Transient Velopharyngeal Insufficiency After Calcified Stylohyoid Ligament Resection.

Elongation of the stylohyoid process or calcification of the stylohyoid ligament is known as the Eagle syndrome. Mostly, it is seen incidentally on imaging or with extreme suspicion and usually patients are asymptomatic.Surgery is the preferred method in symptomatic patients. Transcervical or transoral methods may be preferred as surgical route.A 28-year-old female patient who had formerly underwent tonsillectomy presented with throat and ear pain. A neck computed tomography was performed, and the patient was diagnosed as Eagle Syndrome. Surgery was recommended.Patient developed transient velopharyngeal insufficiency on postoperative day 4. Ventilation exercise and follow-up was recommended. Complaints of the patient decreased on the 15th day.It should be kept in mind that stylohyoid ligament may be calcified in young age group and middle age group patients with dysphagia or odynophagia, and differential diagnosis should be performed. Another issue is the condition of velofaringeal insufficiency which may occur due to the damage of the pharynx muscles by deep dissection during surgery.

Length of the ossified stylohyoid complex and Eagle syndrome.

PURPOSE: To assess radiographically the presence of an ossified stylohyoid complex (OSHC) with signs and symptoms of Eagle syndrome or other oro-facial painful diseases in patients attending our institution and to confirm that the important issue for study is to know the length of the ossificated portion of the stylohyoid complex only. METHODS: We separated 1000 consecutive files, and after selection, 922 panoramic radiographs were evaluated. Assessed parameters were gender and age of the patients, size, and location of the analyzed OSHCs. In addition, the length parameters of the studied OSHCs were also determined in 100 extra radiographs. RESULTS: Normal length of OSHCs was between 2.83 and 4.16 cm and OSHCs measuring more than 4.17 cm long comprising 23.2% of the sample. Any of the patients with OSHC presented signs or symptoms of the Eagle syndrome or any other orofacial painful disease. CONCLUSIONS: This is the first study on OSHCs using the mandatory parameters of normal, short and elongated length in the studied population. Our results suggest that the presence of an OSHC is not an important feature for pain detection in the Eagle syndrome and is not an important risk factor for development of throat pain in this and other painful orofacial diseases. Our results are different from those previously published in other populations and suggest that the widely used lengths of 2 to 4 cm for measuring the OSHCs are not adequate parameter. It is desirable to define first the short, normal and abnormal parameters of OSHCs in each studied population.

Primary Cutaneous Osteosarcoma.

Primary cutaneous osteosarcoma is an exceedingly rare malignant mesenchymal neoplasm of the skin which produces bone, osteoid, or chondroid material and does not involve the underlying bone. The most common site for extraskeletal osteosarcoma is in the deep soft tissues of the thigh, upper extremities, and retroperitoneum; however, it may occur anywhere in the body. Involvement of the skin is rare and when it does occur it is more commonly due to metastatic disease rather than a primary malignancy. Only 16 cases of primary cutaneous osteosarcoma have been described in the literature. We report an uncommon case of primary cutaneous osteosarcoma. Our patient is an 84-year-old male with an unremarkable medical history who presented to the dermatology clinic complaining of a 0.5 x 0.4 cm pink flesh to translucent-appearing, shiny, papule on the right superior jawline which was not connected to the underlying bone. Clinically the differential diagnosis included basal cell carcinoma, trichoepithelioma, and other cutaneous adnexal tumors. An excisional biopsy was performed which demonstrated an unremarkable epidermis with a hypercellular reticular dermis with occasional large spindled cells with amphophilic cytoplasm. The deep dermis was involved by mature osteoid formation and infiltration of highly mitotically active, atypical epithelioid and spindled cells with abundant nuclear pleomorphism, amphophilic cytoplasm, and poorly defined cell borders. Occasional multinucleate forms were seen. Immunohistochemistry was performed which showed strong positive staining with vimentin. Without connection to the underlying bone, osteosarcoma of periosteal, parosteal, or osseous origin was excluded. Based on these histomorphologic findings, a diagnosis of primary cutaneous osteosarcoma was made. Our case adds to the dearth of literature regarding primary cutaneous osteosarcoma and provides primary care physicians, dermatologists, and pathologists much needed insight into this rare condition.

