Three-Dimensional Identification of Eagle’s Syndrome- A Case Report
Hassan Baallal*, Akhaddar Ali, Gazzaz Miloud, el Moustarchid Brahim
Department of Neurosurgery, University of King Mohammed V Souissi, AfricaE
Submission: June 27, 2016; Published: July 11, 2016
*Corresponding author: Hassan Baallal, Department of Neurosurgery, University of King Mohammed V Souissi, Mohammed V Military Teaching Hospital, Rabat, Morocco, Africa, Tel: 212661295918; Email: [email protected]
How to cite this article: Hassan B, Akhaddar Ali, Gazzaz M, el Moustarchid B. Three-Dimensional Identification of Eagle’s Syndrome- A Case Report. Glob J Oto. 2016; 1(3): 555565. DOI: 10.19080/GJO.2016.01.555565
The case in question is a 35-year-old man, with a For Peer Review history of bilateral laterocervical pain episodes radiating to the orbital region for over 3 years. He had no history of surgery or trauma. A careful clinical examination radiographs and 3D computed tomography scan revealed 47mm long bilateral styloid processes. In 1937 Eagle documented cases in which elongation of the styloid process (over 25 mm), appeared to be the cause of pharyngeal and cervical pain. Several pathophysiologic mechanisms leading to Eagle’s syndrome have been proposed, but all revolve around mechanical compression of the styloid processes on adjacent structures resulting in direct or referred pain.
Eagle syndrome is represented by alternate discomfort in the oropharynx that may emit to the labyrinth; zygomatic bone; or nape it is generally characterized as dul and persistent another ordinary manifestations include pain with rotation of the head [1-4]; dysphagia; trigeminal neuralgia. It is rarely announced [4,5]. Eagle syndrome is provoked by a prolongation styloid, process that compresses nearby formations including, nerves and blood vessels, usual styloid processes are, intermediate to 2.5 and 3.0cm in length. Linear distance greater than 3cm are treated elongated [5,6].
The case in question is a 35-year-old man, with a For Peer Review history of bilateral laterocervical pain episodes radiating to the orbital region for over 3 years. He had no history of surgery or trauma. He was presented with trigeminal neuralgia at the commencement of the functional disorder and was treated unsuccessfully with carbamazepine since then Physical examination mentioned intensification of the pain by palpation of the tonsillar fossa. Cervical Computed tomography with three-dimensional reconstruction reveal elongation of the styloid processes that were 47mm long on the two sides (Figure 1). The findings were compatible with Eagle syndrome and the patient established of symptomatic treatment, prosthetic rehabilitation and succeeding clinical follow up without have use for any surgery.
Figure 1: Three-dimensional identification of eagle’s syndrome using computed tomography.
Styloid process (SP) is a cylindrical structure in front of the stylomastoid foramen, inferior and anterior, extending from the inferior face of the petrous part of the temporal bone toward the tonsillar fossa between the internal and external carotid arteries.
The SP proceeds as the stylohyoid ligament and attaches to the
lesser horn of the hyoid bone. The internal jugular vein, vagus,
glossopharyngeal, accessories, and hypoglossal nerve, internal
carotid artery, sympathetic chain, and sphenomandibular
ligament are located at its medial point [7-12]. Stylohyoid complex
develops from the second branchial (Reichter cartilage) arch.
Stylohyoid complex consists of four segments: [8-10].
In1937, Eagle reported two observations in which an elongated
styloid process had relations with facial spasm more uncommonly,
symptoms such as dysphagia, and/or facial pain recurrent throat
pain, foreign body sensation, as a direct result of an elongated
styloid process or calcified stylohyoid ligament . However
that may be proximately 4% of the population is thought to have
an elongated styloid process, just among 4% and 10.3% of this
category is thought to truly be symptomatic . The authentic
etiology of the elongated SP due to calcified and ossified bone and
ligament is not explicit. It was proposed that endocrine disorders
in female at menopause, persistence of mesenchymal elements,
surgical trauma; local chronic irritations, growth of the osseous
tissue and mechanical stress or trauma during development of
SP could result in calcified hyperplasia of the SP [15,16]. Eagle
syndrome is now thought to be due to 2 distinct variety, the
standard form succeeding from cranial nerve intrusion causing
stretching of the XII cranial nerve [17-20] and the second type
from distraction of the carotid vessels.
In a research, Okabe et al.  discovered a notable relationship
between the serum calcium (Ca) concentration and the SP
length among 80-year-old subjects. The longer the SP was, the
higher the serum Ca concentration was in this sample. They also
evaluated the correlation between the SP length and heel bone
density in these subjects. Management is medical or surgical
but there is a lack of evidence, particularly on non-surgical
options. These include; nonsteroidal anti inflammatory drugs,
diazepam, carbamazepine, heat application, transpharyngeal
injection of local analgesia, and physiotherapy. Surgery is by the
transphayrngeal or extra-oral approach and may be curative. The
extra-oral approach involves external scarring, but provides better
visualisation of the surgical field and reduced risk of infection. But
the less invasive transpharyngeal route may predispose to injury
of local structures, infection, and post-procedure oedema, due to
a limited surgical field. While surgical failure rates of around 20%
have been described, more recent studies demonstrate complete
resolution of symptoms in most cases with few post-operative
complications, chiefly a transient marginal mandibular nerve
Eagle syndrome is a unusual pathology, whichever be diagnosed by
associating physical examination and radiographic examinations
together. Its treatment success is determined by constituting a
exact diagnosis and taking into account the symptoms to select between a medical or surgical treatment. In this particular case,
the symptomatic treatment was realized, prosthetic rehabilitation
and subsequent clinical follow up without the need of any surgical