Eagle Syndrome

A 51-year-old man visited to our department with a complaint of sore throat and foreign body sensation for 1 month. Initially, he was diagnosed as acute tonsillitis at local clinic and received antibiotic medication. However, the symptoms persisted. Physical examination showed a symmetric appearance of tonsil without hypertrophy, but a sensation of stiffness was palpated over left-sided tonsillar fossa. An X-ray of skull anteroposterior and lateral view revealed an elongated styloid process with calcified ligament on the left side (Figure 1A and B). Three-dimensional computed tomography of the neck demonstrated the anatomic correlation of the elongated styloid process with stylohyoid ligament (measured 8.5 cm on the left side, 4.6 cm on the right side) and hyoid bone (Figure 1C and Supplemental Video).

Figure 1.

A and B, An elongated styloid process with calcified ligament over the left side skull (anteroposterior and lateral view). C, Three-dimensional computed tomography of the neck demonstrated the anatomic correlation between the elongated styloid process with stylohyoid ligament and hyoid bone.

Eagle syndrome is a rare disease, but it may cause the possible complication of internal carotid artery dissection and consequent ischemic stroke secondary to the pressure of elongated styloid process. ^1,2 Tonsillostyloidectomy is recommended for the symptomatic patient.