Eagle syndrome presentation and outcomes in a large surgical case series

ObjectiveThe purpose of this study is to describe both the common and uncommon symptoms associated with Eagle syndrome and share our experience treating a large group of patients with surgical intervention, primarily intraoral excision of the calcified stylohyoid ligament.MethodsThis retrospective case series included 56 patients at least 18 years of age or older with a diagnosis of Eagle syndrome. All operations were conducted by a single surgeon at a tertiary medical center from 2015 to 2022. Charts were reviewed for demographics, prior medical/surgical history, symptoms, imaging results, operative details, and follow-up history. A phone survey inquired about presenting symptoms and symptom resolution following surgery.ResultsThe most common areas of pain were the ear (64.3%), underneath the angle of the mandible (50%), throat (46.4%), and neck (30.4%). Over 70% of patients reported tinnitus, dysphagia, and pain that were exacerbated by head rotation. Fifty-one of the 56 patients underwent surgical treatment, 92.2% via intraoral and 7.8% via cervical approaches. All patients (100%) reached in a phone survey stated that their symptoms resolved or improved after surgery.ConclusionEagle syndrome typically presents with common symptoms. However, healthcare providers must also be vigilant for less common manifestations, such as seizures or episodes of dizziness/fainting. These may be caused by calcification of the stylohyoid ligament. Intraoral surgical resection of the calcified ligament is a safe and effective treatment for most patients.Level of EvidenceLevel 4. Eagle syndrome is a relatively rare but debilitating disease that greatly afflicts patients, mainly women older than 30 years of age, and frequently evades early diagnosis. It commonly manifests as pain affecting the ear, angle of the mandible, throat, and anterior upper neck that is exacerbated by cervical rotation. Other symptoms include tinnitus, dysphagia, globus sensation, and rarely, seizures or lightheadedness. Intraoral surgical resection of the calcified stylohyoid ligament is low-risk and greatly improves or completely resolves patients' symptoms.image