Eagle syndrome refers to elongation of the styloid process or calcified stylohyoid ligament. Normal length of styloid process is 2.5cm. When the length of styloid becomes more than 3cm it can be considered as elongated. It was first described by Watt Eagle in 1937. Ossification of the stylohyoid ligament was described by an Italian anatomist Pietro Mrchetti in the17th century.
An elongated styloid process occurs in about 4% of population. In this, only 4-10.3% will be symptomatic. Incidence is about 0.16% with a female: male ratio of 3:1.
Surgical trauma or mechanical stress, Tonsillectomy, pharyngeal trauma. Local chronic irritation leading to proliferation of osseous tissue at the insertion of the stylohyoid ligament
Congenital due to persistence of cartilaginous elements of precursors of styloid process
Signs and symptoms:
Classic eagle syndrome: Due to fibrous tissue resulting in distortion of the cranial nerve endings, seen after pharyngeal trauma or tonsillectomy.
- Ipsilateral dull and persisting pharyngeal pain, centred in the ipsilateral tonsilar fossa.
- Pain will be radiated to ear and aggravated by rotation of head
- A mass of bulge may be palpable
- Dysphagia with sensation of foreign body in throat
- Increased salivation
- Cervicofacial pain
- Voice changes
Stylocarotid syndrome: not correlated with tonsillectomy, mainly caused due to compression of sympathetic chain in the carotid sheath
- Compression of external and internal carotid artery
- Pain along with the distribution of the artery, which is aggravated by rotation and compression of neck
- In case of internal artery involvement there will be supraorbital pain and parietal headache. In case of external carotid artery involvement the pain radiates to the infraorbital region.
CT scan (3DCT): helps to obtain a 3 dimensional measurement of the styloid process.
X-ray: anteroposterior and lateral view. Reveals the elongated styloid process
Name: Mrs S D H
Age: 36 yrs.
Patient presented with the complaints of neurological pain over the left post auricular region radiating to neck and left temporal region over the last year, which increased the last 3 days. Complaint of pain is more on reading or straining neck for a long time, at night, cold weather, sleeping on left side and is better by rest. She also complaints of occasional vertigo with severe pain.
There is no history of any visual disturbance, nausea or vomiting, no history of syncopal attacks, no history of head injury.
Past medical and treatment history: nothing significant
Allergic history: not allergic to any food or drug
diet: mixed diet, regular eating habits
Thirst: 2 l/day
Aversion: cucumber, spinach
Bowel and bladder habits: regular
Sleep: good, occasionally disturbed with complaints
General physical examination:
Moderately built and nourished
Well oriented with time, place, and person.
No signs of pallor cyanosis, clubbing, icterus, oedema or lymphadenopathy
Tempt.: afebrile at the time of examination
B.P: 130/80 mm of Hg
Pulse: 76 b/mint
Head and Neck:
No swelling over the left side of the neck
No restriction of movements
On palpation: no tenderness, no palpable mass, no lymphadenopathies.
Investigations done: CT scan:
- Bilateral elongated styloid process
- Calcified stylohyoid ligament on right side
- Generalized periodontitis
Management of the case:
As there is an irreversible pathological change, ie elongation of bone with calcification of ligament, a palliative approach was adopted corresponding to the 7th observation of Kent, “full time amelioration of the patient, yet no special relief ”. Remedy acts favourably and the patient will be relived of symptoms in regard to intensity of pain and progress of disease and possible complications.
Neuralgic pain over the left side of head
< Strain, pressure, night
Prescription: 2.5.2017 Natrum sulph 200 – 2pks/ once in a wk
- No ii pills 3 – 3 – 3 (Explain your abbreviations) (plain globules)
Natrum sulph was selected mostly based on 1) sycotic miasm – overgrowth of bone tissue and calcification. Also chronic periodontits. Hydrogenoid constitution indicated by aggravations form cold, cucumber disagrees, aggt. watery food. Symptoms like pain over the left side of head which is piercing and like electric Agravation on strain of muscles, pressure, cold weather, night, and better by rest. Also,painless infection of gums.
Approach to this case is a palliative one. Mechanical compression cannot be removed completely with our medication, but the remedy will act like an anti miasmatic and constitutional as it covers miasm, constitution and symptoms. What we can do is reduce or slow down the further progress and management of acute episodes if any comes up. She was under treatment from May and never presented with any acute exacerbations till December. No symptoms suggestive of vascular compression either. About duration of medication, we slowly reduced the medicine. First it was once in a week then once in 15 days, then once in a month. I plan to give placebo and if she is better will stop medicine and wait .
1st Follow up: 16.5.2017
Complaints of pain over the left side of the neck reduced in intensity
No recent episodes of giddiness
No new complaints.
Prescription: Nat sulph 200
4pks/ once in a week
- No ii pills
3 – 3 – 3
2nd follow up: 21.6.2017
Complaints of pain over the left side of the head completely better, no recent attacks of pain
No recent episodes of giddiness
Generals good. No new complaints
Prescription: Nat sulph 200 4pks/ once in a week No ii pills 3 – 3 – 3
3rd follow up: 26.7.2017
No complaints of pain and giddiness.
C/o eruptions (small popular) over the palms with itching
No discharge, no cracks
- Natrum sulph 200 2pks/ once in 15 days
- No ii pills
3 – 3 – 3
4th follow up: 30.8.2017
Not complaining of neck pain and giddiness
Complaints of eruptions on palms subsided
No new complaints