From the Guidelines
A calcified stylohyoid ligament is typically managed conservatively with NSAIDs and local anesthetic injections, with surgical intervention reserved for persistent symptoms. This condition, also known as Eagle syndrome or stylohyoid syndrome, occurs when the stylohyoid ligament connecting the styloid process to the hyoid bone becomes partially or completely ossified, which can cause pain in the throat, face, or ear, especially when swallowing, turning the head, or opening the mouth 1. The glossopharyngeal nerve (CN IX) is responsible for branchial motor innervation to the stylopharyngeus muscle and visceral motor parasympathetic innervation to the parotid gland, and its dysfunction can lead to symptoms such as dysphagia, ipsilateral sensory loss on the pharynx and posterior tongue, and impaired taste 1.
Symptoms and Diagnosis
- Pain in the throat, face, or ear, especially when swallowing, turning the head, or opening the mouth
- Dysphagia
- Ipsilateral sensory loss on the pharynx and posterior tongue
- Impaired taste
- Diagnosis is typically confirmed through radiographic imaging such as panoramic X-rays or CT scans that show the elongated or calcified structure 1
Management
- Conservative approaches such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen 400-600mg three times daily or naproxen 500mg twice daily for pain relief
- Local anesthetic injections with lidocaine 1-2% into the tonsillar fossa may provide temporary relief
- Physical therapy focusing on stretching and strengthening neck muscles can also help
- Surgical intervention may be necessary for persistent symptoms, either through an intraoral or external approach to remove the calcified ligament 1
Pathophysiology
- Abnormal ossification of the stylohyoid ligament, possibly due to aging, previous trauma, or congenital factors
- Neurovascular compression, trauma, or neoplasms along the course of the glossopharyngeal nerve can also contribute to symptoms 1
From the Research
Definition and Symptoms
- Calcified stylohyoid ligament is also known as an elongated styloid process, and the symptom complex it produces is called Eagle's syndrome 2.
- The symptoms of Eagle's syndrome include neck pain, sore throat, foreign body sensation in the throat, dysphagia, and otalgia, which may be worsened by yawning, opening the mouth wide, or turning the head laterally 2.
- The condition can be associated with carotid artery dissection and can present as a complication of tonsillectomy procedure 2, 3.
Diagnosis and Treatment
- Diagnosis of calcified stylohyoid ligament is made with appropriate radiological examination, such as conventional radiographs, computed tomographic scans, or volumetric computerized tomography 2, 4, 5.
- Non-surgical treatment options include re-assurance, analgesia, anti-inflammatory medications 2.
- Surgical treatment options include shortening of the elongated styloid process by transoral or external approach, and transoral endoscopic-assisted styloidectomy 2, 3, 6.
- The choice of surgical modality depends on individual surgeon preference and experience, and the location of the styloid process 6.
Clinical Presentation and Management
- Calcified stylohyoid ligament can present with symptoms similar to other head and neck pain conditions, making diagnosis challenging 2, 4.
- Manual therapy precautions, such as modifying spinal manipulation techniques to minimize rotation of the neck, may be necessary in patients with elongated styloid processes and calcified stylohyoid ligaments 4.
- A thorough diagnostic workup is essential to rule out other conditions and to determine the best course of treatment 4, 5.