Dysphagia is a relatively common condition in the general population and has a wide range of underlying etiologies. We present the case of a 58-year-old male who presented with a complaint of progressive difficulty swallowing for two years in duration associated with unintentional weight loss. He has been using a proton pump inhibitor therapy for more than one year, but he had only mild improvement in his symptoms. Recently, the patient started to experience neck pain during swallowing and he underwent a head and neck computed tomography scan, which demonstrated an extensive elongation of the left styloid process that measured 14.9 cm. The clinical and imaging findings were consistent with Eagle syndrome and the decision was made to perform a resection of the left styloid process. Excision of the left styloid process was made using the external cervical approach. At the follow-up visit, the patient reported a near-complete resolution of his complaints. Eagle syndrome is a very rare etiology of dysphagia. The case highlights an example of Eagle syndrome with an extremely long styloid process. This diagnosis should be considered when encountering a patient with dysphagia and neck pain.

Eagle\'s syndrome is a rare cause of cervicofacial pain and is due to abnormalities in the stylohyoid process, stylohyoid ligament or lesser cornu of the hyoid bone. Generally, patients affected by Eagle\'s syndrome present with pain in the lateral or upper neck, angle of the mandible, submandibular space and throat (exacerbated by head movements and/or mastication); foreign body sensation; headache and referred otalgia. A 66-year old gentleman presented with a 36-month history of recurrent pain localising mainly to the right angle of the mandible and radiating to the submandibular triangle. No pathological changes were noted on multiple ultrasound scans. Flexible nasendoscopy revealed a right vocal cord palsy. Initially, the CT scan revealed an abnormality in the stylohyoid complex, and the patient was managed conservatively. Subsequent three-dimensional CT scan noted significant worsening of the abnormality in the stylohyoid complex. Due to progressive nature of the patient\'s symptoms and progression of stylohyoid complex calcification noted on imaging, the patient was listed for surgery. He underwent partial styloidectomy and vocal cord injection for cord paralysis secondary to impingement on the vagal nerve by the stylohyoid complex. The patient recovered well and denies any ongoing stylalgia. Various cases of Eagle\'s syndrome have been managed successfully in a conservative manner. However, the authors of this case report suggest that patients with Eagle\'s syndrome should be monitored closely. A delay in surgical intervention can lead to complications such as complete ossification of the stylohyoid complex and impingement on surrounding structures. This, in turn, increases intra-operative complexity.

PAIN in the craniofacial and neck region can be both intriguing and equally frustrating for the surgeon. This is principally because there is a multitude of related pain syndromes in this region, many of which are lacking in physical signs. Diagnosis then becomes even more dependent on an accurate description of the pain in terms of character, localization, duration, radiation, relieving and exacerbating factors. Familiarity and identification of a more obscure causative factor in a particular case lends itself not only to liberate the patient but also an increased awareness of the practitioner for the need to consider the coinciding minute diagnostic points of otolaryngology, ophthalmology and rhinology besides dentistry and oral surgery. The characteristic elongation of a styloid process may explain some occasions of pharyngeal, ear pain and sometimes headache, which have defied exhaustive diagnostic studies. A large spectrum of signs and symptoms has been mentioned in various reports of Eagle\'s syndrome. Diagnosis can be made with careful clinical evaluation and confirmed with radiographs showing an elongated styloid process or calcification of the stylohyoid complex. Styloidectomy is the procedural choice for Eagle\'s syndrome having high success rate. In our case, the intraoral approach for styloidectomy was not the routine one, for which the post-operative outcome was exceptionally good without any complications.

Carotid artery dissection is a significant etiology of juvenile stroke. Blunt trauma from an elongated styloid process can rarely cause carotid artery dissection, which is one of well-known clinical presentations of Eagle\'s syndrome as known as stylocarotid syndrome. Growing number of publications contributed improved awareness and diagnostic modalities for this clinical entity, thus the carotid artery dissection from an elongated styloid process is often diagnosed appropriately. The management of carotid artery dissection in stylocarotid syndrome tends to be nonconservative (ie, removal of the process or carotid stenting) presumably due to a publication bias prone to surgical intervention. However, the compression of elongated styloid process to carotid artery is usually difficult or even dangerous to directly prove. Furthermore, stent fracture with subsequent stent and carotid artery occlusion has been reported as a complication of the treatment. Here, we report a male presenting with acute embolic stroke due to carotid artery dissection with the ipsilateral elongated styloid process who has been managed conservatively for more than 1.5 years without any sequelae. We will discuss the management strategy and emphasize the importance of patient education of daily life, since the surgical intervention seems not always necessary in this clinical setting.

Eagle\'s syndrome is rare condition described in 1937 by W. Eagle, and is secondary to the elongation of the styloid process and/or calcification of the stylohyoid ligament. Although it occurs asymptomatically in the majority of cases, the pressure exerted by this alternative structure from an anatomical point of view against the neighbouring areas can trigger a great variety of symptoms. It is often wrongly diagnosed, leading to multiple interconsultations with different professionals. This means that the professional must take it into account in those cases of pain in the maxillofacial region without any clear aetiology. The case is presented of a 63year-old patient in whom the only symptom was an invalidating occipital neuralgia, with visits to numerous physicians. A 3-dimension cone beam computed tomography (CBCT) confirmed the clinical suspicion. The treatment consisted of partial resection of both styloid processes.

Eagle\'s syndrome (ES) refers to symptomatic elongation of the ossified styloid process. A styloid process greater than 2.5 cm in length should be considered abnormal; however, an elongated styloid process is not sufficient for a diagnosis of ES; only an abnormal styloid process in association with symptoms can confirm the syndrome. In this case report, we discuss a 54-year-old man who has come to our attention with various symptoms: dysphagia to both solids and liquids, difficulty swallowing, neck pain, and a foreign body sensation during bilateral neck rotation and mouth opening. The diagnosis is performed radiologically because conventional radiographs have many potential disadvantages, whereas, computed tomography (CT) scans and reconstructions allow the length and angulation of the styloid process to be measured and the relationship between the elongated styloid processes and adjacent anatomical structures to be evaluated. Moreover, CT allows for differential diagnosis and provides detailed information needed for surgical planning.

Eagle\'s syndrome is a condition that causes pain in the Craniofacial and cervical region of the neck. Symptoms related to the Eagle\'s syndrome may be confused with the variety of neuralgias, oral, dental and temporomandibular joint (TMJ) conditions. In this paper, a case of the very young female suffering with the difficulty in swallowing and recurrent dull pain in the throat with restriction of the movement of head to the left side was presented. A thorough past medical and dental history, extra oral and intra oral examination coupled with the panoramic radiographic interpretation were used to diagnose Eagle\'s syndrome.

Eagle\'s syndrome is a disease without a clear lesion that is associated with repeated episodes of pharyngalgia, odynophagia, the sensation of a foreign body in the pharynx, tinnitus, and otalgia in which patients displaying these types of symptoms must be given a differential diagnosis. It is known to be characterized by styloid process elongation or increasing compression to adjacent anatomical structures through stylohyoid ligament calcification. In serious cases, continuous pressure to the carotid artery can lead to a stroke. Diagnosis is confirmed through clinical symptoms, radiological findings, and physical examinations. The most common type of treatment consists of a surgical excision of elongated styloid process. Nonetheless, this study presents a case of treating Eagle\'s syndrome with conservative management.