From the Guidelines
Eagle syndrome should be diagnosed and treated based on symptom severity, with conservative management including NSAIDs and physical therapy for mild cases, and surgical intervention for severe or persistent cases. Eagle syndrome is a rare condition where an elongated styloid process or calcified stylohyoid ligament causes pain in the neck, throat, and face. Diagnosis typically involves physical examination, where pressing on the tonsillar area reproduces symptoms, and imaging studies like CT scans to visualize the elongated styloid, as CT neck is useful to characterize the anatomy of the stylohyoid ligament in patients with glossopharyngeal pain 1. Treatment depends on symptom severity, with the goal of improving quality of life and reducing morbidity and mortality. For mild cases, conservative management includes:
- NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily)
- Muscle relaxants such as cyclobenzaprine (5-10mg three times daily)
- Physical therapy focusing on stretching and strengthening neck muscles. For severe or persistent cases, surgical intervention to shorten the styloid process may be necessary, either through an intraoral or external approach. The condition occurs when the styloid process, normally about 2.5cm long, extends beyond 3cm, potentially compressing nearby nerves and blood vessels. Patients should seek medical attention if they experience persistent throat pain, difficulty swallowing, or pain when turning their head, as proper diagnosis and treatment can significantly improve quality of life.
From the Research
Definition and Symptoms of Eagle Syndrome
- Eagle syndrome is a condition characterized by a wide range of symptoms, including cervical pain and dysphagia, due to an elongated styloid process or calcified stylohyoid ligament 2.
- The symptoms of Eagle syndrome can be benign or dangerous, and patients can present with a variety of clinical manifestations, including hemiparesis, aphasia, loss of consciousness, and headache 3.
Diagnosis of Eagle Syndrome
- The diagnosis of Eagle syndrome is typically made using a CT scan, which is considered the gold standard for diagnosis 2.
- The CT scan can be aided by 3D reconstructive imaging and angiography to confirm the diagnosis and rule out other conditions 2.
Treatment of Eagle Syndrome
- The treatment of Eagle syndrome can include medical management, such as analgesics, corticosteroids, antidepressants, and anticonvulsants, as well as surgical approaches, including extraoral, transoral, and endoscopic-assisted procedures 2.
- Physical therapy management, including manual therapy and therapeutic exercises, can also be effective in managing the symptoms of Eagle syndrome 4.
- For vascular Eagle syndrome, the best treatment strategy may be endovascular internal carotid artery stenting with antiplatelet therapy, followed by surgical removal of the elongated styloid process to prevent stent fracture 3.
Pain Management in Eagle Syndrome
- The management of pain in Eagle syndrome can include the use of acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids, as well as adjuvants such as muscle relaxants and anticonvulsants 5, 6.
- The choice of pain management strategy should be tailored to the individual patient and take into account the severity and nature of the pain, as well as the potential risks and benefits of each treatment option 5, 6.