Stylalgia: Our Experience of 101 Cases Treated by Intraoral Styloidectomy
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ORIGINAL ARTICLE
Stylalgia: Our Experience of 101 Cases Treated by Intraoral Styloidectomy Dheeraj V. Lambor1 • Radhika Ranganath Shetgaunkar1
•
Carnegie De Sa1
Received: 24 July 2020 / Accepted: 17 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract Evidence from research and literature suggest that Eagle’s syndrome may present with a variety of symptoms creating diagnostic predicament amongst clinicians. We describe a detailed clinical review of symptomatology, diagnosis and management of hundred and one cases of stylalgia. The aim of our study was to asses effectiveness of intraoral styloidectomy as a definitive modality of treatment in stylalgia. A prospective clinical study was conducted in a tertiary referral centre and included 101 patients presenting with symptoms suggestive of stylalgia. The diagnosis of stylalgia was confirmed by history and clinical examination supplemented by orthopentomogram. All patients underwent intra oral styloidectomy following adequate trial of medical treatment. The success rate of intraoral styloidectomy was found to be 80. 19% i.e. 81 out of 101 patients were considered as cured based on pain assessment using visual analogue scale pre and post operatively. Though medical treatment can provide short term relief of symptoms, styloidectomy is the proven definitive modality of treatment for stylalgia. Keywords Eagle’s syndrome Styloidectomy Orthopentomogram Visual analogue scale Elongated styloid process
& Radhika Ranganath Shetgaunkar [email protected] 1
Department of ENT, Goa Medical College and Hospital, Bambolim, Goa 403201, India
Introduction Eagle’s syndrome refers to constellation of neuropathic and vascular occlusive symptoms caused by a pathological elongation of styloid process [1]. It was 1st described by Watt W. Eagle, an otolaryngologist at Duke University in 1937. The styloid process is a slender outgrowth at the base of the temporal bone, immediately posterior to the mastoid apex. It lies caudally, medially, and anteriorly towards the maxillovertebro pharyngeal recess which contains carotid arteries, internal jugular vein, facial nerve, glossopharyngeal nerve, vagus nerve, and hypoglossal nerve [2]. With the stylohyoid ligament and the small horn of the hyoid bone, the styloid process forms the stylohyoid apparatus, which arises embryonically from the Reicherts cartilage of the second branchial arch. Mineralisation or calcification of the styloid complex can cause elongated styloid process in 2–28% of general population [3]. Eagle defined the length of a normal styloid process as 2.5–3.0 cm. In 1937, Eagle described 2 possible clinical expressions attributable to elongated styloid process, as follows: the ‘‘classic Eagle syndrome’’ which is typically seen in patients after pharyngeal trauma or tonsillectomy, and it is characterized by ipsilateral dull and persistent pharyngeal pain, centred in the ipsilateral tonsillar fossa, that can be referred to the ear and exacerbated by rotation of the head. A mass or bulge may be p
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