Entrapment of the glossopharyngeal nerve in patients with Eagle syndrome: Surgical technique and outcomes in a series of 5 patients: Clinical article

Department of Neurosurgery, University of Illinois at Chicago, Illinois 60612, USA.
Journal of Neurosurgery (Impact Factor: 3.74). 04/2009; 111(6):1226-30. DOI: 10.3171/2009.1.JNS08485
Source: PubMed


Eagle syndrome is characterized by unilateral pain in the oropharynx, face, and earlobe, and is caused by an elongated styloid process or ossification of the stylohyoid ligament with associated compression of the glossopharyngeal nerve. The pain syndrome may be successfully treated with surgical intervention that involves resection of the styloid process. Although nerve decompression is routinely considered a neurosurgical intervention, Eagle syndrome and its treatment are not sufficiently examined in the neurosurgical literature.
A review was performed of cases of Eagle syndrome treated in the Department of Neurosurgery at the University of Illinois at Chicago Medical Center over the last 7 years. The clinical characteristics, radiographic imaging, operative indications, procedural details, surgical morbidity, and clinical outcomes were collected and analyzed.
Of the many patients with facial pain treated between 2001 and 2007, 7 were diagnosed with Eagle syndrome, and 5 of these patients underwent resection of the elongated styloid process. There were 4 women and 1 man, ranging in age from 20 to 68 years (mean 43 years). The average duration of disease was 11 years. In all patients, a preoperative workup revealed unilateral or bilateral elongation of the styloid process. All patients underwent resection of the styloid process on the symptomatic side using a lateral transcutaneous approach. There were no surgical complications. All patients experienced pain relief immediately after the operation. At the latest follow-up (average 46 months, range 7 months to 7.5 years) all but 1 patient maintained complete pain relief. In 1 patient, the pain recurred 12 months postoperatively and additional interventions were required.
Eagle syndrome may be considered an entrapment syndrome of the glossopharyngeal nerve. It is a distinct clinical entity that should be considered when evaluating patients referred for glossopharyngeal neuralgia. The authors' experience indicates that patients with Eagle syndrome may be successfully treated using open resection of the elongated styloid process, which appears to be both safe and effective in terms of long-lasting pain relief.

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    ABSTRACT: Eagle's syndrome refers to a rare constellation of neuropathic and vascular occlusive symptoms caused by pathologic elongation or angulation of the styloid process and styloid chain. First described in 1652 by Italian surgeon Piertro Marchetti, the clinical syndrome was definitively outlined by Watt Eagle in the late 1940s and early 1950s. This article reviews how underlying embryologic and anatomic pathology predicts clinical symptomatology, diagnosis, and ultimately treatment of the syndrome. The length and direction of the styloid process and styloid chain are highly variable. This variability leads to a wide range of relationships between the chain and the neurovascular elements of the neck, including cranial nerves 5, 7, 9, and 10 and the internal carotid artery. In the classic type of Eagle's syndrome, compressive cranial neuropathy most commonly leads to the sensation of a foreign body in the throat, odynophagia, and dysphagia. In the carotid type, compression over the internal carotid artery can cause pain in the parietal region of the skull or in the superior periorbital region, among other symptoms. Careful recording of the history of the present illness and review of systems is crucial to the diagnosis of Eagle's syndrome. After the clinical examination, the optimal imaging modality for styloid process pathology is spiral CT of the neck and skull base. Surgical interventions are considered only after noninvasive therapies have failed, the two most common being intraoral and external resection of the styloid process.
    Acta Neurochirurgica 05/2012; 154(7):1119-26. DOI:10.1007/s00701-012-1385-2 · 1.77 Impact Factor
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    ABSTRACT: Abstract Eagle (Arch Otolaryngol. 1937;25:584 and Arch Otolaryngol. 1949;49:490) first identified elongation of the styloid process and ossification of the stylohyoid ligament as a cause of orofacial pain. The elongated styloid process presses on the internal carotid artery and adjacent structures, including branches of the glossopharyngeal nerve and this produce orofacial pain. Some authors define an elongated styloid process as longer than 4 cm because this length is associated with an increase in the incidence of Eagle’s syndrome. The syndrome is diagnosed by exclusion (Walkman SD. Atlas of Uncommon Pain Syndromes. Philadelphia: Elsevier Science; 2003), and the diagnosis is confirmed by radiological studies and computed tomography. Treatment can be divided into medical, interventional, and surgical techniques. We report a patient with symptoms of glossopharyngeal neuralgia, who was diagnosed with Eagle’s syndrome on the basis of diagnostic imaging. The length of the stylohyoid process was 63 mm on the left side and 64 mm on the right. Treatment was performed by applying pulsed radiofrequency to the glossopharyngeal nerve with satisfactory results. The technique was performed twice on an outpatient basis, produced no complications or side effects, and proved effective in the short and medium term in decreasing the intensity of pain.
    Pain Practice 10/2012; 13(5). DOI:10.1111/j.1533-2500.2012.00592.x · 2.36 Impact Factor
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    ABSTRACT: Background Many nerve injuries have been associated with Eagle syndrome. The cranial nerves V, VII, IX, and X have been reported to be injured by the elongated styloid process in this syndrome. Methods We describe a case of Eagle syndrome with atypical symptoms of hypoglossal nerve palsy and Horner syndrome. ResultsA 56-year-old woman presented with right hypoglossal nerve palsy, right Horner syndrome, right neck pain, and symptoms mimicking transient cerebral ischemia. An angioscan showed elongated styloid process bilaterally with the right process compressing the right carotid artery causing a 75% stenosis. After an en bloc resection of the right styloid process, there were no further episodes of paresthesias. The neck pain completely disappeared, as well as the Horner syndrome. As for the hemitongue, the fasciculations disappeared but the atrophy remained. Conclusion This is the first Eagle syndrome case report describing a motor paralysis of a cranial nerve. (c) 2014 Wiley Periodicals, Inc. Head Neck 36: E136-E138, 2014
    Head & Neck 12/2014; 36(12). DOI:10.1002/hed.23675 · 2.64 Impact Factor
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