Educational Pearls:

Eagle Syndrome: Elongation of styloid process or ossification of stylohyoid ligament

• Presenting Symptoms: Unilateral tonsillar pain, retromandibular pain, odynophagia, referred otalgia, focal tenderness to palpation

• Epidemiology: 

  • F>M

  • > 30 years of age

  • Usually unilateral

• Etiology: Hypothesized to be related to focal trauma (tonsillectomy), endocrine disorders, or end-stage renal disease (ESRD)

• Pathophysiology: Long styloid process or ossified stylohyoid ligament that causes mechanical irritation of surrounding nerves

• Diagnosis: CT with 3D reconstruction (preferred modality), X-ray

• Treatment: 

  • Conservative

    • Analgesia

    • Anticonvulsants

    • Transpharyngeal steroid or lidocaine injection

    • Topical heat

    • Avoid manual fracture; does not usually relieve symptoms

  • Surgical

    • Styloidectomy or styloid reduction —> gold standard of treatment

    • Either intraoral or externally  

      • Caution to avoid CN VII damage

      • Significant risk of failure (~20%)