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Campisi R, Caranti A, Meccariello G, Stringa LM, Bianchini C, Ciorba A, Pelucchi S, Vicini C. Transoral robotic styloidectomy for Eagle syndrome: A systematic review. Clin Otolaryngol 2024; 49:293-298. [PMID: 38290994 DOI: 10.1111/coa.14145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/29/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES The aim of the study is to conduct a systematic review of the existing literature on styloidectomy performed through transoral robotic surgery (TORS) in Eagle syndrome (ES). DESIGN AND SETTING Two independent reviewers (RC and AC) conducted a systematic review of PubMed and Embase databases, seeking articles on TORS performed for ES treatment. The search was conducted in July 2023. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PARTICIPANTS The review included a total of 17 adult patients, comprising 12 females and 5 males, with an average age of 52.2 years, all diagnosed with ES. MAIN OUTCOME MEASURES For each patient, we assessed the overall length of the styloid process, the affected side, total intervention duration, hospitalization duration, pre and postoperative Visual Analogue Scale (VAS) scores, and the presence of minor and major complications. RESULTS We identified 4 articles describing 17 instances of TORS as a surgical treatment for ES in the literature, totaling 18 styloidectomies. The mean age of the patients was 52.2 years, with 12 females and 5 males. The average operation time, inclusive of the docking phase, was 68.8 minutes. Sixteen patients (94.1% of the total) experienced complete symptom disappearance or near-complete resolution after surgery. One patient (5.9%) showed improvement categorized as 'non-meaningful.' Only one case of minor complication was reported among the 17 procedures (5.9%).
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Affiliation(s)
- Ruggero Campisi
- ENT & Audiology Department, University Hospital of Ferrara, Ferrara, Italy
| | - Alberto Caranti
- ENT & Audiology Department, University Hospital of Ferrara, Ferrara, Italy
| | | | | | - Chiara Bianchini
- ENT & Audiology Department, University Hospital of Ferrara, Ferrara, Italy
| | - Andrea Ciorba
- ENT & Audiology Department, University Hospital of Ferrara, Ferrara, Italy
| | - Stefano Pelucchi
- ENT & Audiology Department, University Hospital of Ferrara, Ferrara, Italy
| | - Claudio Vicini
- ENT Department, Morgagni-Pierantoni Hospital, Ferrara, Italy
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Huang K, Sanjuan-Sanjuan A, Cannavo M, Cass T, Ramirez CA. Does Transcervical Styloidectomy for Eagle Syndrome Improve Quality of Life? J Oral Maxillofac Surg 2022; 80:1989-1995. [PMID: 36174663 DOI: 10.1016/j.joms.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Eagle syndrome is an uncommon disorder that significantly impacts the quality of life (QoL) of patients. No formal QoL study has been carried out on a population of Eagle syndrome patients treated via transcervical approach. We aim to evaluate and analyze the outcomes of the patients with Eagle syndrome treated with transcervical styloidectomy via our modified QoL survey. METHODS A retrospective cohort study was utilized for patients with Eagle syndrome who underwent transcervical styloidectomy at our institution from January 2008 until December 2018. Two QoL surveys were sent to subjects. Patients were asked preoperatively and postoperatively about the presence and intensity of pain, alteration of speech, diet or chewing, limitations of daily activity, mobility or recreation, and the presence of anxiety or mood disturbances related to the disease. The styloid length on preoperative computed tomography scans and the length of the surgical specimen were obtained, and correlations with the Numeric Pain Rating Scale (NPRS) were analyzed. Spearman's rank correlation coefficient was used to determine numerical correlation. Data are expressed as mean ± standard deviation, and P value less than .05 was considered statistically significant. RESULTS The study sample comprised 10 patients with Eagle syndrome who underwent transcervical styloidectomy. Eight patients underwent unilateral styloidectomy, and 2 patients were bilateral. Most patients were female (80%) with a mean age of 46.0. Preoperative NPRS score averaged 5.5 ± 2.7 (range 1 to 10) and postoperative NPRS was 2.1 ± 1.4 (range 0 to 4) (P = .008). No correlation was found between preoperative or postoperative NRPS score and preoperative styloid length and length of styloid resected. QoL survey showed a significant improvement in neck mobility and the anxiety felt by the patients. The survey showed that all patients would recommend surgery to a friend or family member with similar symptoms. Seven patients (70%) would recommend the operation as primary treatment, and the rest would recommend it after conservative options fail. CONCLUSIONS Transcervical styloidectomy was associated with a statistically significant decrease in NPRS and positive QoL changes for patients operated for Eagle syndrome at our institution.
