone trabeculae were found emanating from tendinous insertions of the styloid group of muscles at the mid third of the ESPs. Apical region of the ESPs showed fibro-collagenous mesenchymal tissue with numerous, haphazardly scattered trabeculae of woven bone traversing it. Presence of deeply staining reversal lines all along the length of the ESPs was suggestive of multiple micro-fractures from recurrent traumatic/traction forces, and repeated attempts at repair and ossification. It is proposed that mesenchymal structures composing the stylohyoid ligament at its attachment, and tendinous insertions of styloid muscles into the ESPs are stimulated to undergo metaplastic alterations, by repetitive stress, traction or traumatic stimuli brought to bear upon them, from muscular contractions. This osseous metaplasia of connective cells within them, followed by dystrophic bone deposition, brings about SP thickening and lengthening with their attendant and associated clinico-pathological sequelae.

Refractory neck pain due to Eagle syndrome.

Eagle syndrome, named after Watt W. Eagle, who described the first cases in 1937, is an uncommon syndrome (4-8/10,000 persons) resulting from the styloid process's elongation or mineralization of the stylohyoid ligament.1Badhey A. Jategaonkar A. Anglin Kovacs A.J. Kadakia S. De Deyn P.P. Ducic Y. et al.Eagle syndrome: a comprehensive review.Clin Neurol Neurosurg. 2017; 159: 34-38Crossref PubMed Scopus (54) Google Scholar The typical symptoms are throat and neck pain radiating into the ear, which can be wrongly attributed to various facial neuralgias. A 64-year-old woman had presented to the otolaryngology clinic with a slowly progressive intermittent dull pain in the upper neck of 10 years' duration. The pain was localized to the tonsillar fossa and radiated to the jaw, ear, neck, throat, and oropharynx. It was worsened by head movement and accompanied by dysphagia, a foreign body sensation, a sore throat, and voice changes. She had no history of trauma. The patient had undergone several consultations during the 10-year period, including otolaryngology, family practice, neurology, neurosurgery, psychiatry, and dentistry, with various interventions performed (ie, steroid injection in the temporomandibular joint, radiofrequency ablation, stellate ganglion block, lignocaine infusion, posterior auricular nerve block) without relief. A computed tomography angiogram demonstrated a 4-cm-long styloid process at the level of the mid-internal carotid artery (A and B). Cervical neck incision and styloidectomy were planned. We exposed the common carotid artery and cranial nerves and retracted the posterior belly of the digastric to peel the tendinous attachment around the styloid process toward the mastoid posteriorly and mandible anteriorly for easy separation. The distal end of the styloid process was found to lie close to the hypoglossal, glossopharyngeal, and vagus nerves (C). A 2.5-cm excision of the styloid process was performed. She had complete resolution of the symptoms postoperatively. She had provided written informed consent for the report of her case details and images. The styloid process normally measures 2.5 to 3 cm. However, when its length is >3 cm, the patient will become symptomatic owing to the subsequent pressure on the adjacent structures.1Badhey A. Jategaonkar A. Anglin Kovacs A.J. Kadakia S. De Deyn P.P. Ducic Y. et al.Eagle syndrome: a comprehensive review.Clin Neurol Neurosurg. 2017; 159: 34-38Crossref PubMed Scopus (54) Google Scholar Cervical neck surgery with styloidectomy is the definitive treatment. An alternative approach includes the intraoral transtonsillar route. However, this approach has been associated with high risks, including uncontrolled bleeding and cranial nerve injury because it limits visualization of the important structures.2Strauss M. Zohar Y. Laurian N. Elongated styloid process syndrome: intraoral versus external approach for styloid surgery.Laryngoscope. 1985; 95: 976-979Crossref PubMed Google Scholar

The Eagle Has Landed

Eagle syndrome is a rare medical condition characterized by symptoms related to an elongated styloid process. CT scan of the neck and direct laryngoscopy was obtained and confirmed the diagnosis. Here we report a patient who presented with dysphagia and odynophagia and was found to have an elongated styloid process.