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Objective: The surgical treatment of Eagle syndrome involves an intra- or extraoral approach. This systematic review set out to consolidate current knowledge on the prevalence of complications associated with intraoral and external approaches. Methods: Seven main electronic and two gray literature databases were searched. Studies were blindly selected by two reviewers based on pre-defined eligibility criteria. Studies evaluating any type of complication in the treatment of Eagle syndrome were considered eligible. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for studies reporting prevalence data, case reports, and case series. The Comprehensive Meta-Analysis software (Software version 3.0 – Biostat, Englewood, NJ, USA) was used to perform all meta-analyses. Results: Out of 1728 articles found on all databases, 36 were included for qualitative analysis. Twenty were included for quantitative analysis and meta-analysis. Conclusion: In this study, the highest rate of complications was found in the intraoral approach. [ABSTRACT FROM AUTHOR]

Styloid-stylohyoid syndrome is characterized by discomfort and pain in the pharynx and larynx due to an overly long (≧30 mm) styloid process. Fibrous adhesions between the styloid process and the hyoid bone have been reported in styloid-stylohyoid syndrome, which is extremely rare. Here, we report a case of a 33-year-old woman with no relevant medical history who in January 2022, reported experiencing left submandibular pain and was referred to our hospital. Computed tomography scans (CT) revealed overlong bilateral overlong styloid processes near the hyoid bone (length, approximately 75 mm bilaterally), and she was diagnosed with styloid-stylohyoid syndrome. Bilateral styloidectomy was performed under general anesthesia. The styloid process and hyoid bone on the left side were attached to fibrous connective tissues. The nodule had a pseudo-articular structure. Histopathologically, a transition from bone to cartilage was observed. Eight months postoperatively, the patient was symptom-free. [ABSTRACT FROM AUTHOR]

Study design: Literature Review. Objective: Abnormal bone structures in the neck can cause headache, neck pain, and difficulty swallowing, but also cerebrovascular events. We introduce the term "osteovascular conflicts" to describe this phenomenon. The objective of this study was to conduct a literature review of such conflicts involving the anterior and posterior cerebral circulation. Furthermore, we aimed at presenting additional illustrative cases from our institution both for increasing awareness for unusual osteovascular conflicts, and for assessing the practice and care of such patients. Methods: We focused on osteovascular conflicts in the neck leading to cerebrovascular events related to an abnormal bone structure causing arterial or venous compression, dissection, and/or occlusion. We excluded pure vascular forms without cerebrovascular repercussions. Our PubMed/MEDLINE search for articles published in any language and for which an English abstract was available (from 1966 to 2022) included Eagle's neurovascular, bow hunter's syndrome, and golfer's stroke, excluding trauma-induced artery dissections or compressions and those concerning systemic bone disorders. We also provided illustrative cases collected by the authors. Results: All studies were either case reports or small case series. We found 82 cases of Eagle's neurovascular, 258 of bow hunter's syndrome, and 17 golfer's stroke cases. Mean ages were 52, 48, and 47 years, respectively. Male predominance was evident: 81% for Eagle's, 74% for bow hunter's, and 93% for golfer's. Conclusion: Osteovascular conflicts are rare but important causes of cerebrovascular events and often go unrecognised. A greater awareness of cerebrovascular symptoms related to these conflicts can facilitate early diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: Eagle syndrome is a rare condition with a prevalence estimated at 4%, with 0.16% exhibiting symptoms of Eagle’s syndrome resulting from an elongated styloid process or a calcified stylohyoid ligament, compressing over nearby vessels and nerves. Symptoms range from simple headache, neck pain, and odynophagia to cerebral ischemia. Since it can be an incidental finding, management is controversial and ranges from conservative treatment to surgical intervention, including internal carotid stenting and styloidectomy. Clinical presentation: We report two cases of Eagle’s syndrome. Case one (Vascular variant): 44 years old presented with left-sided weakness with Magnetic Resonance Imaging and an angiogram of the brain showing a right middle cerebral artery hemispheric infarct with a right internal carotid artery (ICA) dissection and elongated styloid processes more on the left. The patient’s condition improved with supportive care. He was treated with aspirin, atorvastatin, and an intensive 16-week rehabilitation program. Case two (Classic variant): 41 years old presented with refractory occipital headache and neck pain without vascular insult. Magnetic resonance of both patients showed a long styloid process. Conclusions: Eagle’s Syndrome is a rare entity and perhaps overlooked as an anatomical variant that ought to be considered a possible etiology in atraumatic ICA dissection in patients with no discernable risk factors. As observed in case one, with atraumatic ICA dissection and unremarkable connective tissue disease work-up, highlighting anatomical variant, as an etiology to his ischemic stroke. Styloidectomy should be considered to avert risk of recurrent IC dissections in such patients with atraumatic IC dissection and classic eagle’s syndrome with refractory orofacial pain syndromes exacerbated by head movement or yawning.