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Affiliation(s)
- Kevin Huang
- Resident, Oral and Maxillofacial Surgery, St John Ascension Hospital, Detroit, MI
| | - Alba Sanjuan-Sanjuan
- Fellow, Head, and Neck Microvascular Surgery, St John Ascension Hospital, Detroit, MI
| | - Matthew Cannavo
- Resident, Oral and Maxillofacial Surgery, St John Ascension Hospital, Detroit, MI
| | - Tammy Cass
- Doctorate Nurse Practitioner, Head, and Neck Microvascular Surgery, St John Ascension Hospital, Detroit, MI
| | - Carlos A Ramirez
- Program Director, Oral and Maxillofacial Surgery/Fellowship director Head and Neck Microvascular Surgery, St John Ascension Hospital, Detroit, MI.
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Kumar PS, Singh DK, Gupta SK, Raina S, Prasad BK. Of Eagle's Syndrome and Finding Some Clarity on Its Management. Indian J Otolaryngol Head Neck Surg 2022; 74:2184-2189. [PMID: 36452859 PMCID: PMC9702270 DOI: 10.1007/s12070-020-02079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022] Open
Abstract
Eagle's Syndrome is a much discussed yet controversial and debatable diagnosis of exclusion which is treated by many specialities with often unsatisfactory results. Due to entrapment/impingement on surrounding neurovascular structures by elongated styloid process patient may present with multitude of symptoms. Treatment is controversial and opinions are divided on choice of conservative and surgical management. Aim was to study outcomes of conservative and surgical modalities of treatment of Eagle's Syndrome and bring some clarity on management, what to offer, to whom and when. This prospective observational descriptive study included 15 patients of Eagle's Syndrome, 7 were treated with conservative method and 8 underwent resection of styloid process with intraoral approach. With objectives in mind to study efficacy of both management modalities, pain visual analogue scale (VAS) scores were recorded pre-intervention, post-intervention and during follow up on 1, 3 and 6 months and compared. Conservative management resulted in up to 70% reduction in pain VAS scores till 3 months of therapy (mean pre-intervention score being 3.71, 3 months-1, 6 months-1.29), while surgical modality resulted in nearly 99% reduction in mean pain VAS scores up to 3 months and even improved after 6 months (mean pre-intervention score being 6.75, 3 months-0.5, 6 months-0.13). With this we can conclude that conservative management provide satisfactory short-term (up to 3 months) results but recurrences are known, while surgical resection of elongated styloid process gives better long-term results (6 months and beyond).
