Laboratory Studies

Blood work is required to exclude possible systemic diseases. A complete blood count (CBC) is obtained if infection is suspected.

Imaging Studies

Lateral view radiographs of the skull can be substituted for panoramic radiographs of the mouth; the disadvantage of this view is the overlapping between styloid processes of both sides and/or with adjoining bony structures. An antero-posterior view radiograph should be obtained to determine whether the styloid process is medially or laterally deviated.

An advantage of orthopantomogram (panoramic view) is that the entire length of the process can be seen very distinctly and its deviation can also be made out clearly. Although conventional radiographs provide a rough idea of the anatomy, the actual diagnosis is difficult due to the superimposed anatomical structures.

CT scanning (and in particular 3-D CT scanning; see images below) represents an extremely valuable imaging tool in patients with Eagle syndrome, offering an accurate evaluation of the styloid process in relation to its anatomical relationship with the other head and neck structures, to its length and to its usefulness in surgical planning.

CT scan: calcification of the stylohyoid ligament.

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Three-dimensional reconstruction CT scan.

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CT scanning of the skull base and neck is best for diagnosis, although an accurate case history and the specialist’s intuition are also important for the differential diagnosis.

Three-dimensional cone-beam CT is an excellent alternative to study the styloid process.

A study by Kent et al suggested that the distance from the tip of the styloid process to the tonsillar fossa may be a better diagnostic criterion for Eagle syndrome than the actual length of the styloid process. Using conventional and 3-D CT scanning analysis in persons with Eagle syndrome, glossopharyngeal neuralgia, or neither condition (asymptomatic controls), the study found that the average distance from the tip of the styloid process to the tonsillar fossa was significantly smaller in the Eagle syndrome cases (12.7 mm, versus 21.4 mm and 24.8 mm, respectively). Moreover, no significant difference was found in the average length of the styloid process between each group of subjects.^[31]

Diagnostic Procedures

Reproduction of the patient’s pain on palpation of the tonsil or tonsillar fossa and relief of this discomfort by injection of local anesthetic are diagnostic. In the lidocaine infiltration test, 1 mL of 2% lidocaine is infiltrated into the anterior pillar and deep into the tonsillar fossa; after a few minutes, if the patient’s symptoms are relieved temporarily, the test is regarded as positive, confirming the diagnosis of Eagle syndrome.^[32]

Treatment & Management

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Media Gallery

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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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)

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

Disclosure: Nothing to disclose.

Manuele Casale, MD Specialist 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.

Fabrizio Salvinelli, MD Professor of Otolaryngology, 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, Ryte, Neosoma, MI10<br/>Received income in an amount equal to or greater than $250 from: , Cliexa;;Neosoma<br/> Received ownership interest from Cerescan for consulting; for: Neosoma, eMedevents, MI10.

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.