A 27 year old presented to the busy OPD of Hindu Rao Hospital, with complaints of pain in the tonsillar fossa and upper neck which radiates to the epsilateral ear. The pain gets aggravated on swallowing. She had foreign body sensation, discomfort and migraine headaches, and also some nonspecific symptoms for TMJ dysfunction. She had undergone a tonsillectomy three years earlier. Further questioning revealed no history of trauma and previous dental interventions .
Her previous doctors had diagnosed it as Temporomandible joint dysfunction but on examination that didn’t quite seem the case. The doctor examined her ears to check for Otitis but no abnormality was found. On using a laryngoscope the doctor found no abnormality in the laryngeal and pharyngeal space.
On Transoral palpation of the styloid process in the tonsillar fossa, the patient shrieked in pain. The doctor had found his answer. He sent her to get an A-P view with an open mouth Xray done as well as a lateral view of the skull which confirmed his suspicion.
Eagle’s syndrome is the term given to the symptomatic elongation of the styloid process or mineralisation of the stylohyoid or stylomandibular ligament or posterior belly of the digastric muscle. And contrary to belief, Eagle’s syndrome is very common in India !
Symptoms of Eagle’s syndrome are pharyngeal pain localised in the tonsillar fossa or hyoid bone, hypersalivation, foreign body sensation, rarely voice change. The pain is triggered by head rotation, lingual movements, swallowing or chewing.
Diagnosis can usually be made on physical examination by digital palpation of the styloid process in the tonsillar fossa and radiographically (panoramic radiograph, computed tomography scan, magnetic resonance imaging).
The vagueness of symptoms and the infrequent clinical observations are often misleading, so the correct diagnosis is most important. Because these patients are often seen by a dentist, it is important that dentists are aware of the syndrome and its treatment
Treatment – Excision of the styloid process by transoral or cervical approach.