The experience of treatment of coblation assisted surgical approach to Eagle's syndrome.

OBJECTIVE: This article aimed to Summarize our therapeutic experience with Transoral coblation assisted surgical approach used for treatment of Eagle's syndrome. METHODS: sixty-two consecutive patients, from 2010 to 2015, underwent coblation assisted surgical treatment to remove elongated styloid process transorally. Outcomes were assessed in terms of intraoperative and postoperative complications, patients' evolution and efficiency of treatment. RESULTS: The amount of bleeding was 1ml~4ml, average 2.7ml, unilateral operation time was 3min to 10min, average 6.2min, bilateral for 7min to 15min, average 13.5min. no bleeding and complications after operation. Pseudo membrane completely off the 14days or so, the cure rate was 58.1%, the efficiency of 30.6%. CONCLUSION: In order to get a good curative effect, we should pay attention to the accurate diagnosis, choose the appropriate way of intubation and mouth opening device, pay attention to the details of the operation, maximize the effect of coblation to achieve a more minimally invasive treatment effect.

Eagle Syndrome: An Unusual Cause Limited Mouth Opening and Surgical Management.

Eagle syndrome, defined "stylalgia," occurs when an elongated styloid process or calcified stylohyoid ligament causes dysphagia, facial pain recurrent throat pain or foreign body sensation, also associated symptoms such as neck or throat pain with radiation to the ear. The symptoms related to this condition can be confused or misdiagnosed to a wide variety of facial neuralgias. The incidence of Eagle syndrome varies among population. Usually asymptomatic, it occurs in adult patients, and can be diagnosed by physical examination and radiologically. A 30-year-old male patient presented to the maxillofacial unit of Sulaimaniyah Teaching Hospital with a complaint of pain in the right side of face interfering with mouth opening and causing deviation to the right side of mouth for 6 months duration. The elongated styloid process of the right side was resected surgically by the intra-oral approach. The patient was asymptomatic and comfortably followed up for 5 months.

Eagle syndrome.

Eagle syndrome, also known as elongated styloid process, is a condition first described by Watt Eagle in 1937. It occurs when an elongated styloid process or calcified stylohyoid ligament causes recurrent throat pain or foreign body sensation, dysphagia, or facial pain. Additional symptoms may include neck or throat pain with radiation to the ipsilateral ear. It is usually hard to diagnose because the symptoms related to this condition can be confused with those attributed to a wide variety of facial neuralgias. In this article, a case of Eagle syndrome exhibiting unilateral symptoms with bilateral elongation of styloid process is reported.

Eagle syndrome surgical treatment with piezosurgery.

INTRODUCTION: Eagle syndrome (ES) is an uncommon complication of styloid process elongation with stylohyoideal complex symptomatic calcification. It is an uncommon condition (4% of the population) that is symptomatic in only 4% of the cases. Eagle syndrome is usually an acquired condition that can be related to tonsillectomy or to a neck trauma. A type of ES is the styloid-carotid syndrome, a consequence of the irritation of pericarotid sympathetic fibers and compression on the carotid artery. Clinical manifestations are found most frequently after head turning and neck compression. Although conservative treatment (analgesics, anticonvulsants, antidepressants, local infiltration with steroids, or anesthetic agents) have been used, surgical treatment is often the only effective treatment in symptomatic cases. MATERIALS AND METHODS: We present the case of a 55-year-old patient, successfully treated under endotracheal anesthesia. The cranial portion of the calcified styloid process was shortened through an external approach, using a piezoelectric cutting device (Piezosurgery Medical II; Mectron Medical Technology, Carasco, Italy) with MT1-10 insert, pump level 4, vibration level 7. RESULTS: No major postoperative complications such as nerve damage, hematoma, or wound dehiscence occurred. After 6 months, the patient was completely recovered. Two years after the surgery, the patient did not refer any symptoms related to ES. CONCLUSIONS: The transcervical surgical approach in patients with ES seems to be safe and effective, despite the remarkable risk for transient marginal mandibular nerve palsy. This risk can be decreased by the use of the piezoelectric device for its distinctive characteristics--such as precision, selective cut action, and bloodless cut.

