Abstract
A 34-year-old female presented with a 3-week history of new-onset right-sided head and neck pain and mild right otalgia. On careful clinical examination, note was made of tenderness and palpable click on the right side of her hyoid bone, along with worsening of symptoms on right head turning. On suspicion of Eagle’s syndrome, a CT neck was the initial imaging study obtained. It showed a thickened and elongated styloid process with calcification of her stylohyoid ligament, diagnostic for Eagle’s syndrome (Figure 1) (1). She underwent styloid resection without complications with resolution of her symptoms.
Axial (a and b) and sagittal (c) high-resolution bone window CT scans of the neck demonstrate an ossified and elongated right styloid process and calcified stylohyoid ligament (white solid arrows). This is seen to extend from its superior extent at the skull base (c) to its inferior attachment into the anterolateral hyoid bone, adjacent to the right small cornu (white arrow in b). Note the normal left styloid process (dashed white arrow in a).
Eagle’s syndrome presents a diagnostic challenge (2). Although readily recognized when imaging is obtained, the syndrome often presents as vague and common symptoms such as headache, earache and throat pain, among others (1,2). Presence of cervicogenic headaches in Eagle’s syndrome is believed to be caused by irritation or impingement of the carotid sheath and its contents. Although lateral view plain film radiographs can be diagnostic, a high-resolution neck CT scan provides better characterization of the suspected lesion along with its relationship to adjacent structures and any associated complications (such as carotid dissection or narrowing), and it helps to rule out other possible etiologies in indeterminate cases.