CASE 11059 Published on 26.07.2013

Bilateral Eagle syndrome


Head & neck imaging

Case Type

Clinical Cases


Cekaj E, Baruti E, Cekaj (Beno) I

1- Regional Hospital of Durres, Durres ALBANIA
2- Private dental Clinic
3- Private dental Clinic

48 years, male

Area of Interest Head and neck ; Imaging Technique CT
Clinical History
The patient presented to the dentist with recurrent pain in the oropharynx and face especially during chewing more on the right side. After checking his teeth an orthopantomogram (OPT) was requested. Based on the findings the patient went on to undergo computed tomography (CT) of the cervical spine.
Imaging Findings
On the OPT an elongated styloid process was noted on the left and calcification along the stylohyoid ligament on the right (on the right we thought it was the calcified ligament because its image was composed by two separated parts) (red arrows Fig. 1). This was confirmed on CT. The combination of calcified ligament and styloid process measured 62.6 mm on the right and the styloid on the left 57.5 mm (Fig. 2, 3)
The Eagle syndrome refers to symptomatic elongation of the styloid process or calcified stylohyoid ligament. It is often bilateral. In most cases the cause is not known, however, the condition is sometimes associated with disorders causing heterotopic calcification like myositis ossificans progressiva (fibrodysplasia ossificans progressiva) or postraumatic ossification. It was first described by Watt Eagle in 1937. [1-4]
Eagle defined the length of a normal styloid process at 2.5-3.0 cm and >3cm is generally considered to be in keeping with Eagle syndrome, but different studies have shown a range of normality from 1.52 to 4.77 cm [5-12]
An elongated styloid process occurs in about 4% of the general population, while only a small percentage (between 4-10.3%) of these patients is symptomatic. [13] So the true incidence is about 0.16%, with a female-to-male predominance of 3:1. Bilateral involvement is quite common but does not always involve bilateral symptoms. No significant difference is detectable between the right and left sides.
The syndrome can be divided into two main sub types: due to compression of cranial nerves and due to compression of the carotid artery. Patients can have facial pain while turning the head, dysphagia, foreign body sensation, pain on extending tongue, change in voice sensation, hypersalivation, tinnitus or otalgia, visual symptoms, syncope, sympathetic plexus irritation (carotidynia), eye pain and parietal pain [1, 3, 13, 14, 15]
Imaging modalities are orthopantomography and 3D computed tomography. An advantage of orthopantomography (panoramic view) is that the entire length of the process can be seen very distinctly and its deviation can also be made out clearly. Conventional radiographs provide a rough idea of the anatomy, the actual diagnosis is difficult due to the superimposed anatomical structures. CT scanning (and in particular 3-dimensional CT reformation) represents an extremely valuable imaging tool in patients with Eagle syndrome, offering an accurate evaluation of the styloid process in relation to its anatomical relationship with the other head and neck structures, to its length and to its usefulness in surgical planning [1, 2, 3, 6, 8, 11]
Treatment can be surgical or non-surgical. Nonsurgical means medical therapy with analgesics, anticonvulsants, antidepressant or local infiltration with steroids or long-acting local anaesthetic agents. Surgical treatment may be with intraoral or extraoral approach. Our patient underwent surgery with intraoral approach with two surgeries within three weeks and now he is doing well. [16, 17]
Differential Diagnosis List
Eagle syndrome
Trigeminal neuralgia
Temporomandibular disorders
Glossopharyngeal neuralgia
Salivary gland disease
Final Diagnosis
Eagle syndrome
Case information
DOI: 10.1594/EURORAD/CASE.11059
ISSN: 1563-4086