Entrapment of the glossopharyngeal nerve in patients with Eagle syndrome: surgical technique and outcomes in a series of 5 patients

Shin, John H.; Herrera, Sebastian R.; Eboli, Paula; Aydın, Sabri; Eskandar, Emad H.; Slavin, Konstantin V.

doi:10.3171/2009.1.jns08485

Cited by 32 publications

(30 citation statements)

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“…As would be predicted by its anatomic course, the glossopharyngeal nerve is most frequently involved. Eagle's syndrome must thus be considered in the differential diagnosis of glossopharyngeal neuralgia [76,78,79]. Involvement of the hypoglossal nerve and ansa cervicalis are rare.…”

Section: Clinical Featuresmentioning

confidence: 99%

Eagle’s syndrome: embryology, anatomy, and clinical management

2012

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Background Eagle's syndrome refers to a rare constellation of neuropathic and vascular occlusive symptoms caused by pathologic elongation or angulation of the styloid process and styloid chain. First described in 1652 by Italian surgeon Piertro Marchetti, the clinical syndrome was definitively outlined by Watt Eagle in the late 1940s and early 1950s. Methods This article reviews how underlying embryologic and anatomic pathology predicts clinical symptomatology, diagnosis, and ultimately treatment of the syndrome. Results The length and direction of the styloid process and styloid chain are highly variable. This variability leads to a wide range of relationships between the chain and the neurovascular elements of the neck, including cranial nerves 5, 7, 9, and 10 and the internal carotid artery. In the classic type of Eagle's syndrome, compressive cranial neuropathy most commonly leads to the sensation of a foreign body in the throat, odynophagia, and dysphagia. In the carotid type, compression over the internal carotid artery can cause pain in the parietal region of the skull or in the superior periorbital region, among other symptoms. Conclusions Careful recording of the history of the present illness and review of systems is crucial to the diagnosis of Eagle's syndrome. After the clinical examination, the optimal imaging modality for styloid process pathology is spiral CT of the neck and skull base. Surgical interventions are considered only after noninvasive therapies have failed, the two most common being intraoral and external resection of the styloid process. Embryology and phylogenyThe embryologic history of the styloid process, stylohyoid ligament, and hyoid bone is a subject of debate. Revilla and Stuyt [69] suggest that the styloid process, stylohyoid ligament, and lesser cornu of the hyoid bone develop from endochondral ossification of Reichert's cartilage, the cartilaginous component of the second branchial arch. They assert that after 3 months of fetal life, Reichert's cartilage is disrupted and divided into five distinct components (from proximal to distal): tympanohyal, stylohyal, ceratohyal, hypohyal, and basyhyal [58,69]. The tympanohyal component contributes to the tympanic bone and the base of the styloid process. The stylohyal component contributes to the majority of the styloid process, and the hypohyal and basyhyal components contribute to the hyoid bone. In many animals the ceratohyal component ultimately becomes the epihyoid bone. In humans, Revilla and Stuyt [69] contend that it degenerates to form the stylohyoid ligament.In contrast, during their detailed description of Reichert's cartilage in 50 human embryos and fetuses, RodriguezVazquez et al. [72] suggested that the second branchial arch cartilage is formed in two distinct segments separated by mesenchymal tissue. The proximal and larger segment is continuous with the otic capsule and becomes the styloid process. The smaller and more distal component forms the

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Section: Clinical Featuresmentioning

confidence: 99%

Eagle’s syndrome: embryology, anatomy, and clinical management

2012

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“…If the preoperative diagnosis is correct, surgical interventions are the fundamental and unique treatments for both ES and GPN [2][3][4][5][6][11][12][13][14][15]. However, it is important to recognize that some of these patients can be 'cured' with medication alone.…”

Section: Discussionmentioning

confidence: 96%

“…This helped us to ''excavate'' the ES patients. ES was previously demonstrated twice in the neurosurgical literature, with those studies identifying the etiology as entrapment of the glossopharyngeal nerve caused by compression of the nerve by bony elements as it travels medially to the styloid process in the neck, and patients with its symptoms are often referred to neurosurgeons for operative consideration with a tentative diagnosis of GPN [2,6]. These patients underwent resection of the styloid process on the symptomatic side using a lateral transcutaneous (external) approach.…”

Section: Discussionmentioning

confidence: 98%

“…The diagnosis is usually confirmed by a typical history, aggravation of symptoms on palpation of the tonsillar fossa, relief of symptoms with injection of local anesthetics, and measurement of the styloid process with a three-dimensional CT scan [2][3][4]. Surgical excision of the elongated styloid process is the treatment of choice and may be performed via an intraoral or trans-cervical approach [5,6]. The intraoral approach is preferred by ENT surgeons since it is relatively easy to perform, involves no extensive facial dissection, and does not lead to external scarring, which is inevitable with a trans-cervical approach.…”

Section: Introductionmentioning

confidence: 99%

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Surgical management of Eagle’s syndrome: an approach to shooting craniofacial pain

