Title: Eagles Syndrome

Imaging Findings:
Figures Plain film and CT imaging of the cervical spine reveal abnormally long styloid processes originating from the skull base which can extend to, and appear contiguous with the hyoid bone.

Clinical:
Of the 4% of the population with some extent of stylohyoid chain ossification, only 4% of these may exhibit clinical symptoms. Dysphagia, odynophagia, headaches, or foreign body sensation most commonly arise following cervicopharyngeal trauma, the most common of which is iatrogenic in the form of routine tonsillectomy (1).

Etiology:
Embryologic second branchial arch (Reichert’s cartilage) gives rise to the stylohyoid chain and contains potential ossification centers which can eventually mineralize to varying degrees (2). With ossification of the stylohyoid chain comes a progressive decrease in elasticity and the potential for associated clinical symptoms. Theories as to the stimulus for ossification include aging, reactive healing following surgical or nonsurgical trauma. The styloid process is considered elongated when it exceeds 30.0mm (3).

References:
1. Manganaro AM, Nylander J. Eagle’s syndrome: a clinical report and review of the literature. General Dentistry 1998; 46:282-284.
2. Camarda AJ, Deschamps C, Forest D.. Stylohyoid chain ossification: a discussion of etiology. Oral Surg Oral Med Oral Pathol 1989; 67:508-514.
3. Keur JJ, Campbell JPS, McCarthy JF, Ralph WJ. The clinical significance of the elongated styloid process. Oral Surg Oral Med Oral Pathol 1986; 61:399-404.