Helical scans (140 kV,
220 mAs/section,
0.315 pitch,
0.67-mm thickness,
0.33-mm increment,
16 × 0.625 collimation,
the orbitomeatal line as a scanning baseline),
were performed on all cases using a Philips Brilliance 16 multidetector scanner (Philips Healthcare,
Cleveland,
Ohio) with axial,
coronal and sagittal reconstructions in bone and soft tissue windows.
Further Volume rendered and Surface shaded display 3 Dimensional reconstructions were performed using Philips Extended Brilliance workspace software and measurements of the styloid process taken using electronic callipers.
The styloid process often demonstrates a variable length.
Kaufman et al .
reported a cut off of 30 mm as the upper limit for a normal styloid processes.
Moffat et al.
performed a cadaver study and reported that the normal length between 1.52 cm and 4.77 cm.
Monsour and Young concluded that the syndrome occurs when the styloid process was longer than 40 mm.
In radiological studies,
the length of the styloid process is reported to be no longer than 25 mm.
In our cases styloid process of our cases were as follows—
Patient I
Right – 43.1 mm Pseudosegmented
Left – 30.1 mm Segmented
Patient II
Right- 39.7 mm Elongated
Left – 36.9
Patient IV
Right- 47.3 mm
Left – 50 mm
Patient V
Right – 31.2 mm
Left – 27.3 mm
Patient VI
Right- 33.5 mm
Left – 33 mm
Patient VII
Right- 31.2 mm
Left- 27.3 mm
Patient VIII
Right- 36.4 mm
Left- 33 mm
- A total of 8 patients were observed during a time period of 6 months.
- Of these five were females and three were males
- All the eight patients had bilaterally elongated styloid processes
- Six patients had unilateral symptoms and two had bilateral symptoms
- None of the patients had any history of Tonsillectomy or Trauma
Thus all our styloid processes were accepted as elongated styloid processes.
A 4% prevalence of Eagle’s syndrome in the population is reported and has a female predilication.
There are several theories for etiopathology of Eagle’s syndrome – among which are congenital elongation of styloid process and calcification and ossification of the stylohyoid ligament.
Fini and et al .
reported that past tonsillectomy is related to Eagle’s syndrome..
Although it is common to have elongated styloid process bilaterally ,
symptoms tend to be unilateral.
Imaging modalities for diagnosis of Eagle’s syndrome are lateral head and neck radiograph,
townes cranial skiagram,
,
lateral oblique mandible plain film,
anteroposterior head radiograph,
and panoramic orthopantamotomogram,
computed tomography with 3D reconstruction.
A differential diagnosis of eagle’s syndrome includes,
migraine headache,
Temporomandibular joint disorders,
trigeminal neuralgia,
unerupted or impacted molar teeth,
and faulty dental prosthesis.
A palpation of the styloid process in the tonsillar fossa serves as the initial step in evaluation.
Among radiological investigations,
orthopantamotomography or a skull x ray with anteroposterior and lateral projections are used for initial evaluation followed by non-contrast computed tomography with three dimensional reconstruction to confirm the diagnosis.
Eagle’s syndrome can be treated both surgically and non surgically depending on the symptom severity.