Complete ossification of the stylohyoid chain as cause of Eagle's syndrome: a very rare case report.

AIM: To report on a patient with Eagle's syndrome with a complete and very large ossification of the stylohyoid complex on the right side that to our best knowledge has never been published previously. BACKGROUND: Eagle's syndrome is characterized by a set of symptoms that are caused by the irritation of the neurovascular and soft-tissues caused by an elongated styloid process or ossification of stylohyoid ligament. CASE DESCRIPTION: Because of the high discomfort and pain degree as well as limitations of mandibular and head mobility and also the thickness of the ossifed stylohyoid chain, the patient was treated surgically by removing the hypertrophic segment. CONCLUSION: These symptoms subsided completely after the surgical excision of the anomaly. The elongated styloid process on the left side was symptom free. CLINICAL SIGNIFICANCE: Eagle's syndrome symptoms are not specific and can mimic those of other disorders, the syndrome must be included in the differential diagnosis of patients with pain in the orofacial, pharyngeal and cervical area.

Eagle syndrome: A rare neuropathic disorder affecting head and neck.

To investigate the clinical characteristics of Eagle syndrome (ES) and evaluate psychological distress of the patients. Ten cases of ES were enrolled, clinical characteristics and management were analyzed. Psychological disorders of the patients were assessed by the test of self-rating anxiety scale (SAS) and self-rating depression scale (SDS). There were 8 females and 2 males varying from 34 to 56 years with a mean age of 44.86 ± 8.38 years. The main complaints included foreign body sensation of pharynx, odynophagia, vertigo with turning of the head-neck, pain of anterolateral neck, and toothache. Three cases were right-side affected, 6 cases were left-sided and 1 case was bilateral. Radiographic examination showed the elongated styloid process of bilateral in all cases, however, hypertrophy, improper inclination, abnormal angulation of styloid process and more complete calcification of stylohoid ligament of the complained side were observed compared to the opposite side. Eight cases suffered from anxiety and/or depression. A surgical intervention was carried out on 6 patients to resect the elongated styloid process, the symptoms and mental distress disappeared after the operation and no recurrence was found in their follow-ups. Meticulous interrogation of illness history, proper examination, and radiological studies may be valuable in diagnostic confirmation of ES. It is the hyperostosis, abnormal angulation of the styloid process rather than the simple elongation which is more likely to be attributed to the development of ES. Psychological disorders in ES patients were observed in our study and should be paid more attention in the future research.

Accuracy in the Diagnostics of Styloid Process - Panoramic Radiograph vs. Computed Tomography: A Comparative Study.