Abstract Background Eagle’s syndrome or stylalgia is a relatively rare condition that usually presents with throat pain and dysphagia. Most cases are asymptomatic, and diagnosis is difficult owing to the vague nature of the symptoms. There is a female preponderance. In most cases, the bony tip of the styloid process (SP) is palpable upon careful palpation of the ipsilateral tonsillar fossa. X-ray (Towne’s view) or an orthopantomogram indicates the length of the styloid process or the ossified stylohyoid complex (OSHC). Computerized tomography (CT) of the skull base, apart from measuring length, provides additional details such as medial or ventral angulation and relation to the surrounding neurovascular structures. Case presentation A 40-year-old female patient who presented to our hospital with left-sided throat pain and pricking sensation. After workup, she was diagnosed with left-sided stylalgia. X-ray (Towne’s view) showed that the left styloid process was 27 mm long, and the right styloid process was 24 mm long. CT of the skull base measured the length and angulation of the styloid process on both sides (sagittal and transverse angles), which were found to be 60° and 61° on the left and 64° and 60° on the right side, respectively. The patient underwent left styloidectomy under general anesthesia. Postoperatively, the symptoms were completely relieved by day 7. Conclusion Stylalgia is usually diagnosed on the basis of the elongated styloid process. Solely using the length of the styloid process as a parameter for diagnosis leads to misdiagnosis of cases that present with normal length of the styloid process. This article highlights the importance of CT scans in measuring the angulation of the ossified stylohyoid complex in such cases for accurate diagnosis.

Abstract Background Styloid process (SP) is a cylindrical bony projection that originates from the inferior part of the petrous temporal bone just anteriorly to the stylomastoid foramen. Several nerves, muscles, and ligaments are related closely to the (SP). It is considered elongated when the measurement exceeds 30 mm. The overall prevalence of the styloid process is between 3.3% to 84.4%. The elongation of the styloid process (ESP) is associated with the manifestation of Eagle’s Syndrome (ES) which is characterized by various types of pain in the head and neck region such as headache, tinnitus, otalgia, and trigeminal neuralgia. Eagle’s syndrome occurs in 4–10.3% of individuals with an elongated styloid process (ESP). The objective of the study is to determine the prevalence of (ESP) in the patients who were treated in the Dental Hospital University of Barcelona (HOUB), to review the literature to spot the light on the different demographic data worldwide. Methods The archived panoramic image in the University of Barcelona dental Hospital were consecutively retrieved to investigate the prevalence of (ESP). Of all digital panoramic radiographs (OPG), 400 met the inclusion criteria and were furtherly analyzed. The results are correlated with the participant’s gender, age, and occurrence. Age is subcategorized into three groups. A chi-square test is used to measure the significant differences and the P-value is set at

Eagle's syndrome, or ES, is associated with the elongation of the styloid process and partial or complete mineralization of the stylohyoid ligament. Clinically, the symptoms of ES are characterized by sore throat, neck pain radiating to the ear, dysphagia, and a foreign body sensation when swallowing, resulting from disruption of the neck or pharyngeal region. This report describes 3 male patients (40, 60, and 43 years old) with neck discomfort. These patients were inadvertently diagnosed with ES using multidetector computer tomography and 3-dimensional volumetric computed tomography (MDCT-3D CT). The length of the left styloid process in the first case was 42 mm. In the second case, the size of the right styloid process was 53 mm. In the last case, the length of the right styloid process was 41 mm, while the left side was 43 mm. This syndrome should always be suspected when pain is unilateral and unresponsive to analgesics, mainly in women. Diagnosis requires appropriate examination through radiological examination, special techniques, and experiences. We aim to present and re-emphasize the consideration of a differential diagnosis of ES for diagnosticians.

Background: Eagle's syndrome or stylalgia is a relatively rare condition that usually presents with throat pain and dysphagia. Most cases are asymptomatic, and diagnosis is difficult owing to the vague nature of the symptoms. There is a female preponderance. In most cases, the bony tip of the styloid process (SP) is palpable upon careful palpation of the ipsilateral tonsillar fossa. X-ray (Towne's view) or an orthopantomogram indicates the length of the styloid process or the ossified stylohyoid complex (OSHC). Computerized tomography (CT) of the skull base, apart from measuring length, provides additional details such as medial or ventral angulation and relation to the surrounding neurovascular structures. Case presentation: A 40-year-old female patient who presented to our hospital with left-sided throat pain and pricking sensation. After workup, she was diagnosed with left-sided stylalgia. X-ray (Towne's view) showed that the left styloid process was 27 mm long, and the right styloid process was 24 mm long. CT of the skull base measured the length and angulation of the styloid process on both sides (sagittal and transverse angles), which were found to be 60° and 61° on the left and 64° and 60° on the right side, respectively. The patient underwent left styloidectomy under general anesthesia. Postoperatively, the symptoms were completely relieved by day 7. Conclusion: Stylalgia is usually diagnosed on the basis of the elongated styloid process. Solely using the length of the styloid process as a parameter for diagnosis leads to misdiagnosis of cases that present with normal length of the styloid process. This article highlights the importance of CT scans in measuring the angulation of the ossified stylohyoid complex in such cases for accurate diagnosis. [ABSTRACT FROM AUTHOR]

Background: Styloid process (SP) is a cylindrical bony projection that originates from the inferior part of the petrous temporal bone just anteriorly to the stylomastoid foramen. Several nerves, muscles, and ligaments are related closely to the (SP). It is considered elongated when the measurement exceeds 30 mm. The overall prevalence of the styloid process is between 3.3% to 84.4%. The elongation of the styloid process (ESP) is associated with the manifestation of Eagle's Syndrome (ES) which is characterized by various types of pain in the head and neck region such as headache, tinnitus, otalgia, and trigeminal neuralgia. Eagle's syndrome occurs in 4–10.3% of individuals with an elongated styloid process (ESP). The objective of the study is to determine the prevalence of (ESP) in the patients who were treated in the Dental Hospital University of Barcelona (HOUB), to review the literature to spot the light on the different demographic data worldwide. Methods: The archived panoramic image in the University of Barcelona dental Hospital were consecutively retrieved to investigate the prevalence of (ESP). Of all digital panoramic radiographs (OPG), 400 met the inclusion criteria and were furtherly analyzed. The results are correlated with the participant's gender, age, and occurrence. Age is subcategorized into three groups. A chi-square test is used to measure the significant differences and the P-value is set at < 0.05 for the level of significance. Results: Among the included 400, we found 291 demonstrating (ESP). The prevalence of (ESP) which exceeds 30 mm is 72.75%. It is found that the most common morphological type is type 1 which is regarded as the uninterrupted (ESP) regardless of gender and age group. Concerning the calcification pattern, the most prevalent is the partial calcified (ESP) despite genders and age groups. Conclusion: (OPG) is a sufficient tool for the screening of the elongated styloid process. Regarding the prevalence, our results are considered higher than previously reported prevalence in different populations using (OPG) radiography tool. A study on a wider spectrum of the Spanish population is recommended to further investigate the correlation between the elongated styloid process and the occurrence of Eagle's syndrome. [ABSTRACT FROM AUTHOR]

