From the Research
Surgical intervention, specifically complete styloidectomy, is the most effective treatment for bilateral calcification of the stylohyoid ligaments, with success rates of 80-90%. This condition, also known as Eagle syndrome, can cause significant pain and discomfort due to the mechanical irritation of surrounding structures by the calcified ligaments.
Initial Treatment Approaches
Before considering surgery, initial treatment typically includes:
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain management 1
- Local anesthetic injections with lidocaine 1-2% or bupivacaine 0.25-0.5% into the tonsillar fossa for temporary relief
- Physical therapy focusing on stretching and strengthening exercises for the neck muscles to reduce symptoms
Surgical Options
For patients who do not respond to conservative measures, surgical intervention becomes necessary. The two main surgical approaches are:
- Intraoral approach: involves removing the styloid process through the mouth without external scarring but with a higher infection risk
- Extraoral or transcervical approach: provides better visualization but leaves a neck scar The most recent and highest quality study 2 suggests that an extra-oral approach can be effective in completely relieving symptoms after surgery.
Recovery and Outcomes
Surgery is typically performed under general anesthesia and may require 1-2 days of hospitalization. Recovery takes 2-4 weeks, during which patients should follow a soft diet and use prescribed antibiotics and pain medications. These treatments target the mechanical irritation of surrounding structures caused by the calcified ligaments, which can compress nearby nerves and blood vessels, leading to pain and discomfort. Given the potential for severe pain and restriction of head and neck movement, as seen in cases of extreme development of the stylohyoid complex 3, surgical intervention is often the best course of action to improve quality of life and reduce morbidity and mortality associated with this condition.