ENT-On line Email Consultation from drpaulose.com

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As you can imagine I am very busy to send reply to all the emails which I am getting every day. I know most of them are from genuine patients seeking medical advice on line. But few are wasting my time.

I would like to help you so I have introduced Email Consultations; this allows you to receive my medical advice from the comfort of your computer/mobile instead of waiting for an appointment with a specialized doctor and waiting in the queue to see the doctor.

It’s a small donation towards charity mainly orphanages and food for the hungry (Anna Daanam).

For USD 30 or more you get 3-4 replies and payment can be made through Paypal.

Those who are in India can contribute Rs 1500 or more for 3-4 replies to the Account as given below.

CHARITY Ac No. Dr.K.O.Paulose FRCS

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(Bank: State Bank of India (SBI), Branch: Panavila, Gr floor, Kasthurbham commercial building ,Trivandrum, Kerala. Tel 2332155)

You may also pay directly to the following charitable organization I support-

Name: Employee’s fellowship

Bank: Catholic Syrian Bank, Palayam, Trivandrum, Kerala, India.

Ac No: 096 -1207090 -190001, IFSC code:CSBK0000096

Or

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Bank: Catholic Syrian Bank, Palayam, Trivandrum,Kerala, India

Ac No.0096-01208751-190001

 

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Eagles Stylohyoid Syndrome-3D CT images: Dr.K.O.Paulose FRCS

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Eagle syndrome (Stylohyoid Syndrome) is an aggregate of symptoms caused by an elongated ossified styloid process, the cause of which remains unclear. The clinical diagnosis is generally difficult and must be confirmed by radiologic imaging e.g. plain X-ray, OPG or CT scan. In this case, 3D CT findings are shown in a 38 year old man who underwent intra oral styloidectomy.

Eagle (Stylohyoid) Syndrome: Surgical Treatment

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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.

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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.

Treatment Option:

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.

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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.