Introduction: The length of the Styloid Process (SP) has been a subject of research since Eagle's case report on a syndrome characterised by symptoms related to a painful elongated SP. Various modalities including orthopantomogram, digital radiography, cadaveric measurements, and Multidetector Computerised Tomography (MDCT) scanning have been used to study SP length. The present study aims to determine the normal SP length in the Indian population, specifically among armed forces personnel, using MDCT scans. Aim: To measure the SP length in the Indian population using MDCT scans and establish a cut-off length to define elongation. Materials and Methods: A single centre cross-sectional study was conducted at the Department of Radiology, Command Hospital Pune, Maharashtra, India from January 2023 to March 2023. The SP length was measured in 402 patients referred for CT scans of the head and Paranasal Sinus (PNS), utilising 3D Multiplanar Reformation (MPR), curved reformat, and volume rendering techniques. The patients were divided into six age groups: Group I (60 years). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) Version 28.0, and significance was set at p-value 60 years. Conclusion: A statistically significant difference in SP length was observed between genders, with a significant increase in length with age. In the Indian population, an SP length greater than 28 mm should be considered elongated.

Eagle's syndrome is a condition characterized by elongation of the styli process or calcification of the styloid ligament that can manifest as a constellation of symptoms including dysphagia, globus sensation, hoarseness, headache, and neck pain. Anatomically, this can impinge neurovascular structures, distort the hypopharynx, and stifen the epiglottis and other pharyngeal structures, increasing the difficulty of airway management. The objective of this case study was to discuss the features of Eagle's syndrome and anesthetic considerations in the management of the condition. Intubation may be challenging and presents a scenario where a glidescope is the preferred tool over direct laryngoscopy. Smooth emergence and extubation strategies, including the novel use of lidocaine and dexmedetomidine, are followed to minimize the risk of surgical complications. [ABSTRACT FROM AUTHOR]

Internal carotid artery dissection (ICAD) is a complex clinical problem with a multi-causal etiology, in which the intima of the artery ruptures and is detached by the inflowing blood. Causes include trauma, intense exercise, vomiting, prolonged retroflexion of the neck, and spontaneous dissection. The therapy for this condition consists of treatment with anticoagulants or through endovascular intervention in recurrent cases. The aim of this paper is to present a case of ICAD in a young woman complicated by an ischemic stroke caused by an elongated styloid process. This abnormality was found in 3D computed tomography. In the described case, it was decided to start pharmacotherapy and withdraw from the endovascular treatment due to the technical difficulties of the procedure. The patient had been followed up regularly up to 4 years after the incident. An elongated styloid process may be the cause of Eagle’s Syndrome classified into two types: classical type, and the rare carotid artery type, a component of which is ICAD. It is estimated that the styloid process in this form occurs in 4% of the population, which may indicate that the amount of ICAD caused by this variant of the styloid process is underestimated and should be included in the differential diagnosis of ischemic stroke in young people. [ABSTRACT FROM AUTHOR]

Introduction: A styloid process (SP) is considered extended if it is longer than 30 millimeters (mm), which falls between the typical range of 20 and 30 mm. Eagle's syndrome (ES), a disease associated with the styloid process elongation (SPE), was originally recognized by otorhinolaryngologist “Watt Weems Eagle” in 1937. Aims: The calcification pattern, prevalence, and morphology of the SPE in a hospital-based population in Bhubaneswar were all objectively assessed in the study using cone-beam computed tomography (CBCT). Methods and Material: Radiographic records of 1027 patients have been recovered arbitrarily from the authentic records and assessed. The length of the SP was estimated and characterized by their morphology and calcification design. The collected data were analyzed using Statistical Package for the Social Sciences version 25 software. It was deemed statistically significant if the P value ≤ 0.05. Results: It was seen that 25.8% of the males had the presence of elongation as compared to 30.1% of females, which is 153 males out of 440, and 131 females out of 304 showed elongated SP. Conclusion: The SPE could be a coincidental radiography perception without symptoms. In this study, a substitute for CT or all panoramic radiographs for the estimation and assessment of the SP is the CBCT approach.

Eagle’s syndrome refers to unilateral or bilateral elongation of the styloid process or calcified stylohyoid ligament, along with other symptoms, such as dysphagia, otalgia, tinnitus, and globus pharyngeus. A styloid process is considered elongated or abnormal when it exceeds a normal length of 25-27 mm. However, elongation of the ossified styloid ligament is insufficient for diagnosing Eagle’s syndrome. Instead, a constellation of symptoms in history, as mentioned above, and physical and radiographic examinations contribute to diagnosis. This disorder has long been a diagnostic challenge for clinicians. Hence, it is essential for dentists to have a superior knowledge of this relatively rare entity and its anatomic base. This report presents a case of classical Eagle’s syndrome in a 47-year-old woman with symptomatic bilateral elongation of the styloid process. The lengths of the right and left styloid processes were 60.5 mm and 70.74 mm, respectively, which is one of the longest ever reported.

