An Unusually Long Process: Eagle Syndrome

For a tiny subset of patients, an anomaly in the skull’s architecture can precipitate significant symptoms. That was true for a 34-year-old woman who presented with a 5-month history of diffuse neck pain that increased with movement. For the previous 3 months, discomfort was associated with the feeling that she had a lump in the throat.

An oral examination was normal, as were findings from an assessment of the neck. Video laryngoscopy produced normal results as well. An orthopantomogram (Figure) revealed an extended styloid process on both sides of the neck.

The patient was given a diagnosis of Eagle or stylohyoid syndrome. First detailed by Watt Eagle in 1937, the condition is caused by an elongated styloid process or calcification of the stylohyoid ligament. While the etiology has yet to be defined, the condition can be seen in patients prone to heterotrophic calcification, such as those with chronic renal failure. The symptoms tend to be nonspecific: neck pain, otalgia, dysphagia, foreign-body sensation, visual irregularities, and even syncope. These arise from compression of surrounding nerves or the carotid artery. The diagnosis is confirmed through radiologic identification of the enlarged styloid process, either with computed tomography or an orthopantomogram.

Treatment is surgical excision of a portion of the styloid process through the intraoral route or through an external incision in the neck. The prognosis varies, with as many as 20% of postsurgical patients reporting persistent pain. Our patient underwent intraoral excision of the elongated styloid process, and she remained asymptomatic at the 2-month follow-up visit.