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Affiliation(s)
- Prem Shankar Kumar
- Department of ENT & HNS, Command Hospital (Eastern Command), Kolkata, West Bengal 700027 India
| | - D. K. Singh
- Department of ENT & HNS, Command Hospital (Eastern Command), Kolkata, West Bengal 700027 India
| | - Salil Kumar Gupta
- Department of ENT & HNS, Command Hospital (Eastern Command), Kolkata, West Bengal 700027 India
| | - Sheetal Raina
- Department of ENT & HNS, Command Hospital (Eastern Command), Kolkata, West Bengal 700027 India
| | - B. K. Prasad
- Department of ENT & HNS, Command Hospital (Eastern Command), Kolkata, West Bengal 700027 India
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Dey A, Mukherji S. Eagle’s Syndrome: A Diagnostic Challenge and Surgical Dilemma. J Maxillofac Oral Surg 2022; 21:692-696. [DOI: 10.1007/s12663-020-01396-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022] Open
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Intraoral Styloidectomy Using an Endoscope With Tissue Retractor. J Craniofac Surg 2022; 33:1201-1202. [DOI: 10.1097/scs.0000000000008165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Selvadurai S, Williamson A, Virk JS, Clarke P. Eagle syndrome and carotid artery dissection: a rare skull base cause of stroke. BMJ Case Rep 2022; 15:e247954. [PMID: 35264386 PMCID: PMC8915306 DOI: 10.1136/bcr-2021-247954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/03/2022] Open
Abstract
Eagle's syndrome is a rare collection of symptoms that occur secondary to an elongated styloid process or calcified stylohyoid ligament irritating its surrounding structures. Classically, this presents as unilateral throat pain or rarely, as acute neurological symptoms secondary to compression of the internal carotid artery: so called 'stylocarotid syndrome'. Significant neurological events in teenagers, secondary to Eagle syndrome have not been reported. We discuss the rare case of a teenage boy, diagnosed with right internal carotid artery dissection and middle cerebral artery infarction, with no cause initially identified. Following further admission with a transient neurological episode, he was noted to have elongated styloid processes with the right abutting the site of carotid dissection. He underwent styloidectomy and has since remained symptom free. This case highlights the importance of considering anatomical variants when assessing young patients with neurological symptoms, and the potential morbidity and mortality benefit that early surgical intervention may have.
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Affiliation(s)
| | | | - Jagdeep S Virk
- Otolaryngology, Barts Health NHS Trust, London, UK
- Otolaryngology, Charing Cross Hospital, London, UK
| | - Peter Clarke
- Otolaryngology, Charing Cross Hospital, London, UK
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Han P, Jiang X, Liang F, Ye Y, Wang J, Huang X. Endoscope-Assisted Surgery of the Elongated Styloid Process Using the Retroauricular Approach: An Anatomic Study for Clinical Application. J Oral Maxillofac Surg 2020; 79:622-628. [PMID: 32971058 DOI: 10.1016/j.joms.2020.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Surgical shortening of the styloid process (SP) mainly involves intraoral and transcervical approaches. A retroauricular incision was performed by our surgical team in endoscope-assisted shortening of the SP. This study aimed to clarify the important anatomic landmarks and adjacent structures around the SP through a retroauricular approach. METHODS Fifteen fresh corpses (30 sides) were dissected via a retroauricular approach, and indexes were measured. RESULTS The great auricular nerve (GAN) was divided into the anterior ear branch, lobe branch, and posterior ear branch. The distance from the branch of the GAN to the root of the ear lobe was 21.96 ± 2.55 mm. In the space around the SP, the vertical distance from the junction of the diabetic posterior belly and the mastoid tip to the SP was found to be 12.29 ± 2.46 mm, with a total distance between the skin in front of the mastoid and the facial nerve of 21.63 ± 3.27 mm. The distance between the facial nerve across the SP and the root of the SP was 11.93 ± 2.32 mm. CONCLUSIONS The retroauricular incision starts from the level of the notch between the tragus and extends backward in an arc to avoid injury to the retroauricular branch of the GAN. The posterior fascia of the parotid gland and the leading edge of the sternocleidomastoid muscle, posterior belly of the digastric muscle, and styloid hyoid muscle are regarded as landmarks for the SP.
