Failure of OPHL type IIb due to undiagnosed Eagle syndrome

A 52-year-old man with glottic-supraglottic tumour underwent open partial horizontal laryngectomy (OPHL) IIb. On the 12th day postoperative, laryngoscopy showed necrotic tissue at the level of pexy and an increased distance between tongue base and neoglottis; the neck CT showed cricoid arch rupture and rupture of the pexy. By re-examining the preoperative CT images, the ossification of stylohyoid ligament (Eagle syndrome) was detected and supposed as the possible cause of cricoid rupture due to its traction on the hyoid bone and therefore on the pexy. The stylohyoid ligaments were cut at their insertion on the hyoid bone and a tracheohyoidopexy was performed. Two months after surgery, the patient had only some swallowing impairments. This case represents a complication in OPHL II never reported in literature caused by an undiagnosed Eagle syndrome in preoperative, pointing out the importance to search for any anatomical anomaly that could jeopardise the success of the surgery.