Subscribe to RSS
Modified Craniocervical Approach for Resection of the Styloid Process in Patients with Eagle's Syndrome
Objective Surgical treatment of Eagle's syndrome remains the mainstay of treatment. Palsy of the marginal mandibular branch of the facial nerve is the most significant complication encountered in transcervical resections, due to direct compression during the approach. We proposed a modification of the craniocervical approach to the jugular foramen to resect the styloid process avoiding the marginal mandibular branch and subsequent palsy.
Design This is a single-center retrospective cohort study.
Setting The research was conducted at a tertiary medical center.
Participants From November 2008 to October 2018, 12 patients with Eagle's syndrome underwent treatment using our modified approach.
Main Outcome Measures Demographic data, type of Eagle's syndrome, symptomatic side, size of the styloid process, clinical outcomes, and complications were analyzed.
Results Mean size of the styloid processes was of 3.34 cm on the operated side (2.3–4.7 cm) and 2.98 cm on the other (2–4.2 cm). Intraoperative facial nerve irritation occurred in one case. Resection of the entire styloid process was achieved in all cases. Eight cases experienced complete improvement, three cases had a partial response, and one case failed to improve. There were no cases of recurrence. Two patients presented transient postoperative auricular paresthesia. There were no cases of mandibular branch palsy, nor any other complications in our series.
Conclusions Our modified transcervical approach is effective in avoiding the marginal mandibular branch of the facial nerve, avoiding postoperative palsy.
Received: 28 June 2019
Accepted: 27 September 2019
Article published online:
21 November 2019
© 2019. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Eagle WW. Elongated styloid process. Arch Otolaryngol 1937; 25: 584-587
- 2 Fusco DJ, Asteraki S, Spetzler RF. Eagle's syndrome: embryology, anatomy, and clinical management. Acta Neurochir (Wien) 2012; 154 (07) 1119-1126
- 3 Okur A, Ozkırış M, Serin HI. et al. Is there a relationship between symptoms of patients and tomographic characteristics of styloid process?. Surg Radiol Anat 2014; 36 (07) 627-632
- 4 Al Weteid AS, Miloro M. Transoral endoscopic-assisted styloidectomy: how should Eagle syndrome be managed surgically?. Int J Oral Maxillofac Surg 2015; 44 (09) 1181-1187
- 5 Ceylan A, Köybaşioğlu A, Çelenk F, Yilmaz O, Uslu S. Surgical treatment of elongated styloid process: experience of 61 cases. Skull Base 2008; 18 (05) 289-295
- 6 Chen R, Liang F, Han P, Cai Q, Yu S, Huang X. Endoscope-assisted resection of elongated styloid process through a retroauricular incision: a novel surgical approach to eagle syndrome. J Oral Maxillofac Surg 2017; 75 (07) 1442-1448
- 7 Harma R. Stylalgia: clinical experience of 52 cases. Acta Otolaryngol 1966; 224: 149-155
- 8 Müderris T, Bercin S, Sevil E, Beton S, Kırıs M. Surgical management of elongated styloid process: intraoral or transcervical?. Eur Arch Otorhinolaryngol 2014; 271 (06) 1709-1713
- 9 Cernea CR, Hojaij FC, De Carlucci Jr D. et al. First-bite syndrome after resection of the styloid process. Laryngoscope 2007; 117 (01) 181-182
- 10 Ramina R, Maniglia JJ, Fernandes YB, Paschoal JR, Pfeilsticker LN, Coelho Neto M. Tumors of the jugular foramen: diagnosis and management. Neurosurgery 2005; 57 (1, Suppl): 59-68
- 11 Eagle WW. Symptomatic elongated styloid process; report of two cases of styloid process-carotid artery syndrome with operation. Arch Otolaryngol 1949; 49 (05) 490-503
- 12 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 (04) 286-291
- 13 Kaufman SM, Elzay RP, Irish EF. Styloid process variation. Radiologic and clinical study. Arch Otolaryngol 1970; 91 (05) 460-463
- 14 Sokler K, Sandev S. New classification of the styloid process length--clinical application on the biological base. Coll Antropol 2001; 25 (02) 627-632
- 15 Eagle WW. Elongated styloid process; symptoms and treatment. AMA Arch Otolaryngol 1958; 67 (02) 172-176
- 16 Ilgüy M, Ilgüy D, Güler N, Bayirli G. Incidence of the type and calcification patterns in patients with elongated styloid process. J Int Med Res 2005; 33 (01) 96-102
- 17 Prasad KC, Kamath MP, Reddy KJ, Raju K, Agarwal S. Elongated styloid process (Eagle's syndrome): a clinical study. J Oral Maxillofac Surg 2002; 60 (02) 171-175
- 18 Camarda AJ, Deschamps C, Forest D. I. Stylohyoid chain ossification: a discussion of etiology. Oral Surg Oral Med Oral Pathol 1989; 67 (05) 508-514
- 19 Piagkou M, Anagnostopoulou S, Kouladouros K, Piagkos G. Eagle's syndrome: a review of the literature. Clin Anat 2009; 22 (05) 545-558
- 20 Martin TJ, Friedland DR, Merati AL. Transcervical resection of the styloid process in Eagle syndrome. Ear Nose Throat J 2008; 87 (07) 399-401
- 21 Moffat DA, Ramsden RT, Shaw HJ. The styloid process syndrome: aetiological factors and surgical management. J Laryngol Otol 1977; 91 (04) 279-294