Eagle syndrome

Overview

Eagle syndrome is a rare condition characterized by recurrent pain in the throat, face, or jaw, usually due to an elongated styloid process or calcified stylohyoid ligament. The styloid process is a slender, pointed piece of bone just below the ear. When this bone is abnormally long or the ligament becomes ossified, it can compress nearby structures such as cranial nerves or blood vessels, leading to a variety of symptoms. Eagle syndrome is also known as stylohyoid syndrome and was first described by Watt W. Eagle in the 1930s.

Causes

The exact cause of Eagle syndrome is not always clear, but several factors have been identified:

• Elongated styloid process: A styloid process longer than 3 cm is typically considered abnormal and can cause irritation or compression of nearby nerves or vessels.

• Calcification or ossification of the stylohyoid ligament: This can lead to reduced flexibility and increased rigidity, causing symptoms.

• Trauma or surgery: Particularly tonsillectomy or neck trauma, which may lead to scar tissue formation and irritation in the styloid region.

• Congenital factors: Some individuals may be born with an unusually long styloid process.

Symptoms

Symptoms vary depending on whether the syndrome affects nerves, blood vessels, or surrounding tissues. There are two main types of Eagle syndrome: classic and vascular.

Common symptoms include:

• Persistent throat pain, often unilateral

• Foreign body sensation in the throat

• Facial pain or jaw pain

• Pain while swallowing (odynophagia)

• Ear pain (otalgia)

• Neck pain or tenderness under the jaw

• Headache

In vascular Eagle syndrome:

• Dizziness or lightheadedness

• Transient ischemic attacks (TIAs) or stroke-like symptoms

• Visual disturbances

• Syncope (fainting), especially when turning the head

Diagnosis

Diagnosis is based on clinical history, physical examination, and imaging studies. Key diagnostic steps include:

• Physical examination: Palpation of the tonsillar fossa may elicit pain or allow the styloid process to be felt.

• Imaging:

  • CT scan with 3D reconstruction: Most accurate tool for visualizing the styloid process and its relationship to nearby structures.

  • Panoramic X-rays or lateral neck X-rays: Can show elongation or calcification but are less detailed.

• Lidocaine injection test: Relief of symptoms following local anesthetic injection into the styloid area may support the diagnosis.

Treatment

Treatment depends on the severity of symptoms. Options include both conservative and surgical approaches:

• Conservative treatment:

  • Pain management with NSAIDs or neuropathic pain medications (e.g., gabapentin)

  • Local corticosteroid or anesthetic injections

  • Physical therapy for neck pain

• Surgical treatment (Styloidectomy):

  • Intraoral approach: Access through the mouth, less invasive but limited visibility

  • External cervical approach: Incision in the neck, better visualization and access, preferred for complex cases

Prognosis

The prognosis for Eagle syndrome is generally favorable, especially with proper diagnosis and treatment. Many patients experience complete or significant symptom relief following surgical removal of the elongated styloid process. Conservative treatment may provide symptom control in milder cases. However, delayed or missed diagnosis can lead to prolonged discomfort and reduced quality of life. Recurrence is rare but possible if the styloid process regrows or symptoms persist due to other contributing factors.