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Eagle Syndrome Treatment & Management

  • Author: Vittorio Rinaldi, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: May 06, 2016
 

Medical Therapy

Medical management includes the following:

  • Analgesics
  • Anticonvulsants
  • Antidepressant
  • Local infiltration with steroids or long-acting local anesthetic agents [27]
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Surgical Therapy

The 2 traditional surgical approaches to styloidectomy (removal of the elongated portion of the styloid process) are the intraoral approach (or transpharyngeal) and the extraoral approach.

Eagle introduced and preferentially used the intraoral transpharyngeal approach. Manual fracture of the styloid process was also proposed.[28] This technique should be avoided because it often does not relieve the symptoms and needlessly endangers important surrounding structures.

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Preoperative Details

See Indications.

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Intraoperative Details

Intraoral approach

The surgeon locates the styloid process by digital palpation of the tonsillar fossa. After the incision and the identification of the styloid process, it is necessary to split the muscles, to elevate the mucoperiosteum, and, finally, to fracture and excise the styloid process. If the pharyngeal tonsil is present, performing tonsillectomy first during the same operation is necessary.

The advantages of the intraoral approach are that the method is safe, simple, less time consuming, and an external scar is avoided. The disadvantages are possible infection of deep neck spaces, risk of injury to major vessels, and poor visualization. Intraoral resection of the styloid process is a safe technique, but it is not recommended with bilateral intervention at the same surgery, because of possible great discomfort postoperatively.[26, 29]

A study by Torres et al of a modified, tonsil-sparing transoral approach to removal of an elongated styloid process, as performed in 11 patients with Eagle syndrome involving the carotid artery, found that 10 of the patients experienced complete symptom relief and functional improvement. No intraoperative or postoperative complications were reported in any of the cases.[30]

Extraoral approach

The external approach starts with a cervical incision at the upper two thirds of the anterior margin of the sternocleidomastoid muscle to the hyoid bone. After identification and incision of the platysma muscle and the superficial cervical fascia, the parotid fascia is reflected anteriorly and the carotid sheath and the sternocleidomastoid posteriorly in order to reach the posterior belly of the digastric muscle and the vascular-nervous bundle of the neck. The styloid process can now be palpated. Aponeurotic and muscular insertions are separated from the styloid process. Styloidectomy is then performed. Ceylan et al reported a 93.4% of success after external resection.[26, 31]

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Postoperative Details

For the intraoral approach, patients usually start to take oral soft foods after 4-6 hours, and they are discharged 8-24 hours after surgery. For external approach, patients are usually discharged 36 hours after surgery.

All patients take oral antibiotics and analgesics for 1 week.[26]

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Follow-up

Patients are followed up for at least 1 year (12-20 months) and are examined every 3 months during the first year.[26]

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Complications

The main surgical complications associated with styloidectomy are as follows:

  • Injury to main neurovascular structures
  • Hemorrhage
  • Temporary alterations of speech and swallowing
  • Injury of the facial nerve
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Outcome and Prognosis

The overall success rate for treatment (medical or surgical) is about 80%.

The failure of treatment may be associated with the presence of other causes involved in the pathogenesis of the problem (multifactorial etiology).

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Contributor Information and Disclosures
Author

Vittorio Rinaldi, MD Specialist in Otolaryngology, Division of Otolaryngology, Department of Clinical Sciences and Community Health, University of Milan, Fondazione I.R.C.C.S. Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy

Disclosure: Nothing to disclose.

Coauthor(s)

Fabrizio Salvinelli, MD Professor of Otolaryngology, Campus Bio-Medico, University of Rome

Disclosure: Nothing to disclose.

Manuele Casale, MD Specialist in Otolaryngology, Campus Bio-Medico, University of Rome School of Medicine

Disclosure: Nothing to disclose.

Francesco Faiella, MD Resident in Otolaryngology, Campus Bio-Medico University of Rome School of Medicine

Disclosure: Nothing to disclose.

Manuela Coco Department of Otolaryngology, School of Medicine, Campus Bio-Medico University of Rome

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert M Kellman, MD Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, American Rhinologic Society, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Jack A Coleman, MD Consulting Staff, Franklin Surgical Associates

Jack A Coleman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Sleep Medicine, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, The Triological Society, American Society for Laser Medicine and Surgery, Association of Military Surgeons of the US

Disclosure: Received honoraria from Accarent, Inc. for speaking and teaching.

Acknowledgements

Special thanks to Jonathan George Hart.

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Radiographs of the vertebral spine: a-p and lateral view. Neither distinct malposition nor major degenerative changes of the cervical spine are recognizable. The ligamenta stylohyoidea on both sides is largely ossified. The patient's medical condition might be ascribed to a kerato-stylohyoidal syndrome.
CT scan: calcification of the stylohyoid ligament.
Three-dimensional reconstruction CT scan.
 
 
 
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