Eagle Syndrome Treatment & Management
- Author: Vittorio Rinaldi, MD; Chief Editor: Arlen D Meyers, MD, MBA more...
Medical management includes the following:
Local infiltration with steroids or long-acting local anesthetic agents 
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. This technique should be avoided because it often does not relieve the symptoms and needlessly endangers important surrounding structures.
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.
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]
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.
Patients are followed up for at least 1 year (12-20 months) and are examined every 3 months during the first year.
The main surgical complications associated with styloidectomy are as follows:
Injury to main neurovascular structures
Temporary alterations of speech and swallowing
Injury of the facial nerve
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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