Intra Oral Versus External Approach in the Surgical Management of Eagle’s Syndrome

Eagle syndrome is defined as an elongation of the styloid process. It is a radioclinic entity characterized by heterogeneous polymorphic symptomatology. Its management is essentially through intra oral or external surgery. The objective of our work is to highlight the various diagnostic means and to propose a surgical therapeutic attitude on the clinical and radiological basis. This is a retrospective study performed at the ENT department of the Heinrich Lubke Hospital in Diourbel between March 2015 and March 2017. The study involved 15 patients with confirmed Eagle's syndrome based clinical and computed tomography evidence. Epidemiological, diagnostic and therapeutic data were collected from patient records and the Operative Record register. The choice of the surgical approach was based on Langlais’ classification, the measurement of the styloid process and the complications. The study included 15 patients, counting 14 women and one man with a sex ratio (male / female) of 0.071. The age of the patients varied between 23 years and 55 years with an average of 31.33 years. The chief complaints were foreign body sensation in the throat (15 patients, 100%), headache (15 patients, 100%), dysphagia (11 patients, 66.6%), neck pain (6 patients; 40%), periorbital and temporal pain (5 patients, 33.33%), otalgia with tinnitus (4 patients, 26.66%). The average size of the styloid process was 4.085 cm (1.608 inches). Only one patient received exclusively medical treatment. The others received surgical treatment by external approach (9 patients, 64.3%) or intra-oral approach after prior tonsillectomy (5 patients, 35.7%). The styloidectomy was bilateral in 10 patients (71.14%) and unilateral in 4 patients (28.57%). Eagle syndrome is a condition considered rare. Its curative treatment is essentially surgical with an intraoral or external approach. We recommend the external approach because it offers a better exposure of the operative field, and control of the cervical neurovascular elements. The external approach generates little postoperative pain thereby shortening the period of hospitalization.