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Eagle Syndrome

Eagle's Syndrome


Presentation

  • Only 3 weeks after her initial presentation did a repeat CT showed a “foreign body” in her right neck. This presentation would lead to an assumption of a migrated fish bone into the neck.[ijcfm.org]
  • A 35-year-old man presented with sharp neck pain and a foreign-body sensation in the throat. Computed tomography showed elongated styloid processes, and a diagnosis of Eagle’s syndrome was made.[nejm.org]
  • DOI: CASE REPORT A 35-year-old woman presented in the accident and emergency department with a 2-day history of right-sided Horner’s syndrome.[bjgp.org]
  • We present rare and diagnostic radiographic evidence of this on both plain film radiographs and CT scans.[ajnr.org]
  • Med J Aust 2015; 202 (9): 491. doi: 10.5694/mja14.01227 Published online: 18 May 2015 A 38-year-old man presented with influenza A (H1N1) pneumonia complicated by acute respiratory distress syndrome, resulting in an extended intensive care unit stay ([mja.com.au]
Localized Pain
  • pain, odynophagia, dyphagia, otalgia and limited neck mobility.[jpccr.eu]
Plethora
  • […] death has been recorded in literature, and it was only at autopsy that it was revealed that the elongated styloid process had been compressing both the carotid sinuses; radiographic films had failed to show the anatomical changes. 14, 15 There is a plethora[sajr.org.za]
Malnutrition
  • Even when life-threatening complications are absent, glossopharyngeal neuralgia can be a severely debilitating disease, leading to depression, suicidal tendencies, fear of swallowing, weight loss and malnutrition.[jiaomr.in]
Pneumonia
  • Med J Aust 2015; 202 (9): 491. doi: 10.5694/mja14.01227 Published online: 18 May 2015 A 38-year-old man presented with influenza A (H1N1) pneumonia complicated by acute respiratory distress syndrome, resulting in an extended intensive care unit stay ([mja.com.au]
Bruxism
  • There was no hypertrophy of the masseter muscles, which were soft on palpation, and signs suggesting bruxism were absent. The otorhinolaryngological examination noted an absence of earache or atrial flow, a lack of sinus pathology.[jomos.org]
Heart Disease
  • For example, gum disease has been associated with other illnesses such as diabetes and heart disease. But Eagle syndrome may be a conditions you're not familiar with.[colgate.com]
Referred Otalgia
  • Less frequent symptoms are referred otalgia, headache, carotidynia, dizziness, and dysphagia. A range of cranial nerve palsies may occur. Pain is often unilateral and more than one symptom is usual.[bjgp.org]
Fracture
  • Carotid stent fracture from Stylocarotid Syndrome. Radiology Case. 2016 Jun; 10(6):1-8. 4. Han MK, Kim do W, Yang JY. Non surgical treatment of Eagle’s syndrome: a case report. Korean J Pain. 2013; 26 (2): 169-72. 5.[jpccr.eu]
  • Transpharyngeal manipulation with manual fracturing of the styloid process does not usually relieve symptoms but also poses the risk of damaging the nearby neurovascular structures.[sajr.org.za]
  • Symptoms may be due to rheumatic styloiditis and degenerative changes; compression of local structures by an elongated styloid process or fracture of the ossified stylohyoid ligament with scar tissue proliferation; tendinosis at the insertion of the ligament[bjgp.org]
  • Theories include the following: 1) traumatic fracture of the styloid process causing proliferation of granulation tissue, which places pressure on the surrounding structures (7) ; 2) compression of adjacent nerves, the glossopharyngeal, lower branch of[ajnr.org]
  • […] congenital (persistence of cartilaginous elements of precursors of styloid process) or acquired (proliferation of osseous tissue of the stylohyoid complex). [3] There are several explanations for the symptoms, based on anatomical understanding namely: Fracture[ijcfm.org]
Osteophyte
  • Correlation between ossification of the stylohyoid ligament and osteophytes of the cervical spine. J Rheumatol 1997;24:1575-81. [Figure 1], [Figure 2], [Figure 3] [Table 1], [Table 2][jiaomr.in]
Limitation of Neck Movement
  • The mineralized and elongated styloid process refers to unilateral or bilateral elongation of the styloid process that does not result in any significant pain, discomfort, or limitation of neck movement.[jiaomr.in]
Fear
  • A person with this condition may worry that something is seriously wrong and delay medical treatment out of fear. However, Eagle syndrome is highly treatable, with excellent outcomes for most people who seek treatment.[medicalnewstoday.com]
  • Even when life-threatening complications are absent, glossopharyngeal neuralgia can be a severely debilitating disease, leading to depression, suicidal tendencies, fear of swallowing, weight loss and malnutrition.[jiaomr.in]
Headache
  • Get immediate emergency care if suddenly experience any of these symptoms: headache weakness loss of balance changes in vision confusion While Eagle syndrome is rare and poorly understood, it’s easily treated with surgery or medication.[healthline.com]
  • Exertional headache as unusual presentation of the syndrome of an elongated styloid process. Headache. 2009;49(5):776–779. Ramadan SU, Go kharman D, Kacar M, Kos_ar U. Diffuse stylohyoid chain ossification. Diagn Interv Radiol. 2007;13:176–178.[sajr.org.za]
  • The most common inclusions are glossopharyngeal neuralgia, sphenopalatine neuralgia (also known as Sluder's syndrome), histamine cephalgia (cluster headaches), migraine headaches, carotidynia, myofascial pain dysfunction, impacted third molars, and other[jiaomr.in]
  • Occasionally, it manifests as odynophagia, dysphonia, increased salivation, and headache. Not rarely, patients believe that they have not properly healed from their tonsillectomy.[emedicine.medscape.com]
  • […] swallowing difficulties a feeling that there is something stuck in the throat shooting pains from the throat to the ear or jaw pain at the base of the tongue pain when swallowing or turning the head to one side a persisting ringing or buzzing in the ears a headache[medicalnewstoday.com]
Dysesthesia
  • Some of the differential diagnoses includes laryngopharyngeal dysesthesia, third molar impaction or dental-related pain, neuralgia of the sphenopalatine ganglia, glossopharyngeal and trigeminal nerve, temporomandibular joint disorders (TMDs), chronic[sajr.org.za]
  • These include the following: Temporomandibular disorders Laryngopharyngeal dysesthesia Hyoid bursitis Sluder syndrome Glossopharyngeal neuralgia Esophageal diverticula Migraine-type headaches Sphenopalatine neuralgia Cervical arthritis Temporal arteritis[emedicine.medscape.com]
Paresthesia
  • Eagle’s syndrome associated with lingual nerve paresthesia: A case report. J Oral Maxillofac Surg. 2014;72:886.e1–886.e4. Raina D, Gothi R, Rajan S. Eagle syndrome. Indian J Radiol Imaging. 2009;19:107–108. Beder E, Ozgursoy OB, Ozgursoy SK.[sajr.org.za]