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Affiliation(s)
- Ping Han
- Associate Professor, Department of Otolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; and Associate Professor, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyu Jiang
- Resident, Department of Otolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Resident, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; and Resident, Department of Otolaryngology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Faya Liang
- Associate Professor, Department of Otolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; and Associate Professor, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuchu Ye
- Professor, Resident, Department of Otolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; and Professor, Resident, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingyi Wang
- Professor, Resident, Department of Otolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; and Professor, Resident, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoming Huang
- Professor, Department of Otolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; and Professor, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Evaluation of postoperative pain after tonsil-sparing styloidectomy. Eur Arch Otorhinolaryngol 2020; 277:2011-2015. [PMID: 32215739 DOI: 10.1007/s00405-020-05930-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Styloidectomy is the mainstream treatment for Eagle's syndrome when conservative treatment fails. However, the clinical efficacy of tonsil-sparing styloidectomy remains controversial. This study aimed to evaluate postoperative pain after tonsil-sparing styloidectomy in patients with Eagle's syndrome. METHODS This retrospective study enrolled 14 patients who underwent tonsil-sparing styloidectomy (TSS group) and 22 patients who underwent traditional tonsillect-styloidectomy (TTS group). Pain was evaluated using the 11-point numeric rating scale (NRS-11) at the following time points: on admission, 1 day after the operation, 3 days, postoperatively, 1 week postoperatively, 2 weeks, postoperatively, and 3 months, postoperatively. RESULTS The postoperative course was uneventful in both groups. Pain with movement was significantly reduced 3 months, postoperatively (1.28 ± 1.1), compared with the preoperative baseline level (4.78 ± 0.9) (P < 0.001). There was no significant difference in the rate at which pain decreased between the TSS group (n = 9/14; 64.3%) and the TTS group (n = 17/22; 77.3%) (P = 0.396). One week postoperatively, resting pain in the TSS group (4.36 ± 0.7) was significantly lower than that in the TTS group (5.41 ± 0.8) (P = 0.001); pain with movement in the TSS group (5.00 ± 0.8) was significantly lower than that in the TTS group (5.86 ± 0.7) (P = 0.002). Two weeks postoperatively, resting pain in the TSS group (1.14 ± 0.4) was also significantly lower than that in the TTS group (1.73 ± 0.6) (P = 0.003). CONCLUSIONS Tonsil-sparing styloidectomy is a safe and effective modality for treating Eagle's syndrome. Although there was no significant difference in surgical risk or long-term outcomes between tonsil-sparing styloidectomy and traditional tonsillect-styloidectomy, tonsil-sparing styloidectomy can alleviate perioperative pain.
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Constanzo F, Ramina R, Coelho Neto M. Modified Craniocervical Approach for Resection of the Styloid Process in Patients with Eagle's Syndrome. J Neurol Surg B Skull Base 2019; 82:e179-e183. [PMID: 34306934 DOI: 10.1055/s-0039-3400297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022] Open
Abstract
Objective Surgical treatment of Eagle's syndrome remains the mainstay of treatment. Palsy of the marginal mandibular branch of the facial nerve is the most significant complication encountered in transcervical resections, due to direct compression during the approach. We proposed a modification of the craniocervical approach to the jugular foramen to resect the styloid process avoiding the marginal mandibular branch and subsequent palsy. Design This is a single-center retrospective cohort study. Setting The research was conducted at a tertiary medical center. Participants From November 2008 to October 2018, 12 patients with Eagle's syndrome underwent treatment using our modified approach. Main Outcome Measures Demographic data, type of Eagle's syndrome, symptomatic side, size of the styloid process, clinical outcomes, and complications were analyzed. Results Mean size of the styloid processes was of 3.34 cm on the operated side (2.3-4.7 cm) and 2.98 cm on the other (2-4.2 cm). Intraoperative facial nerve irritation occurred in one case. Resection of the entire styloid process was achieved in all cases. Eight cases experienced complete improvement, three cases had a partial response, and one case failed to improve. There were no cases of recurrence. Two patients presented transient postoperative auricular paresthesia. There were no cases of mandibular branch palsy, nor any other complications in our series. Conclusions Our modified transcervical approach is effective in avoiding the marginal mandibular branch of the facial nerve, avoiding postoperative palsy.
