The X-Files: December 2006

Marshall Deltoff
January 04, 2008
Written by Marshall Deltoff
This 43-year-old woman presented with throat discomfort, describing it as if “something was stuck in my throat,” with painful neck rotation, and some discomfort during swallowing.
56This 43-year-old woman presented with throat discomfort, describing it as if “something was stuck in my throat,” with painful neck rotation, and some discomfort during swallowing.

DIAGNOSIS
Eagle’s syndrome
•    can involve elongation of the styloid process and stylohyoid ligament ossification or calcification
•    may possess one or more articulations
•    most common in patients with mucopolysaccharidoses and diffuse idiopathic skeletal hyperostosis (DISH)
•    can cause compression of the glossopharyngeal nerve (a type of entrapment syndrome)
•    provides radiographic evidence of mineralization of the stylo-hyoid-stylomandibular ligament complex
•    is more frequent in women

POSSIBLE CLINICAL PRESENTATIONS
•    usually an incidental finding
•    sharp, intermittent pain along the glossopharyngeal nerve
•    pain in the throat; ear pain; vertigo; dizziness; tinnitus; voice alteration; cough; sinusitis; sensation of a “lump” in the throat; dysphagia; pain on opening the mouth; pain on turning the head; pain on the side of the face; or, fracture of ossified ligament may occur

TREATMENT OPTIONS
•    soft diet
•    use of an intraoral splint
•    physiotherapy
•    cortisone injections and anti-inflammatory medication (only short-term pain benefit)
•    injections of local anesthetics at the ligament insertion
•    surgical resection of the elongated styloid process or ossified ligament may be the only treatment that alleviates the symptoms•

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