Workup

  • Workup Blood work is required to exclude possible systemic diseases. A complete blood count (CBC) is obtained if infection is suspected.[emedicine.medscape.com]
Cervical Spine X-Ray
  • While lateral plain cervical spine X-rays demonstrate an elongated styloid process, the gold standard is CT scanning, with 3D reconstruction, which displays the proximity of an elongated, ossified styloid process to adjacent structures.[bjgp.org]

Treatment

  • Treatment Surgery is a common and effective treatment for Eagle syndrome. Surgery to shorten the styloid process is the primary treatment for Eagle syndrome. This procedure, called a styloidectomy, can be done through the mouth or neck.[medicalnewstoday.com]
  • Eagle Syndrome and cervical disc herniation – combined symptomatology and treatment.[jpccr.eu]
  • Treatment can last anywhere from three months or as an ongoing course for pain management.[colgate.com]
  • Now, the main treatment for FBS is the intraparotid injection of botulinum toxin (BT) based on different treatment procedures.[jomos.org]
  • Resection of the elongated styloid process is the treatment of choice for long-term benefit.[sajr.org.za]

Prognosis

  • Treatment and prognosis In many cases, once the cause of pain has been attributed to the styloid process rather than a more sinister entity, no further treatment is required, or perhaps analgesics can be offered for pain alleviation.[radiopaedia.org]
  • However, the prognosis in surgical failures should also be considered. Compression of the internal carotid artery because of styloid elongation can lead to a transient ischaemic attack which is quite intimidating.[sajr.org.za]

Etiology

  • Stylohyoid chain ossification: A discussion of etiology. Oral Surg Oral Med Oral Pathol 1989;67:515-20. 13. Guo B, Jaovisidha S, Sartoris DJ, Ryu KN, Berthiaume Ml, Clopton P, et al.[jiaomr.in]
  • Various etiologic theories have been proposed to explain the development of Eagle syndrome. The first one stresses the congenital elongation of the styloid process due to the persistence of the cartilaginous precursor.[ejo.eg.net]
  • The pathogenesis of Eagle Syndrome (ES) is still misunderstood, and several theories have been proposed for its etiology.[jomos.org]
  • Etiology This topic is still being debated.[emedicine.medscape.com]
  • Although etiology and pathophysiology of this syndrome was poorly understood, it was first defined as “stylalgia”and related to abnormal length of the styloid process or calcified stylohyoid membrane[ 2 ].[kbb-forum.net]

Epidemiology

  • EPIDEMIOLOGY There is a lack of robust statistical evidence regarding the true prevalence of Eagle syndrome.[bjgp.org]
  • Elongated styloid process: an epidemiological study on digital panoramic radiographs. J Clin Exp Dent. 2017 Dec. 9 (12):e1446-52. [Medline]. [Full Text]. Sekerci AE, Soylu E, Arikan MP, Aglarci OS.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiological explanation of FBS depends on an irritative or traumatic factor in the sympathetic nerve fibers of the parotid gland.[jomos.org]
  • The pathophysiological mechanism of symptoms is debated as well.[ajnr.org]
  • The clinical manifestations of Eagle syndrome have been explained by varied pathophysiological explanations. Fracture of the styloid process may lead to granulation tissue proliferation, which causes pressure on surrounding structures.[ejo.eg.net]
  • […] that dystrophic and degenerative changes in the hyoid complex of the styloid process might be the cause for ES, others suggest that cervico-facial inflammations, tumours, tonsillectomies and trauma could play a major role in causing ES. 4 The suggested pathophysiological[sajr.org.za]
  • Results were derived using three dimensional (3-D) cone-beam computed tomography (CT) scans from 542 patients. [19] Pathophysiology Eagle considered tonsillectomy responsible for the formation of scar tissue around the styloid apex, with consequent compression[emedicine.medscape.com]

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