(1) Background: \"Eagle Syndrome\", also known as \"stylalgia\" or a \"stylohyoid chain anomaly\", typically manifests with ipsilateral orofacial pain, a foreign body sensation in the throat, and ear-related symptoms. Despite these common presentations, its potential association with carotid artery dissection is not widely acknowledged. (2) Methods: This article presents an extremely rare case of a patient diagnosed with an ischemic stroke in the left hemisphere, followed by the dissection of the left internal carotid artery, initially with an unidentified cause. Subsequent examinations revealed elongated left styloid processes directly compressing the dissected artery. (3) Results: After initial treatment involving pharmacological and mechanical thrombectomy, styloidectomy restored blood flow to the internal carotid artery. The patient remained symptom-free during a 12-month follow-up. (4) Conclusions: This case emphasizes the importance of considering anatomical variations within the stylohyoid chain when assessing young individuals with neurological symptoms. Furthermore, it underscores the potential benefits of early surgical intervention in reducing the morbidity and mortality associated with this condition.

(1) Background: Stylohyoid syndrome, known as classical Eagle Syndrome (cES), is characterized by calcification of the stylohyoid chain with numerous nonspecific symptoms, mainly pain. This study introduces minimally invasive cervical styloidectomy (MICS). (2) Methods: MICS was performed on sixty-five patients diagnosed with classical Eagle Syndrome. Patients underwent meticulous differential diagnosis. Surgical plans were established based on the findings from neck angioCT. (3) Results: The healing process was uneventful, without significant complications. The overall success rate was 97.0%, with a follow-up of a minimum of six months. In one case, the surgery did not yield the desired improvement. In one case, a partial relapse of symptoms was observed. (4) Conclusions: MICS is a straightforward and efficient surgical treatment technique for stylohyoid syndrome.

Stylalgia also referred to as Eagle\'s or stylohyoid syndrome (first described by Watt Eagle) is a constellation of signs secondary to an elongated styloid process or due to mineralization of the stylohyoid or stylomandibular ligament or the posterior belly of the digastric muscle (Malik et al. in Iran J Otorhinolaryngol 30(6): 101, 2018). The Eagle\'s syndrome includes symptoms ranging from stylalgia (i.e., pain in the tonsillar fossa, pharyngeal or hyoid region) to foreign-body sensation in the throat, cervicofacial pain, otalgia or even increased salivation or giddiness. Diagnosis is primarily based on symptomatology, physical examination and radiographic investigations and should not be missed. However, palpation of tonsillar fossa with radiological demonstration of the elongated styloid process confirms the diagnosis. Surgical treatment by tonsillo-styloidectomy produces satisfactory results in stylalgia. (Malik et al. in Iran J Otorhinolaryngol 30(6):101, 2018).

Eagle\'s Syndrome is a much discussed yet controversial and debatable diagnosis of exclusion which is treated by many specialities with often unsatisfactory results. Due to entrapment/impingement on surrounding neurovascular structures by elongated styloid process patient may present with multitude of symptoms. Treatment is controversial and opinions are divided on choice of conservative and surgical management. Aim was to study outcomes of conservative and surgical modalities of treatment of Eagle\'s Syndrome and bring some clarity on management, what to offer, to whom and when. This prospective observational descriptive study included 15 patients of Eagle\'s Syndrome, 7 were treated with conservative method and 8 underwent resection of styloid process with intraoral approach. With objectives in mind to study efficacy of both management modalities, pain visual analogue scale (VAS) scores were recorded pre-intervention, post-intervention and during follow up on 1, 3 and 6 months and compared. Conservative management resulted in up to 70% reduction in pain VAS scores till 3 months of therapy (mean pre-intervention score being 3.71, 3 months-1, 6 months-1.29), while surgical modality resulted in nearly 99% reduction in mean pain VAS scores up to 3 months and even improved after 6 months (mean pre-intervention score being 6.75, 3 months-0.5, 6 months-0.13). With this we can conclude that conservative management provide satisfactory short-term (up to 3 months) results but recurrences are known, while surgical resection of elongated styloid process gives better long-term results (6 months and beyond).

Eagle\'s syndrome is one of the commonly overlooked cause of foreign body sensation in throat with referred otalgia. Incidence of symptomatic cases was rare. Elongated Styloid process may present with myriad symptoms. The diagnosis needs a cautious approach and the management is mainly aimed at reduction of the length of elongated section. Prospective study in the Department of ENT Stanley Medical College, Chennai. Study period-January 2018 to September 2018. Clinical examination followed by radiological investigations done to confirm the diagnosis. Stylo-tonsillectomy was done in the selected 20 subjects and post-operative outcomes were compared with pre-operative questionnaires. The progression of symptoms were evaluated for resolution and studied. Pharyngeal symptoms are more common. The length of styloid is associated with symptom complex presentation. The incidence was 0.17% in general population coming to ENT OPD and more common among women with mean age of 43 years. Bilateral presentation was more common and the longest length recorded in the study was 78 mm. Single investigation is not enough to confirm the diagnosis. A minimum of two investigations are needed for planning surgical management. Intra-oral approach with stylo-tonsillectomy was done with no major complications in post-operative period. Pre-operative symptoms were recoreded by use of McGill\'s pain questionnaire and compared with post-operative scores. Dysphagia was the major post-operative early symptom which took a week minimum to subside. Clinical findings and atleast 2 imaging studies needed for diagnosis of the disorder. OPG though economical can be aided to great extent by use of Conebeam CT or 3D CT to study the elongated styloid process. Stylo-tonsillectomy is a safer approach with minimum complications and earlier relief of pre-operative symptoms. Surgical management with reduction of length of elongated styloid followed by adequate analgesia remains mainstay in treatment.

