Endoscopy-assisted transoral resection of the styloid process in Eagle's syndrome. Case report

The clinical features of Eagle's syndrome were first described by Eagle in 1937 [1]. The syndrome is characterized by recurrent throat pain, pharyngeal foreign body sensation, dysphagia, referred otalgia, and neck pain. The cause of these symptoms is considered to be elongated styloid process, or ossified stylohyoid or stylomandibular ligament.Since the diagnosis is not easy, the incidence of Eagle's syndrome in the general population may be underestimated [2]. Since the symptoms vary and are non-specific, patients with the Eagle's syndrome seek treatment in different clinics such as otolaryngology, family practice, neurology, neurosurgery, psychiatry, and dentistry. Three-dimensional computed tomography (3D-CT) has several advantages over conventional coronal and axial CT images, including providing accurate anatomical images and the relation between adjacent tissues, and is thus potentially useful for the diagnosis of Eagles syndrome. A number of groups have advocated the use of 3D-CT for radiologic examination of patients with Eagle's syndrome.Eagle's syndrome can be treated pharmacologically or surgically, or both. Surgical treatment involves decompression of the glossopharyngeal nerve by resection of the elongated styloid process, which may be accomplished through either a transoral or extraoral approach [3-5]. Each of these two approaches has advantages and disadvantages, and the best surgical approach for Eagle's syndrome remains controversial. We report here a case of Eagle's syndrome in whom the elongated styloid process was removed endoscopically through a transoral approach. Endoscopy-assisted transoral resection may resolve the disadvantage of the transoral approach.A 42-year-old man presented with a 3-months history of right neck pain that worsened on turning to the left. He did not complain of any other symptoms such as globus sensation or odynophagia. Physical examination was negative. Palpation of the tonsils did not worsen the pain. 3D-CT reconstruc