Presentations

Abstract

Introduction: Eagle syndrome is a rare condition caused by the elongation or calcification of the styloid process or stylohyoid ligament. The styloid process is a slender, pointed bone extending from the base of the skull near the temporal bone, while the stylohyoid ligament connects the styloid process to the hyoid bone. Elongation or calcification of these structures can put pressure on adjacent tissues and nerves, leading to a range of clinical symptoms.

Case Information: A 53-year-old female, who had undergone a total thyroidectomy approximately 10 years ago for unknown etiology, presented to the Ear Nose and Throat (ENT) clinic with worsening left-sided neck pain and a sensation of fullness over the past 6 months. Her medical history includes hypertension, obesity, hypothyroidism, asthma, fibromyalgia, and tobacco use. Given her history of long-term tobacco use, there was concern for possible carcinoma. However, she reported no constitutional symptoms such as weight loss, fatigue, or fever. On examination, tenderness was noted along level 2 of the left neck, but no masses or other abnormalities were appreciated. A CT scan of the neck with contrast was ordered to further investigate the cause of her neck pain. The imaging revealed an enlarged left styloid process and an ossified, thickened left stylohyoid ligament, suggestive of Eagle Syndrome. No masses were observed on the CT scan. Unfortunately, due to missing documentation, follow up and treatment details could not be determined for this case report

Discussion/Clinical Findings: Eagle syndrome is an acquired condition of unknown cause, characterized by the elongation of the styloid process or calcification of the stylohyoid ligament. Due to its rare prevalence-affecting approximately 4% of the population, with only 0.16% showing symptoms-it is often overlooked in differential diagnoses. The subtlety of its symptoms, which can resemble those of cervical arthritis, head and neck masses, and facial neuralgias, contributes to the challenge of accurate diagnosis. Recognizing Eagle syndrome is crucial because its management differs significantly from other similar conditions. The utility of CT in diagnosing Eagle syndrome is paramount, as it provides clear imaging of the styloid process and surrounding structures. An elongated styloid process can compress several structures, including cranial nerves (primarily the glossopharyngeal nerve), the external carotid artery, the internal jugular vein, and the pharynx. Additionally, the stylopharyngeus muscle and the muscles of mastication may be indirectly affected by the compression of nearby nerves. CT scans can reveal elongation of the styloid process or calcified ligaments with high specificity, facilitating accurate diagnosis and distinguishing Eagle syndrome. Early and accurate identification through CT imaging enables appropriate treatment interventions, which may include conservative management, corticosteroid injections, or surgical intervention, thus improving patient outcomes and preventing unnecessary, potentially invasive procedures that may arise from misdiagnosis.

Conclusion: In conclusion, this case highlights the importance of considering Eagle Syndrome in patients with unexplained neck pain and a sensation of fullness, especially those with a history of tobacco use and chronic pain syndromes, as seen in this patient. The CT imaging revealed an enlarged left styloid process and an ossified stylohyoid ligament, supporting the diagnosis of Eagle Syndrome. This case emphasizes the need for thorough evaluation of such symptoms to ensure accurate diagnosis and appropriate management.