Islam Abdou Elzahaby1* and Elsherbini Elazazy Elshal2
1Lecturer of surgical oncology at oncology center Mansoura University, Egypt
2Consultant of oral and maxillofacial surgery at Mansoura international hospital, Egypt
Received: 21 December, 2016; Accepted: 27 January, 2017; Published: 28 January, 2017
Islam Abdou Elzahaby, Dr. Lecturer of Surgical Oncology at Oncology Center Mansoura University, E-mail:
Elzahaby IA, Elshal EE (2017) Stylohyoid Syndrome and its Surgical Treatment – A Case Report and Review of the Literature. Arch Otolaryngol Rhinol 3(1): 013-016. DOI: 10.17352/2455-1759.000035
© 2017 Elzahaby IA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Styloid; Eagle syndrome; Stylalgia; Styloidectomy
Stylohyoid syndrome or eagle’s syndrome is caused by calcification of the stylohyoid ligament or elongation of the bony styloid process. It may remain asymptomatic or it may present with facial neuralgia, foreign body sensation in pharynx, throat pain or even otalgia and cephalgia. Diagnosis is mainly based on clinical examination and confirmed by the radiological findings. The mainstay treatment is surgical excision via external approach or intraoral approach. We are reporting a case of unilateral stylohyoid syndrome along with the literature review.
Stylohyoid syndrome or Eagle syndrome or stylalgia is an uncommon syndrome that affects about 4% of population and is more common in middle aged females between 30-50 years [1,2].
The aetiology of this syndrome was reported to be due to anatomical or pathological elongation of the styloid process or calcified stylohyoid ligament. Eagle defined the length of a normal styloid process at 2.5-3.0 cm [1,3,4].
In most instances this syndrome is diagnosed incidentally or by exclusion due to its rarity and heterogeneous symptomatology, nevertheless its primary symptom is oropharyngeal pain or stylalgia which may radiate to the ear and may be exaggerated by head movement or even chewing, yawing and speaking [5,6].
The diagnosis of this syndrome therefore represents a challenge . Patients with eagle syndrome may pass undiagnosed or even receive psychotherapy being diagnosed as having a psychological disturbance rather than an organic disease.
Stylohyoid syndrome can be successfully treated by surgical styloidectomy either intra or extra-orally (transcervical), however, some authors reported successful conservative medical treatment [8-10].
We hereby reporting a patient of stylohyoid syndrome who sought medical advice at different clinics without relief and lastly he came at our oncology clinic for exclusion of malignancy due to his cancer phobia as his father has had nasopharyngeal carcinoma where we suspected stylohyoid syndrome and was proved by the 3D reformatted CT.
A 45-year-old male patient presented to the oncology center at Mansoura University, complaining of a dull-aching intermittent pain in left upper neck region of ten months duration, the pain was radiating to oropharynx, the patient also gave a history of long standing intermittent odynophagia and a foreign body sensation in the throat. The pain is exacerbating with turning the head to the right side. There was no recent history of tonsillectomy or any other cervicopharyngeal trauma. The patient sought medical advice at a dental, otolaryngeology and neurology clinics with no improvement. Cancer phobia was the drive that made the patient seek service at our oncology center since his father has had nasopharyngeal carcinoma.
Physical examination revealed no palpable masses in the neck or in the tonsillar regions however moderate tenderness was expressed by the patient while palpating the left tonsillar region.
Radiographic evaluation revealed (3D reformatted computed tomography) elongated styloid process (calcified stylohyoid complex), measuring 6.7 cm on left side and 2.3 cm on right side (Figure 1). So we suspected a stylohyoid (Eagle) syndrome. Confirmation of the diagnosis was made by local infiltration of 2% lidocaine in the left paratonsillar region which led to immediate pain relief.