Objective To investigate the correlation between the ossification of the styloid hyoid ligament and Bell’s facial paralysis and provide a reference for clinical diagnosis and treatment. Methods A case of ossification of the bilateral stylohyoid ligament with Bell's facial palsy caused by ossification of the bilateral stylohyoid ligament was diagnosed by clinical manifestations, differential diagnosis and imaging examination. The surgical plan was determined, and combined surgical resection of the ossified area of the styloid hyoid ligament and the greater horn of the hyoid was performed. Postoperative cefoxitin sodium anti-inflammatory treatment, methylprednisolone hormone treatment, acyclovir antiviral treatment, mecobalamin nutritional neurotherapy, and the relevant literature were analyzed. Results The patient experienced pain when swallowing before surgery, disappearance of right frontal ridges, incomplete eyelid closure, and ptosis of mouth corners. An MRI scan of the brain excluded intracranial space-occupying lesions and resulted in the diagnosis of Bell’s facial paralysis. High-resolution CT of the styloid process confirmed ossification of the styloid hyoid ligament. Styloid process shortening and partial hyoid resection were performed under general anesthesia. Half a month after discharge, the symptoms of sore throat and pain in swallowing disappeared, facial nerve function recovered well, right eyelid closure function recovered well, and right mouth droop improved. The facial nerve function basically returned to normal after 1 month of follow-up. A review of the relevant literature showed that ossification of the stylohyoid ligament to form pseudojoint dilation can locally stimulate the peripheral facial nerve and lead to facial paralysis symptoms. Conclusion Ossification of the styloid hyoid ligament is usually characterized by pharyngeal pain, which can be confirmed by imaging examination. Ossification of the styloid hyoid ligament with facial paralysis is rare in the clinic, so it is necessary to make a clear diagnosis and treat the symptoms.

The stylohyoid muscle, one of the four suprahyoid muscles and one of the three styloid muscles, is a small thin muscle running from the styloid process to the hyoid bone. It is intimately related to the styloid process and the styloid ligament. It draws the hyoid bone superiorly and posteriorly along with the posterior belly of the digastric muscle. It functions mainly during swallowing and opening of the mandible. Clinically, it has received much attention for its association with Eagle's syndrome. In this review, anatomic considerations with clinical implications of the stylohyoid muscle will be covered. [ABSTRACT FROM AUTHOR]

Aim: The styloid process (SP) is often considered elongated when it is longer than 33 mm. The aim of this study is to assess the prevalence of the elongated styloid process (ESP) among dental patients and the role of dental pathology as a possible etiological factor. Materials and Methods: In total, 2000 consecutive panoramic radiographs of normal people were retrieved from the College of Dentistry, Ajman University, Ajman, UAE, during the 2-year study period. Two calibrated observers evaluated the radiographs to minimize interobserver bias and error. A caliper was used to measure the length (in millimeters of the ESPs directly on the radiographs from the caudal margin of the tympanic plate to the tip of the SP). The ESP was considered present when the measurements were >30mm. Results: This study indicates that the prevalence of the ESP was about 6.9% among the patients who attended the dental school clinic. Of the 2000 panoramic radiographs reviewed, ESP could be measured in 100 cases at least on one side. There was a significant difference between distributions on the left and right sides. The distribution also depends significantly on age and gender. The incidence of related symptoms was higher than that reported in previous studies. Condusions: The incidence of ESP among dental patients was estimated to be 6.9%, more prevalent among the elderly compared to the young people and bilateral. Odds ratio (OR) in favor of developing ESP in males is 2.378 times more than that in females. In contrast, the OR in favor of having unilateral ESP in males is less than that in females by 0.284. [ABSTRACT FROM AUTHOR]

Stylalgia also referred to as Eagle's or stylohyoid syndrome (first described by Watt Eagle) is a constellation of signs secondary to an elongated styloid process or due to mineralization of the stylohyoid or stylomandibular ligament or the posterior belly of the digastric muscle (Malik et al. in Iran J Otorhinolaryngol 30(6): 101, 2018). The Eagle's syndrome includes symptoms ranging from stylalgia (i.e., pain in the tonsillar fossa, pharyngeal or hyoid region) to foreign-body sensation in the throat, cervicofacial pain, otalgia or even increased salivation or giddiness. Diagnosis is primarily based on symptomatology, physical examination and radiographic investigations and should not be missed. However, palpation of tonsillar fossa with radiological demonstration of the elongated styloid process confirms the diagnosis. Surgical treatment by tonsillo-styloidectomy produces satisfactory results in stylalgia. (Malik et al. in Iran J Otorhinolaryngol 30(6):101, 2018) [ABSTRACT FROM AUTHOR]

