An Uncommon Extensive Bilateral Continuous Ossification of the Stylohyoid Chain Extending to the Hyoid Bone in...

Eagle's syndrome is a rare cause of cervicofacial pain and dysphagia arising from elongation of the styloid process or ossification of the stylohyoid ligament complex. While styloid elongation >3 cm is relatively common, extensive continuous ossification of the stylohyoid chain with continuity to the hyoid bone remains uncommon. We report a 42-year-old man with a six-month history of persistent throat pain and globus sensation unresponsive to conservative measures. Clinical examination showed bilateral tonsillar fossa tenderness with palpable bony projections, more pronounced on the left. Cone-beam computed tomography (CBCT) revealed marked bilateral elongation and ossification of the stylohyoid complex, measuring 8.04 cm on the right and 10.11 cm on the left, exceeding the longest previously reported length of 8.5 cm. Due to the extent and proximity to the hyoid bone, surgical excision was performed via an extraoral transcervical approach, resulting in complete symptom resolution. This case represents one of the most extensive bilateral ossifications of the stylohyoid chain documented, with the longest reported stylohyoid complex to date. Such extreme elongation likely contributed to mechanical irritation and restricted neck movement. Early recognition with advanced imaging (CBCT) and tailored surgical planning are critical to avoid misdiagnosis and achieve excellent outcomes in these rare variants.