Stylalgia Revisited: Clinical Profile and Management

Document Type: Original

Authors

Department of Otorhinolaryngology and Head and Neck Surgery, Hamdard Institute of Medical Sciences and Research and HAHC Hospital, Jamia Hamdard university, Hamdard Nagar, Delhi-110062, India.

Abstract

Introduction:
Eagle’s syndrome is a constellation of signs secondary to an elongated styloid process or due to mineralization of the stylohyoid or stylomandibular ligament or the posterior belly of the digastric muscle. The syndrome includes symptoms ranging from stylalgia (i.e. pain in the tonsillar fossa, pharyngeal or hyoid region) to foreign-body sensation in the throat, cervicofacial pain, otalgia, or even increased salivation or giddiness.
 
Materials and Methods:
We describe a clinical study of 12 patients with Eagle’s syndrome, along with their clinical profile and the treatment offered. Patients were diagnosed based on history and clinical examination, as well as the Xylocaine 2% tonsillar fossa injection test. A visual analog scale (VAS) was used for comparison of pain before and up to 3 months after treatment. Radiology (orthopantomogram or three-dimensional computed tomography) was used for further exploration. Nine patients underwent tonsillo-styloidectomy surgery and three underwent medical treatment with pregabalin (75 mg/day).
 
Results:
The majority of surgically-managed cases (88%) achieved a definitive benefit by tonsillo-styloidectomy surgery, whereas all medically managed cases achieved only short-term pain relief.
 
Conclusions:
Besides the common throat diseases, the symptoms associated with Eagle’s syndrome may be similar to those due to cervicofacial neuralgias, dental, or temporo-mandibular joint diseases. Diagnosis is primarily based on symptomatology, physical examination and radiographic investigations, and should not be missed. Treatment by tonsillo-styloidectomy produces satisfactory results in stylalgia.

Keywords

Main Subjects


1. Eagle WW. Elongated styloid process. Arch Otolaryngol. 1948; 47:639-40.

2.Singhania A A, Chauhan NV, George A, Rathwala K. Lidocine Infiltration Test: An Useful Test in the Prediction of Results of Styloidectomy for Eagle’s Syndrome. Indian J Otolaryngol Head Neck Surg. 2013; 65:20-3.

3. Naik SM, Naik SS. Tonsillo-Styloidectomy for Eagle’s Syndrome: A Review of 15 cases in KVG Medical College Sullia. Oman Med J. 2011; 26920: 122-6.

4. Yavuz H, Caylakli F, Yildiram T, Ozluoglu LN. Angulation of the styloid process in Eagle’s syndrome. Eur Arch Otorhinolaryngol. 2008; 265: 1393-6.

5. Eagle WW. Elongated styloid process: Symptoms and treatment. AMA Arch Otolaryngol 1958; 67:172–6.

6. Bozkir MG, Boga H, Dere F. The evaluation of elongated styloid process in panoramic radiographs in edentulous patients. Turk J Med Sci. 1999; 29:481–5.

7. Kaufman SM, Elzay RP, Irish EF. Styloid process variation. Radiologic and clinical study. Arch Otolaryngol 1970; 91:460–3.

8. Correll RW, Jensen JL, Taylor JB, Rhyne RR. Mineralization of the stylohyoid-stylomandibular ligament complex: A radiographic incidence study. Oral Surg Oral Med Oral Pathol 1979; 48:286–91.

9. Rizzatti-Barbosa CM, Ribeiro MC, Silva-Concilio LR, Di Hipolito O, Ambrosano GM. Is an elongated stylohyoid process prevalent in the elderly? A radiographic study in a Brazilian population. Gerodontology 2005;22:112–15.

10. Keur JJ, Campbell JPS, McCarthy JF, Ralph WJ. The clinical significance of the elongated styloid process. Oral Surg 1986; 61: 399–404.

11. Montalbetti L, Ferrandi D, Pergami P, Savaldi F. Elongated styloid process and Eagle’s syndrome. Cephalgia. 1995; 15: 80–93.

12. Murtagh RD, Caracciolo JT, Fernandez G. CT findings associated with Eagle syndrome. Am J Neuroradiol. 2001; 22(7): 1401–2.

13. Harma R. Stylalgia: Clinical experience of 52 cases. Acta Otolaryngol.1966; 224:149-55.

14. Jan A. Stylohyoid syndrome. J Pak Med Assoc 1989; 39:23.

15. Liu SH, Wang Y, Zhang RH, Liu SY, Peng HH. Diagnosis and treatment of 23 cases with stylohyoid syndrome. Shanghai Kou Qiang Yi Xue 2005; 14:223–6.

16. Unlu Z, Orguc S, Eskiizmir G, Aslan A, Bayindir P. Elongated styloid process and cervical spondylosis. Clin Med Case Rep 2008; I:57–64.

17. Steinmann EP. Styloid syndrome in the absence of an elongated process. Acta Otolaryngol 1968; 66: 347–56.

18. Maru YK, Patidar K. Styalgia and its surgical management by intra oral route- clinical experience of 332 cases. Indian J Otolaryngol Head Neck Surg. 2003;55(2):87–90.

19. Singh R, Galagali JR.Tonsillostyloidectomy for Eagle’s syndrome: a study of 20 cases. Int J Otorhinolaryngol Head Neck Surg. 2016; 2(1):22-5.

20. Yadav SP, Chanda R, Gera A, Yadav RK. Stylalgia: An Indian perspective.J Otolaryngol 2001; 30:304–6.

21. Piagkou M, Anagnostopoulou S, Kouladouros K, Piagkos G. Eagle’s Syndrome: A Review of the Literature. Clin Anat 2009; 22: 545–58.