This 16-year-old male presents with a head injury. Denies neck pain, chest pain, abdominal pain or extremity pain. States that he did lose consciousness. Focus on the elongated right styloid process in image 1, and the elongated left styloid process of image 2. What do you think the diagnosis could be?
If you came up with Eagle syndrome (the bird in my head) as the diagnosis, then you hit the nail on the head. Image 3 highlights the elongated right styloid process measured at 4.6cm. Image 4 shows the elongated left styloid process measuring 3.4cm.
Clinical presentation of Eagle syndrome can be divided into two main subtypes:
1 – Due to compression of cranial nerves
2 – Due to compression of the carotid arteries
Cranial nerve impingement symptoms typically include facial pain when turning the head, dysphagia, foreign body sensation, pain on extending the tongue, change in voice, sensation of hypersalivization, and/or tinnitus/otalgia. On palpation of the styloid process tips, symptoms should ideally be exaggerated.
Arterial impingement symptoms include mechanical compression which would result in visual symptoms, syncope, carotid dissection, or sympathetic plexus irritation (carotodynia) such as eye pain or parietal pain.
Radiographic features of Eagle syndrome include styloid processes longer than 3cm which can be either unilateral or bilateral. Sometimes, styloid processes are elongated or the stylohyoid ligament is calcified.
Typical treatment includes transpharyngeal injection of steroids/local anesthetic agents. Severe cases would involve surgical excision either via transoral approach or a lateral approach. Transoral approach has the disadvantage of increased infection rates, but does not cause external scarring.
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