Styloid process is a long and slender osseous projection protruding downward, forward and slightly medially from the temporal bone and serves as an anchor point for various muscles associated with the tongue and the larynx. The aim of the present study was to record the length and the angle of Styloid process on three dimensional computed tomography in patients with unilateral symptomatic and palpable styloid process and compare the length and the angle of styloid process of symptomatic side to asymptomatic side on three dimensional computed tomography. 3D-CT face reconstruction were perfomed in all 35 patients (17 females, 18 males of age range 25–69 years). The length of the styloid process and its angulation (transverse and sagittal angles) were measured by means of three dimensional and multiplanar reconstruction images. The length of styloid process on symptomatic side had a mean of 33.61 ± 5.08 mm while on asymptomatic side mean was 31.11 ± 5.02 mm. The mean transverse angle on symptomatic sides had a mean of 72.37° ± 4.48° while on asymptomatic side mean was 74.17° ± 4.48°. The mean sagittal angle seen on symptomatic side was 88.11° ± 5.21° while on asymptomatic side was 87.88° ± 5.03°. Symptomatic side has a longer styloid. Length of the styloid process has a statistical correlation with the symptoms and symptomatic side has a longer styloid. Though there was a difference in transverse and sagittal angulation in symptomatic versus asymptomatic side; but it was not statistically significant. On examination of the opposite asymptomatic side, 5 patients had a palpable styloid process therefore we infer that long styloid process may not always be associated with symptoms. Patients with cervicofacial pain should be evaluated for Eagle syndrome by palpation of styloid process in the tonsillar fossa and further by three dimensional computed tomography (3D-CT). 3D CT is an effective tool in evaluating patients with cervicofacial pain and making a diagnosis of Eagle's syndrome. Therefore, 3D CT should be performed while evaluating patients with these symptoms. [ABSTRACT FROM AUTHOR]

Eagle's syndrome refers to unilateral or bilateral elongation of the styloid process or calcified stylohyoid ligament, along with other symptoms, such as dysphagia, otalgia, tinnitus, and globus pharyngeus. A styloid process is considered elongated or abnormal when it exceeds a normal length of 25-27 mm. However, elongation of the ossified styloid ligament is insufficient for diagnosing Eagle's syndrome. Instead, a constellation of symptoms in history, as mentioned above, and physical and radiographic examinations contribute to diagnosis. This disorder has long been a diagnostic challenge for clinicians. Hence, it is essential for dentists to have a superior knowledge of this relatively rare entity and its anatomic base. This report presents a case of classical Eagle's syndrome in a 47-year-old woman with symptomatic bilateral elongation of the styloid process. The lengths of the right and left styloid processes were 60.5 mm and 70.74 mm, respectively, which is one of the longest ever reported. [ABSTRACT FROM AUTHOR]

Eagle's Syndrome is a much discussed yet controversial and debatable diagnosis of exclusion which is treated by many specialities with often unsatisfactory results. Due to entrapment/impingement on surrounding neurovascular structures by elongated styloid process patient may present with multitude of symptoms. Treatment is controversial and opinions are divided on choice of conservative and surgical management. Aim was to study outcomes of conservative and surgical modalities of treatment of Eagle's Syndrome and bring some clarity on management, what to offer, to whom and when. This prospective observational descriptive study included 15 patients of Eagle's Syndrome, 7 were treated with conservative method and 8 underwent resection of styloid process with intraoral approach. With objectives in mind to study efficacy of both management modalities, pain visual analogue scale (VAS) scores were recorded pre-intervention, post-intervention and during follow up on 1, 3 and 6 months and compared. Conservative management resulted in up to 70% reduction in pain VAS scores till 3 months of therapy (mean pre-intervention score being 3.71, 3 months—1, 6 months—1.29), while surgical modality resulted in nearly 99% reduction in mean pain VAS scores up to 3 months and even improved after 6 months (mean pre-intervention score being 6.75, 3 months–0.5, 6 months–0.13). With this we can conclude that conservative management provide satisfactory short-term (up to 3 months) results but recurrences are known, while surgical resection of elongated styloid process gives better long-term results (6 months and beyond). [ABSTRACT FROM AUTHOR]

Evidence from research and literature suggest that Eagle's syndrome may present with a variety of symptoms creating diagnostic predicament amongst clinicians. We describe a detailed clinical review of symptomatology, diagnosis and management of hundred and one cases of stylalgia. The aim of our study was to asses effectiveness of intraoral styloidectomy as a definitive modality of treatment in stylalgia. A prospective clinical study was conducted in a tertiary referral centre and included 101 patients presenting with symptoms suggestive of stylalgia. The diagnosis of stylalgia was confirmed by history and clinical examination supplemented by orthopentomogram. All patients underwent intra oral styloidectomy following adequate trial of medical treatment. The success rate of intraoral styloidectomy was found to be 80. 19% i.e. 81 out of 101 patients were considered as cured based on pain assessment using visual analogue scale pre and post operatively. Though medical treatment can provide short term relief of symptoms, styloidectomy is the proven definitive modality of treatment for stylalgia. [ABSTRACT FROM AUTHOR]

Objective: The surgical treatment of Eagle syndrome involves an intra- or extraoral approach. This systematic review set out to consolidate current knowledge on the prevalence of complications associated with intraoral and external approaches., Methods: Seven main electronic and two gray literature databases were searched. Studies were blindly selected by two reviewers based on pre-defined eligibility criteria. Studies evaluating any type of complication in the treatment of Eagle syndrome were considered eligible. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for studies reporting prevalence data, case reports, and case series. The Comprehensive Meta-Analysis software (Software version 3.0 - Biostat, Englewood, NJ, USA) was used to perform all meta-analyses., Results: Out of 1728 articles found on all databases, 36 were included for qualitative analysis. Twenty were included for quantitative analysis and meta-analysis., Conclusion: In this study, the highest rate of complications was found in the intraoral approach.