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Affiliation(s)
- Felipe Constanzo
- Department of Neurological Surgery, Neurological Institute of Curitiba, Curitiba, Paraná, Brazil
| | - Ricardo Ramina
- Department of Neurological Surgery, Neurological Institute of Curitiba, Curitiba, Paraná, Brazil
| | - Mauricio Coelho Neto
- Department of Neurological Surgery, Neurological Institute of Curitiba, Curitiba, Paraná, Brazil
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Endoscopy-Assisted Intraoral Removal of Elongated Styloid Process: Mini-Invasive Surgical Treatment of Eagle Syndrome. J Craniofac Surg 2019; 30:e775-e776. [PMID: 31592840 DOI: 10.1097/scs.0000000000005767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this work is to illustrate a transoral mini-invasive approach to safely remove elongated styloid process in Eagle syndrome. A 34-year-old Asian male came to our center referring pharyngeal and cervical pain on the right side on swallowing and opening the mouth. Computed tomography showed elongation of the right styloid process. Surgical removal was performed through endoscopy-assisted intraoral approach using a pituitary curette to perform dissection and piezosurgery for the osteotomy. Surgical intervention was completed in 25 minutes. Postoperative period was uneventful except for transient (12 hours) right facial palsy that resolved spontaneously. Two months after surgery, patient referred resolution of symptoms. This technique is easy to perform and permits to obtain good result with reduction of surgical time and with low risk of complication.
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Galletta K, Granata F, Longo M, Alafaci C, De Ponte FS, Squillaci D, De Caro J, Grillo F, Benedetto F, Musolino R, Grasso G, Siniscalchi EN. An unusual internal carotid artery compression as a possible cause of Eagle syndrome - A novel hypothesis and an innovative surgical technique. Surg Neurol Int 2019; 10:174. [PMID: 31583171 PMCID: PMC6763667 DOI: 10.25259/sni_317_2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 07/31/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Eagle syndrome (ES) is a rare symptomatic condition generally caused by an elongated styloid process (SP) or calcification of the stylohyoid complex. On the diagnosis is made, its treatment remains subjective since the indications for surgical intervention are still not standardized. Although styloidectomy is the surgical treatment of choice, no consensus exists regarding the transcervical or/and transoral route. Here, we report our experience in a patient with bilateral internal carotid artery (ICA) dissection caused by ES, who underwent innovative surgical technique. Case Description: A 53-year-old man, with the right-sided middle cerebral artery acute stroke, underwent computed tomography angiography 3 days after a successful endovascular treatment. The study showed a bilateral ICA dissection with bilateral hypertrophic SPs and a close relationship of ICAs with both SPs anteriorly and C1 transverse process posteriorly. Considering the occurrence of ICA compression by a styloid/C1 transverse process juxtaposition, the patient underwent the left partial C1 transversectomy by an extraoral approach. A temporary paresis of the ipsilateral lower lip lasted 1 month, with a partial remission after 3 months. The patient reported significant improvement of symptoms with a good esthetics and functional outcome. Conclusion: A styloid/C1 transverse process juxtaposition should be considered as an alternative pathogenetic mechanism in vascular ES. When a posterior ICA compression by C1 transverse process is present, a bone reshaping of C1 rather than a conventional styloidectomy can be considered an efficacious treatment which allows a good preservation of the styloid muscles and ligaments.
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Affiliation(s)
- Karol Galletta
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, Italy
| | - Francesca Granata
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, Italy
| | - Marcello Longo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, Italy
| | - Concetta Alafaci
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, Italy
| | - Francesco S De Ponte
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, Italy
| | - Domenico Squillaci
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, Italy
| | - Jolanda De Caro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Grillo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Filippo Benedetto
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, Italy
| | - Rosa Musolino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Grasso
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Enrico Nastro Siniscalchi
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, Italy
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Management of stylohyoid syndrome: A systematic review following PRISMA guidelines. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:281-287. [DOI: 10.1016/j.anorl.2019.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hardin FM, Xiao R, Burkey BB. Surgical management of patients with Eagle syndrome. Am J Otolaryngol 2018; 39:481-484. [PMID: 29764674 DOI: 10.1016/j.amjoto.2018.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/09/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Eagle syndrome, a spectrum of disease resulting from an elongated styloid process and/or calcified stylohyoid ligament, lacks standardized recommendations regarding indications for surgical intervention and approach. STUDY DESIGN Retrospective cohort study. SETTING Single tertiary care institution. SUBJECTS Patients treated surgically for Eagle syndrome between January 2011 and June 2017. METHODS Patients were diagnosed with Eagle syndrome based on thorough clinical workup and assessment. The primary outcome was improvement in pain severity following surgery, with complete resolution of pain being considered clinically meaningful. Wilcoxon rank-sum tests and Fisher's exact were used to compare numerical and categorical variables, respectively. RESULTS Twenty-one patients were diagnosed with Eagle syndrome and underwent surgical resection of the styloid process. Patients most often complained of neck pain (81%), throat pain (62%), and ear pain (48%). Among these patients, 57% of procedures featured a transcervical approach, while the remaining 43% were transoral. The vast majority (90%) of patients experienced improvement in pain severity from a median of 6.0 before surgery to 0.0 afterwards (p < 0.01) as 62% experienced complete resolution. Using multivariable linear regression to model changes in pain severity, neck pain (β = -1.69, p < 0.01) and jaw pain (β = -0.93, p = 0.03) predicted greater relief, while headache (β = 0.82, p = 0.04) predicted an inferior response. Adverse events were uncommon and typically resolved within three months, with 24% experiencing first bite syndrome and 19% reporting numbness. CONCLUSIONS Transcervical and transoral styloidectomy are effective treatments for Eagle syndrome with minimal adverse effects. Patients with classic symptoms of neck or jaw pain benefit most from surgery.
