Unveiling the hidden eagle: Acute parotitis-induced eagle syndrome

Abstract

Context:A cervicofacial pain and foreign body sensation in pharynx associated with styloid process elongation is called Eagle syndrome. Typically, this syndrome is provoked by tonsillectomy or trauma. We report the first case of acute parotitis-induced Eagle syndrome.Case Report:A 65-year-old woman presented with right facial pain. CT scan of neck revealed asymmetric enhancement of the right parotid gland compatible with acute parotitis. All inflammation was resolved with antibiotics. However, the patient complained of pain in right mandibular region out of proportion to inflammation. Review CT found to have an asymmetrically long right styloid process measures. The diagnosis of acute parotitis-induced Eagle syndrome was established.Conclusion:Physicians should have a high index of suspicion for Eagle syndrome in patients with atypical neck pain and elongated styloid process since another significant manifestation of Eagle syndrome is carotid artery compression leading to recurrent syncope or stroke.

Eagle syndrome. A narrative review

“…1,8,9,32 However, other authors, in current studies, indicate that the length of the styloid is variable. 4,29,30,31 They agree that a styloid process exceeding 30mm should be considered elongated.…”

“…This syndrome has three historical periods: the first one began 364 years ago with the first report of ossification of the stylohyoid process reported by Marchetti in 1652. 7,8,10,19,23 Two centuries later, in 1852, Demanchetis [28][29][30]32 and reported two cases related to an abnormal styloid process with pharyngeal and facial symptoms caused by irritation of the carotids. The second period corresponds to the development of radiographic diagnosis, when Grossman correlates pains of the stylohyoid complex, including dysphagia, otalgia, estilalgia, headache, pain in the temporomandibular joint, and various forms of facial pain, with elongation of styloid process.…”

“…In severe cases surgical resection of the styloid process (styloidectomy) 13,28,32,37 Some authors recommend an intraoral or extraoral endoscopically-assisted approach to solve the disadvantages of this procedure 28,31 because it decreases the amount of bleeding, duration of surgery and hospitalization time, and improves the subjective symptoms of patients, being this an effective and minimally invasive solution to treat Eagle syndrome. 28 In general, it is accepted that the intraoral approach should be used only if the distal tip of the styloid process is palpable in the tonsillar fossa, and only if the surgeon is familiar with the technique and management of complications.…”

“…For the nonsurgical treatment there is no real positive long-term effect and after 6 to 12 months, the symptoms reappear. 8,9,12,16,17,18,20,28,30,32,37,41 Eagle syndrome. A narrative review.…”

Anatomical and clinical relevance of elongated styloid process in a sample of the Colombian population

“…There is also evidence of cases not associated with trauma, as reported by Permpalung, Suksaranjit, Chongnarungsin et al (2014) in the United States. The patient had Eagle's syndrome triggered by acute mumps and the styloid process length measured by computed tomography was 53 mm (CHAVES, COSTA, CAVALCANTE et al, 2013).…”