The styloid process sheath (SPS) is a part of the tympanic temporal bone and an incomplete bony sleeve surrounding the styloid process, tympanohyoid cartilage, and dorsal part of the stylohyoid bone. In horses undergoing head CT, we observed a range of SPS sizes and questioned whether differences were early features of temporohyoid osteoarthropathy (THO) or normal anatomic variations associated with age, body weight, sex, or breed. We hypothesized that SPS sizes were positively correlated with age and body weight, but not with sex or breed. Using a convenience population of horses that underwent head CT at our institution (2008-2017), regardless of THO status, we investigated these hypotheses in a retrospective cross-sectional study. The sample comprised 102 horses. The median SPS height was larger medially (4.3 mm) than laterally (2.4 mm) and the median width was 11.1 mm: no difference was detected between sides. Geldings had a significantly larger median SPS width (11.6 mm) than stallions (8.7 mm; P < 0.05) and mares (10.0 mm; P < 0.05). No association was detected between SPS sizes and body weight and breed. Univariate and multivariate analyses initially found significant associations between SPS heights and age. Secondary analyses performed following removal of outliers and horses <2-years old found similar but less pronounced results (annual increase in SPS heights decreased from 3.2-3.8% to 0.9-2.6%). Most associations were insignificant when investigated by age group, but the annual rate of increased size might be faster in older horses. Excessive SPS enlargement was theorized as an essential component of THO.

A 42-year-old male presented with 3-month history of constant right-sided frontal headaches, severe right-sided intermittent sharp jaw pain, odynophagia, globus pharyngis, and worsening episodes of blurry vision in his right eye. Cervicocerebral angiography demonstrated a prominent, 4 cm right sided styloid process with close proximity to the right internal carotid artery (ICA). The patient was referred to otorhinolaryngology for styloidectomy and continued care.

BACKGROUND: Orofacial and cervical pain are a frequent reason for neurology consultations and may be due to multiple pathological processes. These include Eagle syndrome (ES), a very rare entity whose origin is attributed to calcification of the stylohyoid ligament or elongation of the temporal styloid process. We present a series of five patients diagnosed with ES.
METHODS: We describe the demographic and clinical characteristics and response to treatment of 5 patients who attended the headache units of 2 tertiary hospitals for symptoms compatible with Eagle syndrome.
RESULTS: The patients were 3 men and 2 women aged between 24 and 51, presenting dull, intense pain, predominantly in the inner ear and the ipsilateral tonsillar fossa. All patients had chronic, continuous pain in the temporal region, with exacerbations triggered by swallowing. Four patients had previously consulted several specialists at otorhinolaryngology departments; one had been prescribed antibiotics for suspected Eustachian tube inflammation. In all cases, the palpation of the tonsillar fossa was painful. Computed tomography scans revealed an elongation of the styloid process and/or calcification of the stylohyoid ligament in 3 patients. Four patients improved with neuromodulatory therapy (duloxetine, gabapentin, pregabalin) and only one required surgical excision of the styloid process.
CONCLUSIONS: Eagle syndrome is a rare and possibly underdiagnosed cause of craniofacial pain. We present 5 new cases that exemplify both the symptoms and the potential treatments of this entity.

UNASSIGNED: To demonstrate the efficacy of a new novel anterior tonsillar fossa approach in management of elongated styloid process syndrome.
UNASSIGNED: We operated upon 20 patients with confirmed, symptomatic elongated styloid process. None of these patients gave a previous positive history of trauma or any other procedure relating to tonsillar area. All these patients had undergone treatment or were under treatment for neuralgia/TMJ dysfunction syndrome. Diagnosis was confirmed by clinical examination followed by radiological findings.
UNASSIGNED: 12 patients underwent bilateral styloidectomy (60%) and 8 patients, underwent unilateral styloidectomy (40%). The length of stolid process ranged from 34mm to 62mm (mean 44 mm). Post operative follow up period ranges from 6 months to 12 months.17 patients (85%) were asymptomatic & had complete remission of symptoms over a follow up period of 12 months. 2 patients had partial remission of symptoms & 1 patient was lost to follow-up.
UNASSIGNED: Our anterior tonsillar fossa approach to elongated styloid is safe & adequate in effective surgical management & more so with an additional advantage of not requiring tonsillectomy which is often performed in trans-pharyngeal technique.

To evaluate all the cases of chronic neck pain thoroughly to diagnose eagle\'s syndrome. Hospital based prospective study done in the department of otorhinolaryngology at our tertiary care hospital from January 2017 to December 2018. We selected 60 subjects in our study who presented to us with complaints of chronic neck pain associated with referred otalgia, along with aggravation of pain with neck movements, odynophagia, throat pain and foreign body sensation in the throat. After thorough clinical examination an orthopantomogram has been done which revealed elongated styloid process. Conservative management with carbamazepine was tried but only temporary relief was noticed in these patients. Hence intra oral tonsillo-styloidectomy was done and patients were followed up to 3 months. Out of 10 patients, 9 were female and 1 was male. 8 patients had bilateral elongated styloid process and 2 patients had unilateral elongation. Orthopantomogram revealed an average elongation of styloid process of 3.5-5 cm and the average length of the removed styloid process ranged from 0.6-3 cm. All patients showed significant improvement post operatively. Eagle\'s syndrome is not a rarity, but underdiagnosed and missed most of the times. Hence all cases of chronic neck pain should be evaluated thoroughly by taking complete history and proper clinical examination, along with radiological investigations.