BACKGROUND/AIM: The styloid process (SP) becomes clinically relevant when it shows enlargement (>30 mm) in the sense of an elongated SP (ESP) and/or increasing calcification leading to Eagle Syndrome (ES). Panoramic radiograph (PR) or computed tomography (CT) are part of the routine diagnostics in ES. Currently, CT is considered the gold standard. The aim of this study was to investigate the accuracy in the diagnostics/measurements of SP/ESP throughout a comparative study between PR and CT. Furthermore, in addition to measuring established parameters, this study aimed to determine the currently unexamined width in the base and tip of the SP. PATIENTS AND METHODS: The present study examined the radiological findings of bilateral SP in 100 patients who received both PR and CT on the same day. Measurements of the length of the SP and width at the basis and tip were performed. Furthermore, calcification patterns, Langlais classification and the prevalence of ESP were analyzed. RESULTS: There was a highly significant correlation between PR and CT measuring SP for every parameter. Males showed significantly longer SP than females among the age group between 18-75 years. The results of the length measurements of the SP (male: right SP=32.98 mm; left SP=35.21 mm; female: right SP=30.31 mm; left SP=30.92 mm) significantly exceeded the values of comparable studies. CONCLUSION: Consequently, it can be concluded that PR provides accurate measurements when compared to CT for measuring and diagnosing SP/ESP/Eagle syndrome. This study was one of the first to examine the width of the SP in the base and tip, thus these measurements can serve as a baseline for further studies. Since the mean lengths of SP exceeded 30.0 mm in the present study, these findings raise the question of whether the cut-off of 30.0 mm is adequate for the diagnosis of ESP.

Bilateral extracapsular soft-tissue ossification affecting range of TMJ motion in an Airedale terrier.

A 3 mo old female Airedale terrier presented with decreased range of motion of the temporomandibular joint (TMJ), which was first recognized at weaning. Computed tomography (CT) revealed abnormal, bilateral ossification of the soft tissues extending from the region of the tympanic bullae to the medial aspect of the angular process of each mandible. Those ossified structures most closely approximated the location of the lateral pterygoid muscles. The ossified structures were present at presentation and initially manifested as complete ossification on the right side. The condition progressed to complete bilateral ossification by 3 yr of age. The mandibular condyles associated with the temporomandibular joints were malformed. The patient had severe mandibular distoclusion with deviation of the mandible to the left. The left mandibular cheek teeth were positioned in a caudal cross bite. A single treatment of manual stretching and breakdown of the ossified muscle of mastication by placement of tongue depressors within the oral cavity resulted in no increase in TMJ range of motion as measured by the incisal opening. This is the first reported case of spontaneous false ankylosis of the TMJ in an Airedale terrier.

Eagle's syndrome: signs and symptoms.

Eagle's syndrome, an uncommon sequela of an elongated styloid process, can manifest itself as a sensation of a foreign body in the throat and a retrogoniac or anterolateral neck pain often referred to the TMJ and the ear. When treating patients affected by temporomandibular disorders (TMD), complaining of atypical orofacial pain, and with a concomitant radiographic finding of a bilaterally elongated styloid, the possible coexistence of Eagle's syndrome should always be considered. The aim of this review is to present an overview of the epidemiology, pathophysiology, diagnosis, and therapy for Eagle's syndrome and to help the clinician in differential diagnosis with other conditions that can provide similar signs and symptoms.

Eagle's syndrome: treatment by intraoral bilateral resection of the ossified stylohyoid ligament. A review and report of two cases.

The complexities of Eagle's syndrome are examined according to anatomical, historical, clinical, and treatment aspects. There appears to be little correlation between the extent, form, and size of the anomalies of the styloid process and the stylohyoid ligament and the predictability of patients with related symptoms. Surgical treatment and the advantages and disadvantages of each surgical approach (intra- and extraoral) are discussed. The probable causes of enlargement of the styloid process and ossification of the stylohyoid ligament are addressed. Two cases of Eagle's syndrome are presented: one unilateral and the other bilateral. An intraoral modified surgical technique is presented.

Management of eagle syndrome.

PURPOSE OF REVIEW: Eagle syndrome is a challenging clinical presentation with important potential complications. It can be misdiagnosed due to lack of awareness; this review provides information in terms of diagnosis and management of eagle syndrome. RECENT FINDINGS: The importance of early diagnosis of this rare disease is preventing the delay in clinical-surgical treatment. As there is not a universally accepted cut-off for styloid process length, the diagnosis should be confirmed by length of process greater than one-third of the length of mandibular ramus in addition to other clinical symptoms and signs. There are both surgical and pharmacological treatment options for these patients. SUMMARY: Eagle syndrome is a rare clinical condition and its diagnosis is made by physical examination and radiography. When it is suspected by physical examination, definitive diagnosis is confirmed by computed tomography scans of the skull, as the gold standard. Location, degree of elongation of styloid process, and severity and reproducibility of symptoms are important factors in deciding the most appropriate approach. Surgery is frequently the treatment of choice in Eagle syndrome patients. With proper diagnosis and treatment, the prognosis is favourable and recurrence is uncommon.

