Bilateral Atypical Facial Pain Caused by Eagle’s Syndrome
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Recurrent throat pain, “foreign body” sensation, difficulty in swallowing, or vague facial pain is many times caused by the presence of an elongated styloid process. Many times, this condition is misdiagnosed and the patient is treated for facial neuralgia. But once Eagle’s syndrome is confirmed by clinical and radiological examination, the treatment is always surgical resection. The approach maybe intraoral or extraoral

A thirty-two-year-old female patient presented to the hospital with a complaint of bilateral neck pain which was exacerbated when the head was turned to either side and during swallowing since 4 years. She had been reviewed by many consultants over the past few years for the same without getting any relief. there were no other clinical symptoms like headache, temporomandibular pain, or ear pain. There was no history of previous trauma or any surgical procedure. On palpation, the styloid process could be felt quite easily intraorally and extraorally. A course of oral amitriptyline was offered to the patient in an attempt to treat the condition conservatively, but this did not help the patient get relief from pain. Therefore, surgical excision via Risdon’s incision (Figure 1) was planned for the bilaterally elongated styloid processes. When the styloid process was evaluated radiographically, on the right side it was found to be a Type II variation and on the left side a Type I variation. This was confirmed during the intraoperative phase (Figures 2 and 3). Investigations performed included computed tomography scan with 3 dimensional reconstruction (Figures 4 and 5).

The resection of the elongated styloid process was done with general anesthesia with oral intubation. After Risdon’s incision, a subplatysmal flap was elevated with care to preserve the marginal mandibular branch of the facial nerve. The posterior border to the sternocleidomatoid muscle and the posterior belly of the digastric muscle was identified carefully, and the dissection was done in the stylopharnygeal recess. The tip of the elongated styloid process was easily felt in this gap. The entire length was exposed with judicious use of monopolar and bipolar diathermy. The tissues underneath the styloid process were protected using retractors, and the dissection was carefully extended cranially to enable a lengthier resection. A 701 bur was used to cut the elongated styloid process (Figures 6 and 7). Plastic closure with drains in situ was employed (Figure 8). When the patient was reviewed after 24 hours, she was totally symptom-free. Now at one year after surgery, she continues to be symptom-free and is free of any medication.

In conclusion A thorough knowledge of the pain symptoms caused by the elongated styloid process is very important for the oral and maxillofacial surgeon. Eagle’s syndrome must always be considered in the differential diagnosis of patients with cervicofacial pain. Once the diagnosis is confirmed by clinical and regional imaging, resection of the styloid process is the treatment of choice. The immediate relief from pain and other symptoms of the patient is indeed a justification for the surgical resection of the elongated styloid process

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