Treatment of Eagle’s Syndrome By Intended Fracture of The Styloid Process: Report of Two Cases

Yıl 2023, Cilt: 3 Sayı: 1, 58 - 61, 29.04.2023

Meriç Develi , Öznur Özalp , Alper Sindel

Öz

Eagle's syndrome is a symptomatic condition of the long styloid process which radiates to the ear, temporomandibular joint region and presents as facial-neck pain. Diagnosis is usually made by palpation of the styloid process in the tonsillar fossa and three-dimensional computed tomography. Both surgical and conservative treatments can be used in the treatment. Manual fracture of the styloid process may be an alternative treatment for patients who refuse surgical treatment.The first patient, a 36-year-old male, was admitted with the complaint of dysphagia. The second patient, a 29-year-old male, was admitted with the complaint of pain and foreign body sensation in the throat. In both patients, clinical examination revealed increased pain on palpation of the tonsillar fossa. OPG showed elongated styloid processes.These findings together with clinical manifestations established diagnosis of ES. Since both patients refused surgical resection, we preferred fracturing the elongated processes by digital pressure. Procedures were performed under conscious sedation. Post-operative periods were uneventful, and patients reported significant regression in their symptoms at 3-months follow-up. This procedure may be a minimally invasive and successful treatment modality in patients who refused the surgical resection. However, long-term close follow-up of these patients is recommended to evaluate the outcomes of the treatment.

Anahtar Kelimeler

Eagle’s syndrome, fracture, styloid

Kaynakça

• 1. Boucher Y, Mularski A, Felizardo R, Tankere F, Dieb M. Chronic oropharyngeal pain and medical nomadism in an Eagle's syndrome patient: a case report. J Med Case Rep. 2022;16(1):201. Published 2022 May 12. doi:10.1186/s13256-022-03372-0 ).
• 2. Fini G, Gasparini G, Filippini F, Becelli R, Marcotullio D. The long styloid process syndrome or Eagle’s syndrome. J Craniomaxillofac Surg. 2000; 28:123-127.
• 3. Sigdel B, Karn M, Sah K. Bilateral elongated styloid processes: Eagle syndrome. Lancet. 2021 Apr 10;397(10282):1387.
• 4. Yetiser S, Gerek M, Ozkaptan Y. Elongated styloid process: diagnostic problems related to symptomatology. Cranio.1997;15:3:236–241.
• 5. Mayrink G, Figueiredo EP, Sato FR, Moreira RW. Cervicofacial pain associated with Eagle’s syndrome misdiagnosed as trigeminal neuralgia. Oral Maxillofac Surg. 2012;16:207-210.
• 6. Ersan N, İlgüy M, İlgüy D. Eagle sendromu: Olgu bildirimi. Acta Odontologica Turcica. 2016;33:1:30-34.
• 7. Huang K, Sanjuan-Sanjuan A, Cannavo M, Cass T, Ramirez CA. Does Transcervical Styloidectomy for Eagle Syndrome Improve Quality of Life? J Oral Maxillofac Surg. 2022 Dec;80(12):1989-1995.
• 8. Badhey A, Jategaonkar A, Kovacs AJA, Kadakia S, De Deyn PP, Ducic Y, et al. Eagle syndrome: A comprehensive review. Clin Neurol Neurosurg. 2017;159:34-38.
• 9. Al Weteid A.S., Miloro M.: Transoral endoscopic-assisted styloidectomy: How should Eagle syndrome be managed surgically?. Int J Oral Maxillofac Surg 2015; 44: pp. 1181-1187.
• 10. Fusco DJ, Asteraki S, Spetzler RF. Eagle's syndrome: embryology, anatomy, and clinical management. Acta Neurochir (Wien). 2012 Jul;154(7):1119-26.
• 11. Savranlar A, Uzun L, Uğur MB, Ozer T. Three-dimensional CT of Eagle’s syndrome. Diagn Interv Radiol. 2005;11:4:206-209.
• 12. Piagkou M, Anagnostopoulou S, Kouladouros K, Piagkos G. Eagle's syndrome: a review of the literature. Clin Anat. 2009;22:5:545–558.
• 13. Green BN, Browske LKM. Elongated styloid processes and calcified stylohyoid ligaments in a patient with neck pain: implications for manual therapy practice. J. Chiropr. Med. 2014;13:2:128–133.
• 14. Chase DC, Zarmen A, Bigelow WC, McCoy JM. Eagle's syndrome: a comparison of intraoral versus extraoral surgical approaches. Oral Surg Oral Med Oral Pathol. 1986;62:6:625–629.
• 15. Murthy PS, Hazarika P, Mathai M, Kumar A, Kamath MP. Elongated styloid process: an overview. Int J Oral Maxillofac Surg. 1990;19:4:230–231.
• 16. Sham E, Reddy TJ, Menon PS, et al. Anterior Tonsillar Fossa Approach to Elongated Styloid Process. Ann Maxillofac Surg. 2020;10(1):203-209.
• 17. Boedts D. Styloid process syndrome or stylohyoid syndrome? Acta Otorhinolaryngol Belg. 1978;32:273–8.
• 18. Zhang YL, Liao DM, Wei YG, Bai GR. Styloid process syndrome: Length and palpation of the styloid process. Chin Med J (Engl) 1987;100:56–7.
• 19. Chase DC, Zarmen A, Bigelow WC, McCoy JM. Eagle's syndrome: A comparison of intraoral versus extraoral surgical approaches. Oral Surg Oral Med Oral Pathol. 1986;62:625–9.
• 20. Beder E, Ozgursoy OB, Karatayli Ozgursoy S. Current diagnosis and transoral surgical treatment of Eagle's syndrome. J Oral Maxillofac Surg. 2005;63:1742–5.
• 21. Chrcanovic BR, Custódio AL, de Oliveira DR. An intraoral surgical approach to the styloid process in Eagle's syndrome. Oral Maxillofac Surg. 2009;13:145
• 22. Martins WD, Ribas Mde O, Bisinelli J, França BH, Martins G. Eagle's syndrome: treatment by intraoral bilateral resection of the ossified stylohyoid ligament. A review and report of two cases. Cranio. 2013;31:3:226-31.
• 23. Sharma N, Ram R, Kamal R. Unusually elongated styloid process: A report of two cases with literature review. Ann Maxillofac Surg. 2016;6:2:297-299.
• 24. Kaur A, Singh A, Singal R, Gupta S. Is this way; self inflicted fracture of styloid process cures stylalgia. J Med Life. 2013;6:2:202.