Eagle Syndrome

Eagle Syndrome Definition

Eagle syndrome (ES) which is also known as stylohyoid syndrome or styloid syndrome is a condition that results to a painful feeling in the neck and head region caused by a calcification of the stylohyoid ligament or deviation of the styloid process.

The condition is not common and most of the individuals who have it may not experience any symptoms. However, when a certain pressure is exerted on several structures in the neck and head by these ossified structures, a wide variety of symptoms may occur. This disease usually appears with aging.

Symptoms

The ossification of the stylohyoid ligaments and styloid process can contribute an increase to the length and thickness of the styloid process; which will then exert pressure on the adjacent structures such as the glossopharyngeal nerve, internal jugular vein, facial nerve, vagal nerve, carotid artery, and hypoglossal nerve, leading to different types of pressure symptoms.

Symptoms of Eagle syndrome may include:

• Odynophagia which is the difficulty in swallowing
• Pain
• Otalgia or pain in the ear
• Painful feeling in the throat like something is stuck in there
• Pain on chewing food
• Increased saliva secretion
• Painful tongue movements
• Headache
• Coughing
• Dizziness
• Painful movements of the neck such as turning the head on the direction of the affected side
• Bloodshot eyes
• Sinusitis
• Pain along the area where the carotid artery is distributed
• Change in voice

Eagle Syndrome Types

Eagle syndrome is also divided into two and these are:

• Classic Eagle Syndrome – This is caused by the fibrous tissue and can result to unilateral sore throat, distortion of the cranial nerve endings, unilateral neck and facial pain, dysphagia, otalgia, and tinnitus.
• Vascular Eagle Syndrome – This is caused by the compression of the sympathetic chain found in the carotid sheath. It can result to a stroke or transient ischemic event.

Pathophysiology

There is no known cause for Eagle syndrome. Tonsillectomy which is the removal of the tonsils is considered responsible for ES problem. However, the condition is also seen in individuals who have never had their tonsils surgically removed. Because of this, various factors have been considered such as:

• Abnormal angular position and length of the styloid process
• Ossification of muscular tendons and the stylohyoid ligament complex
• Problems involving the ossified stylohyoid ligament such as medialization and fracture which is repaired incompletely as a result of excessive granulation tissue formation and the presence of continuous hyoid bone movements

Diagnosis

Eagle syndrome can be confirmed by a physician through physical examination and radiologic procedures. The occurrence of ES is suspected when an individual presents with the classic form of eagle syndrome symptoms. The diagnosis of the vascular form is harder and needs an expert for an opinion.

Radiologic exams that may be performed are:

• Computed Tomography (CT) Scan – This is an imaging type of test that can confirm the elongated styloid process
• Three dimensional CT reconstruction (3DCT) – It is the recommended imaging technique and it could help in visualizing the styloid process. It could also allow the physician to obtain a better explanation of the lesion and surgical information to the patient.
• Orthopantomogram (OPG) – This can produce images on the enlarged styloid section.

Treatment

Eagle Syndrome can be treated by nonsurgical and surgical procedures. If nonsurgical treatments fail, patients are typically referred to a surgeon. Vascular and classic form of ES is treated surgically.

Treatment options may include:

Medical therapy – These can be antidepressants, analgesics, local infiltration with steroids, and anticonvulsants

Styloidectomy – It is a surgical procedure that involves the removal of the elongated region of the styloid process. The two surgical approaches to this method can either be extraoral approach or intraoral approach, but the latter is preferably used.

References:

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2765187/
2. http://www.caringmedical.com/treatment/eagle-syndrome/
3. http://emedicine.medscape.com/article/1447247-overview#a8
4. Kamal, A; Nazir, R; Usman, M; Salam, BU; Sana, F (November 2014). “Eagle syndrome; radiological evaluation and management.”. JPMA. The Journal of the Pakistan Medical Association 64 (11): 1315–7.
5. Oluseisi AD (2006). Tramatic eagle syndrome: Does neck trauma result in complete ossification in partially ossified stylohyoid ligament. Int J Otorhinolarynogol. 4: 2.
6. Ryan MD (2001). CT findings associated with Eagle’s syndrome. AJNR Am J Neuroradiol. 22:1401–2.