Eagle's syndrome (ES) is characterised by an abnormally elongated styloid process. It remains a complex pathology and the ophthalmological symptoms are relatively rare. Herein, we report two cases who presented to our clinic with unilateral and painful Horner's syndrome. Computed tomography scanning showed the presence of ES with unilateral extrinsic compression of the sympathetic plexus by the styloid. [ABSTRACT FROM AUTHOR]

Eagle's syndrome is one of the commonly overlooked cause of foreign body sensation in throat with referred otalgia. Incidence of symptomatic cases was rare. Elongated Styloid process may present with myriad symptoms. The diagnosis needs a cautious approach and the management is mainly aimed at reduction of the length of elongated section. Prospective study in the Department of ENT Stanley Medical College, Chennai. Study period-January 2018 to September 2018. Clinical examination followed by radiological investigations done to confirm the diagnosis. Stylo-tonsillectomy was done in the selected 20 subjects and post-operative outcomes were compared with pre-operative questionnaires. The progression of symptoms were evaluated for resolution and studied. Pharyngeal symptoms are more common. The length of styloid is associated with symptom complex presentation. The incidence was 0.17% in general population coming to ENT OPD and more common among women with mean age of 43 years. Bilateral presentation was more common and the longest length recorded in the study was 78 mm. Single investigation is not enough to confirm the diagnosis. A minimum of two investigations are needed for planning surgical management. Intra-oral approach with stylo-tonsillectomy was done with no major complications in post-operative period. Pre-operative symptoms were recoreded by use of McGill's pain questionnaire and compared with post-operative scores. Dysphagia was the major post-operative early symptom which took a week minimum to subside. Clinical findings and atleast 2 imaging studies needed for diagnosis of the disorder. OPG though economical can be aided to great extent by use of Conebeam CT or 3D CT to study the elongated styloid process. Stylo-tonsillectomy is a safer approach with minimum complications and earlier relief of pre-operative symptoms. Surgical management with reduction of length of elongated styloid followed by adequate analgesia remains mainstay in treatment. [ABSTRACT FROM AUTHOR]

Eagle's syndrome was first described with all signs and symptoms by W. W. Eagle in the year 1949. It was characterized by abnormal ossification of styloid process leading to either morphological increase in the length of the styloid process itself or abnormal calcification of the stylohyoid ligament. It has been reported in patients of fourth to sixth decade. The surgical management of removal of the elongated styloid was first performed in 1842 even before Eagle's syndrome was completely understood. The establishment of the diagnosis is a challenge in itself as we need to differentiate it from the neuralgias such as glossopharyngeal neuralgia and superior laryngeal neuralgias. Furthermore, the decision of whether to operate or not is another dilemma in itself. We report a case of a 19-year-old girl with classic Eagle's syndrome along with the transcervical surgical management of the same. [ABSTRACT FROM AUTHOR]

Background: Eagle's syndrome is famous for one of the causes of internal carotid artery dissection. The treatment strategy for the illness, however, is not well established. Here, we report a case of internal carotid dissection due to an elongated styloid process successfully treated by carotid artery stenting (CAS). Case Description: A 72-year-old male with temporary dysarthria and consciousness disorder was diagnosed to suffer from multiple cerebral infarctions due to Eagle's syndrome. A cerebral blood flow (CBF) study revealed decreased blood flow and a CAS was performed 15 days after admission to preserve antegrade blood flow, resulting in full recovery of the affected CBF. Conclusion: We reported a case of vascular Eagle's syndrome in which the patient showed fluctuated neurological deficits successfully treated by CAS. Our experience suggests that cases of vascular Eagle's syndrome due to hemodynamic stress can be treated by CAS. [ABSTRACT FROM AUTHOR]

Objective. The objective of this study was to study the morphometry of the styloid process of the temporal bone and the prevalence of an elongated styloid process in relation to side and gender. Material and Method. The present study included 200 human skulls which were procured from the rich osteological collections of the Department of Anatomy, Faculty of Medicine, University of Sarajevo. The styloid process was observed macroscopically on both sides of all the skulls and elongations, if any, were noted. The lengths of the styloid processes were measured using digital vernier calipers. The measurements were taken from the point of emergence of the process (base) up to the tip. Results. Out of 200 specimens, only 14 cases (7%) exhibited an elongated styloid process. The mean length of the styloid process was 25.8±4.68 mm and 24.2±4.54 mm for the right and left sides, respectively. The size of the styloid process did not different significantly between the two sides (P=0.724). The mean length of the styloid process was 24.05±3.54 mm in females and 25.95±5.68 mm in males, and the difference was statistically significant (P=0.023). Conclusion. The study and knowledge of the anatomical variations of the styloid process in the Bosnian population may help clinicians to diagnose Eagle's syndrome. Knowledge of this disorder can prevent the worsening of the painful symptoms related to an elongated styloid process. [ABSTRACT FROM AUTHOR]

Background: A dissection beginning from a point distal to the endpoint of the carotid endarterectomy (CEA) is called distal carotid artery dissection (CAD), which is known as one of the significant surgical complications of CEA. Case Description: We present a case of distal CAD as a perioperative complication after CEA using indwelling shunt. We estimated this pathophysiology to be caused by the mechanical conflict of the inflated balloon with the elongated styloid process. Conclusion: Since a distal CAD can cause severe, irreversible neurological deficits, preoperative assessment of the styloid process should be routinely performed in CEA. [ABSTRACT FROM AUTHOR]

Abstract Objective: To establish baseline data regarding average length of styloid process in adult human dry skulls in Asian population in Pakistani region. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of Anatomy King Edward Medical University, University of Lahore, Services Institute of Medical Sciences, Central Park Medical College, CMH Lahore and Nawaz Sharif Medical College Gujrat, from May to Jun 2018. Methodology: A total of 71 adult human dry skulls with intact styloid processes were studied from the Anatomy museums of various public and private sector medical colleges of Punjab. The length of both styloid processes from root to tip was measured using a measuring scale in centimetres. Results: The length of styloid process varied from a minimum value of 0.8 cm to a maximum value of 4.3cm. Mean length of right and left styloid processes was found to be 1.68 ±.781cm and 1.86 ±.738cm respectively. Out of 14.2% of skulls were found to have styloid process >2.5cm. Mean length of styloid process of the skulls studied in our setting is 1.77 ± 0.76cm. Conclusion: As the styloid process was found to be longer than the normal reported length in 14% of skulls. It might be a reason for symptomatic patients presenting in outpatient ward with throat pain and discomfort which often remains unaddressed and needs consideration.

