A Bulky mass in the floor of the mouth with unexpected diagnosis

Introduction  Dysphagia is a symptom with inconsistent etiology and is encountered daily by the otolaryngologist. Differential diagnoses include diseases of the nervous system, trauma, inflammatory changes, malformations, and space-occupying lesions. Especially in case of derb palpable, painful processes, a careful diagnosis should be made in order not to overlook a malignant process.

Case presentation  A 60-year-old female patient has been suffering from intermittent dysphagia for months. In the course of time, there is additional right submandibular pain radiating into the ear.

On examination by an ENT specialist, a broad dermal mass is palpated dorsally in the floor of the mouth between the tongue and the alveolar ridge on the right side. Cervical ultrasonography reveals echoic formations dorsal to the submandibular gland without a clearly demarcated mass. Using 3D reconstruction in digital volume tomography, a diagnosis of a massively widened styloid process with pronounced ossification of the stylohyoid ligament is made (max. 13x62 mm).

Subtotal resection is performed via a cervical approach. Postoperatively, the patient is without any symptoms.

Conclusion  The present case emphasizes the importance of palpation as an important diagnostic tool. Although Eagle syndrome is a rare condition with nonspecific complaints, it should be considered for differential diagnosis when dysphagia is a symptom. Since in this case the elongated styloid process could not be palpated classically in the tonsillar fossa but as a broad mass in the floor of the mouth, modern 3D imaging led to visualization and diagnosis.

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Artikel online veröffentlicht:
24. Mai 2022