IS Case 588: Eagle syndrome
Imaging Sciences URMC 2010
Publication Date: 2011-11-17
The Eagle syndrome is elongation of the styloid process that may be congenital or post-surgical following tonsillectomy. Styloid process elongation may be secondary to calcification of the stylohyoid ligament or elongation of styloid process secondary to persistent stylohyal cartilage during development. The stylohyoid ligament is anatomically located to several important neurovascular structures in the neck including: the carotid artery, the jugular vein, and cranial nerves IX through XII. Compression of the carotid artery is more common in congenital form of the syndrome while compression of the glossopharyngeal nerve is more common in the post-surgical form.
Patients typically present with pharyngeal pain radiating to the mastoid region as well as a sensation of fullness in the posterior pharynx. Physical examination reveals a hard mass in the posterior pharynx over the stylohyoid ligament that produces symptoms upon compression.
Radiographic findings include elongation of the styloid process extending to the cornu of the hyoid bone that can range anywhere from 2.5 cm to greater than 7.5 cm in length. However, normal styloid processes can extend up to 7.5 cm in length making Eagle syndrome a clinical diagnosis.
CT is not commonly utilized to make the diagnosis of Eagle syndrome, however the relationship of the styloid process to adjacent neurovascular structures has been utilized in surgical management of the syndrome.
Treatment includes surgical resection and non-surgical palliation with anti-inflammatory agents and steroid injections.
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