The purpose of this paper is to summarize and compare known approaches to Eagle’s syndrome treatment, as well as its variety of symptoms and causes. The review was conducted based on publications from doctors around the globe, in order to gain as thorough understanding of the disorder as possible. The syndrome can manifest itself as a slight discomfort in the neck region, dysphagia, migranes, or even in a stroke-like manner resulting in a direct life threat. Depending on its origin, two types of the syndrome were classified: classic and vascular type. When dealing with neck area pain doctors must always take into consideration the Eagle’s syndrome, and by far the best way to recognize it is by performing a CT scan. As for treatment, in the beginning a conservative approach may be best with anti-inflammatory, and anti-anxiety drugs which have been proven to be effective in milder cases. Surgical procedures have also been successfully performed such as styloidectomy, however there is more risk of post- surgical complications. With broad understanding of the subject, and awareness of many treatment strategies, the patients will be diagnosed and treated more effectively and safely.

Objective: To investigate into the prevalence of the SP complex elongation among patients attending RAK Dental College Clinic. Material and Methods: A 3234 radiographic images of patients aged ≥18 years were examined. The O’Carroll (1984) classification of stylohyoid complex was used. Age, gender, ethnicity and patterns of calcification were recorded and analyzed. Chi-squared and ANOVA tests were used to detect potential differences. Results: Male to female ratio was 1.9:1. There were 1150 (35.6%) subjects in age group-I (18-39) and 2084 (64.4%) subjects in the age group-II (≥40). The mean age was 38.12 (±13.2). Fifty seven % (1836) of the subjects were eastern Asians, 671 (21%) Africans, 325 (10%) Middle east, 254 (8%) Europe, and 148 (4%) other ethnicities. A normal SP was found in 1601 (49.51%) of the images, elongated in 903 (27.92%), calcified in 406 (12.55) and undetected in 324 (10.2 %). The elongated and the calcified styloid processes were more common in males (p=0.0078). The elongated and the calcified SP were more frequent in group II subjects (p=0.0004). Eastern Asians had higher percentage of elongated and calcified SP p= 0.00567. Conclusion: Although 1601 (49.51%) of subjects had normal SP, the study revealed a high prevalence of SP elongation among eastern Asians. There is a strong association between the age and the SP elongation. It is crucial to include the head and neck symptoms of non-odontogenic origin in the differential diagnosis of Eagle’s syndrome. The study recommends further investigation using some advanced imaging techniques.

Eagle's syndrome is a condition that typically does not present to pain clinics. It consists of an elongated styloid process greater than 25 mm and/or stylohyoid ligament calcification causing an unusual array of symptoms, relating to anatomical involvement. Multiple specialities may be involved with the diagnosis of this rare condition. Three-dimensional reconstructive computed tomographic (CT) scan remains the gold standard for diagnosis. Depending on the presenting symptoms, care should be directed to an appropriate specialist. Pain surrounding Eagle's syndrome does not typically resolve using simple pharmacological methods. Eagle's syndrome should remain a diagnosis to be considered when faced with non-resolving head/facial pain. [ABSTRACT FROM AUTHOR]

Introduction: Eagle’s syndrome is a poorly understood clinical entity that has variable presentations like recurrent throat pain or foreign body sensation, dysphagia, or facial pain. With a confirmed diagnosis, a surgical approach is considered appropriate for its treatment. This study aims to find out the prevalence of trans-oral extra tonsillar approach of styloidectomy among the operated cases of Department of Otolaryngology-Head and Neck Surgery at a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted among 1,475 who underwent surgery at the Department of Otolaryngology-Head and Neck Surgery in a tertiary care center of Nepal between July 2018 to September 2020 after receiving the ethical clearance from the Institutional Review Committee (Reference number: 0106201802). Convenience sampling was done and data was entered in Statistical Package for the Social Sciences version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Among 1,475 patients enrolled in the study, 24 (1.62%) patients (95% Confidence Interval= 0.97-2.26) underwent trans-oral extra tonsillar approach of surgery for Eagle’s syndrome during the study duration. Conclusions: The prevalence of styloidectomy among the operated cases of our study is low in comparison to other studies done in similar settings. Transoral extra tonsillar approach can be considered as a novel approach for surgical removal of the styloid process in Eagle’s Syndrome.

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.

Objective  Surgical treatment of Eagle's syndrome remains the mainstay of treatment. Palsy of the marginal mandibular branch of the facial nerve is the most significant complication encountered in transcervical resections, due to direct compression during the approach. We proposed a modification of the craniocervical approach to the jugular foramen to resect the styloid process avoiding the marginal mandibular branch and subsequent palsy. Design  This is a single-center retrospective cohort study. Setting  The research was conducted at a tertiary medical center. Participants  From November 2008 to October 2018, 12 patients with Eagle's syndrome underwent treatment using our modified approach. Main Outcome Measures  Demographic data, type of Eagle's syndrome, symptomatic side, size of the styloid process, clinical outcomes, and complications were analyzed. Results  Mean size of the styloid processes was of 3.34 cm on the operated side (2.3–4.7 cm) and 2.98 cm on the other (2–4.2 cm). Intraoperative facial nerve irritation occurred in one case. Resection of the entire styloid process was achieved in all cases. Eight cases experienced complete improvement, three cases had a partial response, and one case failed to improve. There were no cases of recurrence. Two patients presented transient postoperative auricular paresthesia. There were no cases of mandibular branch palsy, nor any other complications in our series. Conclusions  Our modified transcervical approach is effective in avoiding the marginal mandibular branch of the facial nerve, avoiding postoperative palsy. [ABSTRACT FROM AUTHOR]

