Sunday, May 09, 2010

Eagle's syndrome

Introduction:
The styloid process shows lot of variations in its length. In majority of patients it is about 20 – 30 mm long. Technically speaking when the length of styloid process exceeds 30 mm then it is considered to be elongated. The clinical signs and symptoms associated with elongated styloid process was first described by Eagle in 1937. Later this condition became known as Eagle's syndrome / Elongated styoid process. The signs and symptoms of elongated styloid process are pretty vague and often at best misleading. These patients usually go medical shopping visiting neurologists, dental surgeons, psychiatrists and surgeons. The diagnosis of this condition requires awareness and vigilance. This condition can be confirmed by palpating the tonsillar fossa, infiltration of local anesthetic agents and imaging studies.

History:

Historically the ossification of stylohyoid apparatus can be divided into three periods.
This division is purely for better understanding.
Era of anatomists: Anatomists belonging to 17th century described ossification of stylohyoid apparatus they encountered during dissection as normal variants as they were not privy to the clinical details and patient history.
Era of diagnostic radiologists: This period includes the early 20th century. Due to advances in radiological anatomy, radiologists were able to identify ossification of stylohyoid apparatus and correlate this condition with that of the symptoms expressed by the patient. Eagle under whom this syndrome is named belonged to this era.
Era of panoromic radiology: This period includes the mid 20th century. Routine study of panoromic radiographs by dental surgeons threw up more such cases of ossification of the stylohyoid apparatus.

Classification:

Gossman's classification of types of elongated styoid processes: Gossman studies about 4000 patients with elongated styoid process and classified it into three types.

1.Elongated
2.Crooked
3.Segmented
4.Very elongated

Correll's classification of elongated styloid process:

Type I: Elongated styloid process
Type II: Pseudoarticulated styloid process
Type III: Segmental styloid process

Symptoms:
Common symptoms associated with elongated styloid process include:

1.Vague pain in the neck
2.Foreign body sensation in the throat
3.Pain in the throat
4.Painful swallowing
5.Pain while changing head position
6.Pain in the ear
7.Pain over temporomandibular joint
8.Pain radiating to upper limb















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