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Affiliation(s)
| | - Roy Xiao
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Brian B Burkey
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA.
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Kadakia S, Jategaonkar A, Roche A, Chai RL. Tonsillectomy sparing transoral robot assisted styloidectomy. Am J Otolaryngol 2018; 39:238-241. [PMID: 29395278 DOI: 10.1016/j.amjoto.2018.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
Eagle Syndrome can present with a variety of symptoms and be caused by an elongated styloid process or calcified stylohyoid ligament. Patients failing medical management of this disorder may be treated with surgical excision of the styloid process. In the literature, transoral and transcervical approach have both been described. Although transoral approaches typically begin with a tonsillectomy, tonsil-sparing approaches have also been utilized. With the advent of robotic surgery, the potential for a tonsillectomy sparing approach has become a feasible alternative, preventing the pain and morbidity associated with adult tonsillectomy while continuing to provide superior exposure and instrumentation. We report three successful cases of patients treated with tonsillectomy sparing transoral robot assisted styloidectomy. This represents the first application of this technique in the literature and suggests the potential for a paradigm shift in the surgical management of this disease.
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Kim DH, Lee YH, Cha D, Kim SH. Transoral robotic surgery in Eagle's syndrome: our experience on four patients. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:454-457. [PMID: 29327731 PMCID: PMC5782421 DOI: 10.14639/0392-100x-1502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/11/2017] [Indexed: 11/23/2022]
Abstract
Eagle's syndrome is characterised by focal pain in the tonsillar fossa on wide mouth opening or head rotation and various accompanying symptoms. While the syndrome is difficult to diagnose, shortening the styloid process via a transoral or transcervical surgical approach has been shown to be the most effective treatment. The aim of this article was to document our experience with a transoral robotic approach to treat Eagle's syndrome and to present the outcomes of four patients. We reviewed the cases of four patients with Eagle's syndrome who underwent transoral robotic surgery (TORS). The average age of patients was 53.75 years, and there were equal numbers of males and females. The styloid processes were reconstructed in 3D from the preoperative CT scans and were measured as an average of 4.18 cm (range 3.3-5.1). The mean set-up time and operation times were less than 10 minutes and 30 minutes, respectively. All patients were completely relieved of symptoms, and were able to restart an oral diet on post-operative day 1. No patient suffered intraoperative or postoperative complication, including cranial nerve injury, haemorrhage, or deep neck infection. In our experience, transoral excision of the styloid process via a robotic approach can be considered as a feasible treatment option for Eagle's syndrome.
