literature review on the clinical and radiological aspect of eagles syndrome

7/27/2019 Literature Review on the Clinical and Radiological Aspect of Eagles Syndrome

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The clinical and radiological aspect of Eagles syndrome

Name: Kelvin Bird

Id # 0012448


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Abstract:

Eagle syndrome or styloidcarotid artery syndrome,symptoms brought on by compression of

regional structures by elongation of the styloid process by usually more than 30mm or

ossification of the stylohyoid or stylomandibular ligaments. Watt Eagle, an

otorhinolaryngologist described it for the first time in 1937, dividing it into two subtypes or

forms: The classic form and the vascular one. The symptoms vary greatly, ranging from

cervicofacial pain to cerebral ischemia, depending on the underlying pathogenetic mechanism

and the anatomical structures compressed or irritated by the styloid process. The syndrome

generally follows tonsillectomy or trauma. Diagnosis is confirmed by radiological findings.

Palpation of the styloid process in the tonsillar fossa and infiltration with anesthesia are also used

in making the diagnosis. The treatment is primarily surgical; however, some conservative

treatments have also been used. The current literature on Eagle's syndrome is reviewed,

highlighting its often underestimated frequency and its clinical importance.
http://en.wikipedia.org/wiki/Otorhinolaryngologisthttp://en.wikipedia.org/wiki/Otorhinolaryngologist


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Introduction

The styloid process is a cylindrical, long cartilaginous bone located on the temporal bone. The

normal styloid process length is approximately 2030 mm. The muscles and ligaments which

have a role in mastication and swallowing are attached to the styloid process. There are many

nerves and vessels such as carotid arteries adjacent to the styloid process. Both the styloid

process and the stylohyoid ligament develop from the Reicherts cartilage (second pharyngeal

arch). The styloid process elongation can be assumed if either the styloid or the adjacent

stylohyoid ligament ossification shows an overall length in excess of 30 mm. Elongated styloid

process is known as Eagles syndrome when it causes clinical symptoms as neck and

cervicofacial pain. It is supposed that this symptoms and signs are due to the compression of the

styloid process on some neural and vascular structures. Symptoms such as dysphagia, tinnitus,

and otalgia may occur in patients with this syndrome. It may also cause stroke due to the

compression of carotid arteries. The symptoms due to this syndrome can be confused with some

disorders including a wide variety of facial neuralgias, oral, dental and, temporomandibular

diseases. Therefore, a detailed differential diagnosis for SPE should be done.

Clinical Features

The clinical presentation can be challenging as it relates to establishing a causative relationship

between the styloid process or stylohyoid ligament and symptoms. In order to simplify this

process the syndrome is be divided into two main sub type with the associated symptoms

1. due to compression of cranial nerves2. due to compression of carotid artery

Patients can have symptoms related to compression and irritation of cranial nerves in the region

(cranial nerves V, VII, IX and X)

facial pain while turning the head dysphagia foreign body sensation


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pain on extending tongue change in voice sensation of hypersalivation tinnitus or otalgia

On palpation of the styloid process tip, symptoms should ideally be exacerbated.

Additionally compression of the carotid artery may also produce vascular / ischaemic symptoms

as well as pain along the artery to the supplied territory (thought to be mediated by the

sympathetic plexus) including

mechanical compressiono visual symptomso syncope

sympathetic plexus irritationo eye paino parietal pain

Radiographic features

The normal length of the adult styloid in an adult thought to be approximately 25mm while an

elongated styloid is considered > 30mm. Elongation can be unilateral or bilateral

Panoramic radiograph and Computed tomography can both be used to assess the styloid process /

stylohyoid ligament complex.

It has also been proposed that in cases when mechanical vascular compression is potentially the

cause of ischemic symptoms that angiographic examination (CT angiography or catheter

angiography) obtained with the patient's head positioned to reproduce symptoms may

demonstrate mechanical stenosis of the carotid artery .


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Treatment

Treatment of Eagle syndrome is both surgical and nonsurgical. Nonsurgical treatments include

reassurance, nonsteroidal anti-inflammatory medications, and steroid injections.

Surgical treatment is by one of two methods. Otolaryngologist W. Eagle preferentially used atranspharyngeal approach through which the elongated portion of the styloid process was

removed. Although this technique does avoid external scarring, it has been heavily criticized

because of the increased risk of deep space neck infection and poor visualization of the surgical

field (must be performed through the mouth).

Alternatively, the elongated portion can be removed by an extraoral approach. Although both

procedures are effective in removing an elongated styloid process, the extraoral approach is

thought to be superior because of the decreased risk of deep space neck infection and bettervisualization of the surgical field.


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References

Eagle WW. Elongated styloid processes: report of two cases. Arch Otolaryngol 1937; 25:584

587

Eagle WW. Elongated styloid process:symptoms and treatment. Arch Otolaryngol 1958; 67:172

176.

literature review on the clinical and radiological aspect of eagles syndrome

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