An unusual case of excessive angulation of styloid process and ossified stylohyoid complex causing Eagle's syndrome: a case report

BackgroundEagle's syndrome or stylalgia is a relatively rare condition that usually presents with throat pain and dysphagia. Most cases are asymptomatic, and diagnosis is difficult owing to the vague nature of the symptoms. There is a female preponderance. In most cases, the bony tip of the styloid process (SP) is palpable upon careful palpation of the ipsilateral tonsillar fossa. X-ray (Towne's view) or an orthopantomogram indicates the length of the styloid process or the ossified stylohyoid complex (OSHC). Computerized tomography (CT) of the skull base, apart from measuring length, provides additional details such as medial or ventral angulation and relation to the surrounding neurovascular structures.Case presentationA 40-year-old female patient who presented to our hospital with left-sided throat pain and pricking sensation. After workup, she was diagnosed with left-sided stylalgia. X-ray (Towne's view) showed that the left styloid process was 27 mm long, and the right styloid process was 24 mm long. CT of the skull base measured the length and angulation of the styloid process on both sides (sagittal and transverse angles), which were found to be 60 degrees and 61 degrees on the left and 64 degrees and 60 degrees on the right side, respectively. The patient underwent left styloidectomy under general anesthesia. Postoperatively, the symptoms were completely relieved by day 7.ConclusionStylalgia is usually diagnosed on the basis of the elongated styloid process. Solely using the length of the styloid process as a parameter for diagnosis leads to misdiagnosis of cases that present with normal length of the styloid process. This article highlights the importance of CT scans in measuring the angulation of the ossified stylohyoid complex in such cases for accurate diagnosis.