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Affiliation(s)
- D H Kim
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Y H Lee
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - D Cha
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - S H Kim
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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16
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Papadiochos I, Papadiochou S, Sarivalasis ES, Goutzanis L, Petsinis V. Treatment of Eagle syndrome with transcervical approach secondary to a failed intraoral attempt: Surgical technique and literature review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 118:353-358. [DOI: 10.1016/j.jormas.2017.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/30/2017] [Indexed: 11/27/2022]
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17
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Liu Y, Yang H, Cui X. A Case of a Very Elongated Styloid Process. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2017; 10:1179550617728899. [PMID: 28904526 PMCID: PMC5588791 DOI: 10.1177/1179550617728899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/03/2017] [Indexed: 11/16/2022]
Abstract
Eagle syndrome is characterized by recurrent pain in the oropharynx and face due to an elongated styloid process or calcified stylohyoid ligament. In this article, we experienced a case of an elongated styloid process which is very rare in size and detailed treatment process. The patient was a 53-year-old Chinese woman with a chief complaint of frequent episodes of radiating pain in left preauricular region for 2 years. An intraoral approach was chosen to shorten part of her styloid process, and the chief complaint disappeared immediately after the operation.
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Affiliation(s)
- YaLi Liu
- China Medical University, Shenyang, P.R. China
| | - Huaian Yang
- Sleep Medical Center, Shengjing Hospital of China Medical University, Shenyang, P.R. China
| | - Xiangguo Cui
- Sleep Medical Center, Shengjing Hospital of China Medical University, Shenyang, P.R. China
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18
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Eagle syndrome: A comprehensive review. Clin Neurol Neurosurg 2017; 159:34-38. [DOI: 10.1016/j.clineuro.2017.04.021] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 11/21/2022]
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19
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Cheng C, She C, Zhang Q. The experience of treatment of coblation assisted surgical approach to Eagle's syndrome. Am J Otolaryngol 2017; 38:301-304. [PMID: 28259505 DOI: 10.1016/j.amjoto.2017.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This article aimed to Summarize our therapeutic experience with Transoral coblation assisted surgical approach used for treatment of Eagle's syndrome. METHODS sixty-two consecutive patients, from 2010 to 2015, underwent coblation assisted surgical treatment to remove elongated styloid process transorally. Outcomes were assessed in terms of intraoperative and postoperative complications, patients' evolution and efficiency of treatment. RESULTS The amount of bleeding was 1ml~4ml, average 2.7ml, unilateral operation time was 3min to 10min, average 6.2min, bilateral for 7min to 15min, average 13.5min. no bleeding and complications after operation. Pseudo membrane completely off the 14days or so, the cure rate was 58.1%, the efficiency of 30.6%. CONCLUSION In order to get a good curative effect, we should pay attention to the accurate diagnosis, choose the appropriate way of intubation and mouth opening device, pay attention to the details of the operation, maximize the effect of coblation to achieve a more minimally invasive treatment effect.
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20
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Arbildo H, Gamarra L, Rojas S, Infantes E, Vásquez H. Eagle syndrome. A narrative review. JOURNAL OF ORAL RESEARCH 2016. [DOI: 10.17126/joralres.2016.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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21
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Ata-Ali J, Ata-Ali F, Melo M, Andrés-Teruel JC, Soto-Sarrion C. Eagle syndrome compared with stylohyoid syndrome: complete ossification of the stylohyoid ligament and joint. Br J Oral Maxillofac Surg 2016; 55:218-219. [PMID: 27435498 DOI: 10.1016/j.bjoms.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Affiliation(s)
- J Ata-Ali
- Public Dental Health Service, Arnau de Vilanova Hospital. Valencia, Spain; Department of Dentistry, European University of Valencia, Valencia, Spain.
