Styloid Process Injection for Eagle Syndrome




Indications and Clinical Considerations


Eagle syndrome (also known as stylohyoid syndrome ) is caused by pressure on the internal carotid artery and surrounding structures including branches of the glossopharyngeal nerve by an abnormally elongated styloid process or a calcified stylohyoid ligament ( Figure 10-1 ). The pain of Eagle syndrome is sharp and stabbing and occurs with movement of the mandible or with turning of the neck. The pain starts below the angle of the mandible and radiates into the tonsillar fossa, the temporomandibular joint, and the base of the tongue. A trigger point may be present in the tonsillar fossa. Injection of the attachment of the stylohyoid ligament to the styloid process with local anesthetic and corticosteroid serves as both a diagnostic and a therapeutic maneuver. Rarely, the elongated styloid process or calcified stylohyoid ligament may actually cause vascular occlusion ( Figure 10-2 ).




FIGURE 10-1


Ossification of the stylohyoid ligament (Eagle syndrome). Note the large ossified structure (arrows) , which represents an elongated styloid process or ossified stylohyoid ligament or both.

(From Resnick D: Diagnosis of bone and joint disorders , ed 4, Philadelphia, 2002, Saunders.)



FIGURE 10-2


A, Axial computed tomography angiography (CTA) with right sigmoid sinus occlusion (black arrow) and dye present in the left sigmoid sinus (white arrow) . B, Computed tomography (CT) venogram confirming the left internal jugular vein compressed between the styloid process (black arrow) and lateral mass of C1 (white arrow). C, Three-dimensional CTA demonstrating the left internal jugular vein compressed between the styloid process (black arrow) and lateral mass of C1 (white arrow). D, Left internal jugular vein, both compressed between the styloid and C1 lateral mass. E, Sagittal view of subsequent CTA demonstrating compression of the right internal jugular vein with some early recanalization.

(From Callahan B, Kang J, Dudekula A, et al: New Eagle’s syndrome variant complicating management of intracranial pressure after traumatic brain injury. Inj Extra 41:41–44, 2010.)




Clinically Relevant Anatomy


The styloid process extends in a caudal and ventral direction from the temporal bone from its origin just below the auditory meatus. The stylohyoid ligament’s cephalad attachment is to the styloid process, and its caudal attachment is to the hyoid bone. In Eagle syndrome the styloid process is abnormally elongated, either alone or in combination with calcification of the stylohyoid ligament. The elongated process or calcified ligament impinges on the internal carotid artery and branches of the glossopharyngeal nerve ( Figure 10-3 ). The glossopharyngeal nerve exits from the jugular foramen in proximity to the vagus and accessory nerves and the internal jugular vein and passes just inferior to the styloid process (see Figure 10-3 ). All three nerves lie in the groove between the internal jugular vein and the internal carotid artery.


Feb 1, 2019 | Posted by in PAIN MEDICINE | Comments Off on Styloid Process Injection for Eagle Syndrome
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