Eagle’s Syndrome is a rare condition, which often presents with recurrent pain in the throat, foreign body sensation in the throat, dysphagia and referred otalgia due to an elongated styloid process or calcified stylohyoid ligament. It was Eagle (1937) who first described it.
The stylohyoid complex is made of styloid process, stylohyoid ligament, and the small cornus of the hyoid bone. All these structures are derivate from Reichert’s cartilage of the second branchial arch. The styloid process is an elongated conical projection of the temporal bone that lays anterorly to the mastoid process, between the internal and external carotid arteries, and laterally the tonsillar fossa. In this space, the internal carotid artery, the internal jugular vein, the facial, glossopharyngeal, vagus, and hypoglossal nerves are located. From the styloid process, the stylohyoid, the styloglossal, and the stylopharyngeal muscles, and the stylohyoid and the stylomandibular ligaments originate.
The normal length of the styloid process is individually variable, but in the majority of patients it is about 2.5cm. The incidence of Eagle’s syndrome varies among population, but the main incidence is 4% of the general population.
Conservative medical treatment with anti inflammatory drugs is not of any value in long term. Eagle’s syndrome is treated best by surgery.
Styloidectomy which is the treatment of choice, which can be performed by an intra or an external approach. The external surgical approach results in cutaneous scars, longer hospitalization, and risks of facial nerve injuries.
Procedure of Intra oral Styloidectomy
The patients under goes tonsillectomy under general anesthesia. After removal of the tonsil, a sharp elongated styloid process is palpated in the tonsillar fossa. The muscles of the pharyngeal wall are separated, and retracted. Then, an incision was made on the periosteum at the tip of the styloid process. The tip of the elongated styloid process is dissected, stripped of all attachments, and nibbled off using a bone nibbler. The procedure is repeated on the other side in cases of bilateral enlarged styloid processes. The pharyngeal wall is sutured using absorbable sutures. Post op antibiotics are mandatory to avoid deep neck space infection.
I often use Co2 laser for dissection which cause hardly any bleeding and at times operating microscope for better visualization.