| | | | - M Melo
- Department of Dentistry, European University of Valencia, Valencia, Spain
| | | | - C Soto-Sarrion
- Service of Radiology. Arnau de Vilanova Hospital. Valencia Spain
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22
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Spalthoff S, Zimmerer R, Dittmann O, Tavassol F, Dittmann J, Gellrich NC, Jehn P. Piezoelectric surgery and navigation: a safe approach for complex cases of Eagle syndrome. Int J Oral Maxillofac Surg 2016; 45:1261-7. [PMID: 27261164 DOI: 10.1016/j.ijom.2016.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/15/2016] [Accepted: 05/11/2016] [Indexed: 11/29/2022]
Abstract
Eagle syndrome was first described by Eagle in 1937. It is associated with an elongated styloid process and/or calcification of the stylohyoid ligament, mainly resulting in pain in the orofacial region. The treatment of Eagle syndrome includes conservative treatment with physical therapy supported by medication, or surgical removal of the styloid process. Two different surgical approaches are described in the literature: the transoral and transcervical approaches. Both have their limitations and specific intraoperative risks. A modification of the transcervical approach that adds an extra security measure to the treatment of complex cases of Eagle syndrome is presented herein. The styloid process was removed by combining piezoelectric surgery, preoperative digital planning, and surgical navigation. No complication was noted, and the patient recovered quickly after surgery. A follow-up visit 2 months later showed no remaining symptoms of Eagle syndrome on the treated side. Therefore, digital planning and surgical navigation could add valuable safety measures to the treatment of complex cases of Eagle syndrome.
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Affiliation(s)
- S Spalthoff
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - R Zimmerer
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - O Dittmann
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - F Tavassol
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - J Dittmann
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - N-C Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - P Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Kusunoki T, Homma H, Kidokoro Y, Yanai A, Fujimaki M, Ikeda K. A Case of a Very Elongated Styloid Process 8 cm in Length with Frequent Throat Pain for 10 Years. Clin Pract 2016; 6:820. [PMID: 27162604 PMCID: PMC4844813 DOI: 10.4081/cp.2016.820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/03/2016] [Accepted: 02/15/2016] [Indexed: 11/22/2022] Open
Abstract
We experienced a case of an elongated styloid process that was 8 cm in length. The patient was a 68-year-old Japanese man with frequent episodes of left-sided throat pain for 10 years. The elongated styloid process could be diagnosed by 3D-computed tomography (left and right length: 7.8 cm and 8.0 cm, respectively) and successfully treated with surgery, since the anatomic relationships could be fully visualized. Surgical methods for shortening an elongated styloid process involve an intraoral or external approach. The external approach to the styloid process involves a trans-cervical approach to the parapharyngeal space, which enables wider visualization in the operative field than an intraoral approach. In the present case, the styloid process reached the parapharyngal space. Therefore, we selected the external approach and shortened only the left-sided styloid process (the same side as the throat pain). The chief complaint disappeared immediately after the operation.
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Affiliation(s)
- Takeshi Kusunoki
- Department of Otorhinolaryngology, Juntendo University of Medicine, Shizuoka Hospital , Shizuoka, Japan
| | - Hirotomo Homma
- Department of Otorhinolaryngology, Juntendo University of Medicine, Shizuoka Hospital , Shizuoka, Japan
| | - Yoshinobu Kidokoro
- Department of Otorhinolaryngology, Juntendo University of Medicine, Shizuoka Hospital , Shizuoka, Japan
| | - Aya Yanai
- Department of Otorhinolaryngology, Juntendo University of Medicine, Shizuoka Hospital , Shizuoka, Japan
| | - Mitsuhisa Fujimaki
- Department of Otorhinolaryngology, Juntendo University of Medicine, Faculty of Medicine , Shizuoka, Japan
| | - Katsuhisa Ikeda
- Department of Otorhinolaryngology, Juntendo University of Medicine, Faculty of Medicine , Shizuoka, Japan
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Dewan MC, Morone PJ, Zuckerman SL, Mummareddy N, Ghiassi M, Ghiassi M. Paradoxical ischemia in bilateral Eagle syndrome: a case of false-localization from carotid compression. Clin Neurol Neurosurg 2016; 141:30-2. [PMID: 26724428 DOI: 10.1016/j.clineuro.2015.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 10/30/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Peter J Morone
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nishit Mummareddy
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Mayshan Ghiassi
- Northwest Arkansas Neuroscience Institute, Department of Neurological Surgery, Washington Regional Medical Center, Fayetteville, AR, USA
| | - Mahan Ghiassi
- Northwest Arkansas Neuroscience Institute, Department of Neurological Surgery, Washington Regional Medical Center, Fayetteville, AR, USA
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