Kumai

Hamasaki

Yumoto

2016

Eur Arch Otorhinolaryngol

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Eagle's syndrome (ES) and glossopharyngeal neuralgia (GPN) display very similar symptoms preoperatively. The objective of this study is to determine the surgical outcome of intraoral resection of the styloid process (IRSP) for ES, and to observe preoperative findings and treatment outcome of our cases presenting shooting craniofacial pain. In total, 14 symptomatic patients who presented with typical shooting craniofacial pain, had a styloid process longer than 25 mm, and underwent surgical intervention or medication alone from 2011 to 2015 were involved. They were divided into two groups: Group I included eight patients who underwent surgery following 3 months of medication failure, and Group II included six patients who received medication alone. Preoperative physical, radiographic findings and surgical outcomes were examined. In Group I patients, six cases received IRSP and five of those six cases experienced complete relief from symptoms and were confirmed as ES. Two other cases in Group I received microvascular decompression. One showed complete relief from symptoms, and was confirmed as GPN. The other case showed recurrence 1 year postoperatively, received IRSP with complete relief from symptoms, and was confirmed as ES. In Group II, three cases experienced complete relief from symptoms with 3 months of medication alone. IRSP is an effective treatment for ES. There was no clear difference in the preoperative findings for ES and GPN, suggesting the difficulty in making a preoperative differential diagnosis between the two conditions. Close cooperation between ENT and neurosurgery surgeons is needed.

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“…L'abord chirurgical extra-oral [16,41,42] commence par une incision cutanée de 3 à 4 cm sous l'angle mandibulaire en suivant le bord antérieur du muscle sterno-cléido-mastoïdien sur environ ses deux tiers. Cela permettrait de protéger le nerf facial.…”

Section: Thérapeutiqueunclassified

Prise en charge chirurgicale par voie endobuccale d’une patiente atteinte d’un syndrome d’Eagle : cas clinique et revue de la littérature

Bizet

Margottin

Lagarde

et al. 2016

Med Buccale Chir Buccale

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Résumé -Introduction :Le syndrome d'Eagle est un ensemble de symptômes cervicaux résultant de l'élongation du ligament stylohyoïdien puis de son ossification. De diagnostic souvent tardif, la prise en charge thérapeutique est liée à l'ampleur de la symptomatologie associée. Observation : Une patiente de 35 ans avait été adressée par son médecin généraliste pour des douleurs sous-angulomandibulaires postérieures et cervicales droites modérées depuis trois ans. La rotation de la tête était difficile et la flexion provoquait une sensation d'étouffement. L'examen clinique exobuccal révélait une tuméfaction de faible volume, parotidienne et sous-angulomandibulaire droite, ferme et douloureuse à la palpation. Une radiographie panoramique initiale était réalisée et révélait l'inclusion de la 18 et la présence de processus styloïdiens droit et gauche minéralisés, démesurément longs. Une imagerie complémentaire tomodensitométrique précisait l'élongation et la minéralisation bilatérale des ligaments stylohyoïdiens. L'accumulation de tous ces signes faisait suspecter un syndrome d'Eagle. Un traitement chirurgical, justifié par la symptomatologie douloureuse, avait été proposé en première intention. Une approche intra-orale avait été privilégiée sous anesthésie générale. Un an après l'intervention, la patiente rapportait une nette amélioration des symptômes initiaux. Discussion : Les caractéristiques principales et documentées du syndrome d'Eagle sont répertoriées et discutées à partir d'une revue de la littérature. Celles mises en évidence dans le cas clinique rapporté s'y superposent presque totalement. Conclusion : Le chirurgien oral et le chirurgien-dentiste doivent connaître le syndrome d'Eagle comme une cause de douleur cervico-faciale. Ils ont toute leur place dans le dépistage et la prise en charge des patients concernés par cette pathologie.Abstract -Oral approach for surgical treatment in a patient affected by Eagle syndrome : case report and review of the literature. Introduction: Eagle syndrome is defined as a set of cervical symptoms resulting from the styloid process elongation and then its mineralization. Most often diagnosed late, the therapeutic management is related to the extent of the associated symptoms. Observation: A 35-year-old female patient was referred by her doctor for persistent but moderate pains of the posterior right mandibular angle for the past 3 years. Head rotation was difficult and the flexion induced a sensation of suffocation. An extra-oral clinical exam revealed a weak swelling of the right parotidian and posterior mandibular area, which was firm and painful. An initial panoramic X-ray revealed impaction of the right upper wisdom tooth and elongated right and left styloid processes. A CT scan showed the extension of these mineralized processes. All these signs strongly suggested Eagle syndrome. Based on the painful symptoms, surgical management was proposed to the patient, by a seldom-used oral approach under general anesthesia. One year after, the patient reported a drastic improveme...

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Entrapment of the glossopharyngeal nerve in patients with Eagle syndrome: surgical technique and outcomes in a series of 5 patients

Cited by 32 publications

References 9 publications

Eagle’s syndrome: embryology, anatomy, and clinical management

Eagle’s syndrome: embryology, anatomy, and clinical management

Surgical management of Eagle’s syndrome: an approach to shooting craniofacial pain

Prise en charge chirurgicale par voie endobuccale d’une patiente atteinte d’un syndrome d’Eagle : cas clinique et revue de la littérature

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