The styloid process is a subtle process of variable length that originates from the petrous part of temporal bone. From the process originate three muscles: the stylopharyngeus, the styloglossus, the stylohyoideus and two ligaments: stylohyoid and stylomandibular. The styled process of the temporal bone has a variable length as demonstrated for studies conducted in threedimensional computed tomography or dental panoramic three-dimensional scanning, and in dried skulls The normal length of the styloid process is particularly important to establish for the relations of closeness with vascular and nervous structures and their possible compression by an elongated styloid process. Several studies have focused on the effects of changes in length and course of the styloid process, highlighting the relations of the carotid artery and the glossopharyngeal nerve to explain cerebrovascular symptoms or Eagle's syndrome characterized by neck pain and dysphagia. However the association for the abnormal length of styloid process and Eagle's syndrome is not always present and many cases are asymptomatic. In the present study we propose a review of the studies performed with different in vivo radiological techniques and on dried skull collections on the normal and pathological length of the stiloyd process and on its association with the Eagle's syndrome. We also present a morphometric study carried out in dried skulls of our museum collection. The results are discussed in light of the possible variations in the muscular and ligamentous structures consequent to the elongation of the styloid process. [ABSTRACT FROM AUTHOR]

Eagle's syndrome is a condition characterized by an elongated styloid process or a calcified stylohyoid ligament, which can lead to a plethora of symptoms, such as neck and facial pain upon movement, dysphagia, pharyngeal foreign body sensation, headache, and vertigo-like sensations. This pathology may affect one or both of a patient's styloid processes (unilateral or bilateral), with most of these cases going undiagnosed due to the vague nature of their symptoms. Nonetheless, the diagnosis of Eagle's syndrome must derive from the combined findings of both clinical examination and radiographic imaging. Symptomatic patients may require conservative or surgical treatment., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Karapepera et al.)

Stylocarotid artery syndrome (SAS) is a rare variant of Eagle's syndrome that may lead to transient ischemic attack or stroke. The underlying pathophysiological mechanism involves compression of the internal carotid artery by an elongated styloid process (ESP), potentially resulting in vascular occlusion or dissection. An ESP exceeding 2.5 cm is deemed elongated, with a length of 3.0 cm considered clinically significant. Although the prevalence of ESP ranges from 4.0% to 7.3%, symptomatic cases are rare; symptoms are present in only approximately 4.0% of individuals with an ESP. Unlike the typical symptoms of Eagle's syndrome, SAS may not cause pharyngeal discomfort, the sensation of a foreign body in the throat, dysphagia, or facial pain. This absence of characteristic symptoms as well as the development of central nervous system symptoms often leads patients to seek care from neurologists instead of otolaryngologists, increasing the likelihood of misdiagnosis or underdiagnosis. We herein report a unique case of ischemic stroke caused by SAS and present a literature review on cases of SAS-associated ischemic stroke published in the past decade. The reporting of this study conforms to the CARE guidelines., Competing Interests: Declaration of conflicting interestsThe authors declare that there is no conflict of interest.

A 28 year old male was referred with a 5 month history of an inability to eat more than a few mouthfuls of food without early satiety, bloating, epigastric pain, nausea and vomiting. He had lost 37kg in weight (95kg–58kg; 7.4kg/month) by the time of referral. He also described symptoms suggestive of both variants of Eagle's syndrome (glossopharyngeal and styloid-carotid) and symptoms consistent with limitation of internal jugular vein outflow. The patient underwent bilateral styloidectomy and resection of the transverse processes of the C1 vertebra. The patient described post-operative resolution of symptoms including the immediate and ongoing ability to eat a full meal without pain or vomiting. We discuss the possible underlying aetiology for weight loss and why immediate resolution occurred after surgery.

Introduction: Eagle’s syndrome is a constellation of signs secondary to an elongated styloid process or due to mineralization of the stylohyoid or stylomandibular ligament or the posterior belly of the digastric muscle. The syndrome includes symptoms ranging from stylalgia (i.e. pain in the tonsillar fossa, pharyngeal or hyoid region) to foreign-body sensation in the throat, cervicofacial pain, otalgia, or even increased salivation or giddiness. Materials and Methods: We describe a clinical study of 12 patients with Eagle’s syndrome, along with their clinical profile and the treatment offered. Patients were diagnosed based on history and clinical examination, as well as the Xylocaine 2% tonsillar fossa injection test. A visual analog scale (VAS) was used for comparison of pain before and up to 3 months after treatment. Radiology (orthopantomogram or three-dimensional computed tomography) was used for further exploration. Nine patients underwent tonsillo-styloidectomy surgery and three underwent medical treatment with pregabalin (75 mg/day). Results: The majority of surgically-managed cases (88%) achieved a definitive benefit by tonsillo-styloidectomy surgery, whereas all medically managed cases achieved only short-term pain relief. Conclusions: Besides the common throat diseases, the symptoms associated with Eagle’s syndrome may be similar to those due to cervicofacial neuralgias, dental, or temporo-mandibular joint diseases. Diagnosis is primarily based on symptomatology, physical examination and radiographic investigations, and should not be missed. Treatment by tonsillo-styloidectomy produces satisfactory results in stylalgia.