Styloid process syndrome

An Interesting case record of Styloid process syndrome

History:

40 years old male patient presented with complaints of:

1. Severe pain left side of throat - 3 months

2. Pain radiating to left ear

No history of pain while swallowing.

No history of recurrent upper respiratory tract infections.

Patient was not a known diabetic and not a known hypertensive.

On examination:

Throat: Both tonsils normal. No abnormality seen. On palpation a hard mass could be felt under the left tonsil. It was tender to touch.

Investigations:

Xray skull lateral view:

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Shows dense opacity in the styloid process area

X-ray skull AP view

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CT Axial cut skull:

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Imaging studies pointed towards one diagnosis i.e. ossification of stylohyoid ligament.

Management:

Patient was taken up for surgery under General anaesthesia.

Position : Tonsillectomy position (Rose Position)

Mouth kept open using Boyles Davis mouth gag.

Preliminary left tonsillectomy done. Perfect hemostasis secured.

Constrictor muscles forming tonsillar bed teased out exposing dense bony structure underneath.
It was bony hard on palpation. The same was removed using high speed drills.

Surgical video clipping:

Discussion:

Elongated / ossified styloid process can cause following complaints due to compression of neurovascular bundle.

1. Vague pain the neck
2. F.B. Sensation in the throat
3. Pain while changing head position
4. Pain in the ear
5. Pain radiating to upperlimb

Eagle was the first person to describe this condition and hence it is known as "Eagle's syndrome".

Eagle described two variants of this syndrome:

Classic Eagle's syndrome:
Pain is the most important feature of this syndrome due to nerve compression i.e. Glossopharyngeal nerve.

Carotid artery syndrome:
This condition is featured by vascular compression due to enlarged styloid process. This classically causes giddiness on head turning

Tests to diagnose Eagle's syndrome include:

1. Palpation of tonsillar fossa
2. Xylocaine infiltration test: Gives pain relief when xylocaine is infiltrated into the tonsillar fossa

Surgery is reserved for symptomatic cases. Intraoral / cervical approaches can be attempted.

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