Stylohyoid syndrome: surgical approach.

The best-known cervicopharyngeal pain is Eagle syndrome, in which symptomatic elongation of the stylomandibular process occurs and may be accompanied by stylohyoid ligament calcification. Among the causes of elongation of the styloid process, the following may be mentioned: history of trauma, styloid ligament calcification, and formation of bony tissue in the insertion of the styloid ligament. When there is no history of trauma or surgery, it is called the stylohyoid syndrome. In the current study, the clinical case of 34-year-old woman is reported, complaining of pain in the region of the neck, without any history of neck surgery or trauma. A panoramic radiograph and computed tomographic scan showed bilateral elongation of the styloid process. Extraoral surgical intervention was the treatment of choice. It is important to point out that dentists should be aware of this condition to contribute to a better diagnosis and therapeutic procedure.

Chronic oropharyngeal pain and medical nomadism in an Eagle's syndrome patient: a case report.

BACKGROUND: Elongation of the styloid process associated with oropharyngeal pain and dysphagia is known as Eagle's syndrome, a condition whose pathophysiology is still a matter of debate. Given its low prevalence and complex symptomatology, this syndrome is often misdiagnosed, leading to chronic pain and medical nomadism. A 51-year-old woman of African origin with 3-year history of left-side oropharyngeal pain and worsening dysphagia consulted several health professionals. Medical and surgical treatments, including a sinus surgery and the extraction of three healthy teeth, did not improve her symptoms. Evaluation in an orofacial pain clinic revealed an asymmetrically elongated styloid process. Surgical shortening of the elongated styloid process provided complete pain relief and recovery of normal swallowing function. CONCLUSION: Based on this case report, the pathophysiology of Eagle's syndrome is discussed, and the need for specific follow-up in a subpopulation of patients with asymptomatic styloid process elongation is highlighted.

Mandibular nerve entrapment in the infratemporal fossa.

The posterior trunk of the mandibular nerve (V(3)) comprises of three main branches. Various anatomic structures may entrap and potentially compress the mandibular nerve branches. A usual position of mandibular nerve (MN) compression is the infratemporal fossa (ITF) which is one of the most difficult regions of the skull base to access surgically. The anatomical positions of compression are: the incomplete or complete ossified pterygospinous (LPs) or pterygoalar (LPa) ligament, the large lamina of the lateral plate of the pterygoid process and the medial fibres of the lower belly of the lateral pterygoid (LPt). A contraction of the LPt, due to the connection between nerve and anatomic structures (soft and hard tissues), might lead to MN compression. Any variations of the course of the MN branches can be of practical significance to surgeons and neurologists who are dealing with this region, because of possibly significant complications. The entrapment of the MN motor branches can lead to paresis or weakness in the innervated muscle. Compression of the sensory branches can provoke neuralgia or paraesthesia. Lingual nerve (LN) compression causes numbness, hypoesthesia or even anaesthesia of the mucous of the tongue, anaesthesia and loss of taste in the anterior two-thirds of the tongue, anaesthesia of the lingual gums, as well as pain related to speech articulation disorders. Dentists should be very suspicious of possible signs of neurovascular compression in the region of the ITF.

A Prolonged Time to Diagnosis Due to Misdiagnoses: A Case Report of an Atypical Presentation of Eagle Syndrome.

