Eagle syndrome: classic and carotid artery types

To present a number of cases with elongated styloid process (Eagle) syndrome and to discuss the clinical presentation of this disorder.

A clinical study of patients operated on at King Abdul-Aziz University Hospital, Riyadh, from 1992 to 1996.

The study group consisted of seven patients (six females and one male ranging in age from 20 to 43 years). Symptomatically, two distinct groups of patients could be identified: the classic syndrome (including three patients), which occurs in the tonsillectomized patients, and the styloid-carotid artery syndrome (including four patients), which occurs independently of tonsillectomy. In the first type, patients usually complain of spastic and nagging pain in the pharynx radiating to the mastoid region. In the second group, patients usually complain of attacks of syncope in association with pharyngeal pain referred to the course of the carotid artery. Diagnosis is made by history taking, palpating the tonsillar fossa, and radiographic demonstration of the process. Three-dimensional computed tomography reconstruction images were found to be very reliable in measuring the actual length of the styloid process and the stylohyoid ligament.

This unusual disorder should be considered in the differential diagnosis of facial pain in some patients and as the cause of syncope in other patients. The paper discusses the embryologic, anatomic, pathogenetic, clinical, and therapeutic aspects of elongated styloid process with calcified stylohyoid ligament and the differential diagnosis is detailed.