BACKGROUND Eagle syndrome is an unusual condition in which the styloid process (SP) becomes elongated and causes different clinical symptoms due to pressure on adjacent anatomical structures. The symptoms are non-specific and include severe throat, facial, and ear pain, or headaches. They are usually exacerbated by head rotation, swallowing, yawning, or chewing, but atypical presentations exist. It is a difficult pathology to diagnose and it can take several years before a proper diagnosis is made. CASE REPORT This report describes the case of a dental student presenting with an atypical presentation of Eagle syndrome. His styloid processes were 75 mm long and he was affected with severe pain to his throat, the anterior part of his ears, his submandibular area, and his molar teeth. The pain was exacerbated during maximal mouth opening, yawning, mandibular protrusion, and during downward head tilt, but not during the classically described movements of head rotation, swallowing, yawning, or chewing. Due to the absence of the classic symptoms, even with knowledge of the condition and unusual direct access to several oral and maxillofacial specialists, it took 4 years and multiple misdiagnoses to reach the final diagnosis. Following bilateral styloidectomy, all pain subsided. CONCLUSIONS The clinical presentation of Eagle syndrome varies, and the symptoms are non-specific. This greatly increases the complexity of diagnosing the condition and raises the time to diagnosis and the chances of misdiagnoses. It is, therefore, crucial to recognize the diagnostic tools, applicable imaging, and definitive treatment alternatives to successfully identify and treat patients affected.

Mild progressive osseous heteroplasia overlap syndrome with PTH and TSH resistance appearing during adolescence and not early childhood.

PURPOSE: Progressive osseous heteroplasia (POH), a genetic disorder, is associated with Albright's hereditary osteodystrophy (AHO), pseudohypoparathyroidism, and primary osteoma cutis and has common features of superficial ossification and GNAS-inactivating mutations. Disorders due to GNAS-inactivating mutations are classified as "inactivating parathyroid hormone (PTH)/PTHrP signaling disorder type 2." This study reports a case of mild POH overlap syndrome to improve understanding of genotype-phenotype correlations. METHODS: A 13-year and 6-month-old Japanese boy was referred to our hospital with a chief complaint of the lower limb length difference. He underwent clinical, biochemical, radiological, and genetic studies. RESULTS: He showed sporadic GNAS mutation, deep ectopic ossification, small for gestational age (SGA), congenital tooth defect, and lack of AHO features; he met the diagnostic criteria for POH, and mild PTH and TSH resistance was detected. He had constant hyperphosphatasemia and hypocalciuria. At the age of 10 years, he occasionally experienced high iPTH levels. The pituitary stimulation test showed a normal response of all hormones at 3 years of age, but TSH response was decreased (previously 0.770, peak value 4.144 µIU/mL) in the TRH loading test at age 13 years and 6 months. DNA analysis showed a heterozygous p.D189MfsTer14 mutation of GNAS. The parents did not carry this mutation. CONCLUSION: We report a rare case of POH overlap syndrome with PTH/TSH resistance that appeared in adolescence rather than early childhood. Cases diagnosed with POH in early childhood also require reassessment during adolescence. Further studies of the GNAS heterozygous mutation p.D189MfsTer14 may reveal factors involved in POH overlap syndrome.

[Eagle syndrom: A case report]. / Le syndrome de Eagle : à propos d'un cas.

INTRODUCTION: The Eagle syndrome is a rare entity characterized by a hypertrophy of the styloid process responsible for clinical signs in connection with compression of the vasculonervous structures of vicinity. CASE REPORT: Female 40 years old who complained for 7 years about intense right temporo-parietal headache, associated with ocular pains, otalgia, tinnitus and swallowing problems. These symptoms were unilateral. The only notable antecedent was an extraction of the wisdom teeth of the lower arc 10 years before. CONCLUSION: The Eagle syndrome is an unusual syndrome ignored by the majority of the clinicians. The simple palpation of the oropharyngeal walls (tonsils) makes it possible to evoke the diagnosis. This suspicion will be confirmed by Xrays. The surgery presents few risks and the patient is released of symptoms very quickly.