A 25 year old with a sore throat

What do you see on the xray?

Our patient has Eagle syndrome. It is pain in the throat caused by an elongated styloid process or calcified stylohyoid ligament which can push into the floor of the mouth causing pain with swallowing.  It has been reported after tonsillectomy. Occasionally, the elongated bone comes in contact with the internal carotid artery below the skull. If that happens, turning the head can lead to a TIA.

Dr Watt W Eagle described the first cases which occurred after pharyngeal trauma or tonsillectomy. It can cause a feeling of a foreign body in the throat, dysphonia, tinnitus or odynophagia. It is diagnosed by pain on palpation of the tonsillar fossa which is relieved with lidocaine injection.

The treatment for pain which does not respond to NSAIDS is surgery. 

Stylos comes from the greek meaning “pillar” Is is a cylindrical cartilaginous bone located on the inferior aspect of the temporal bonemedial to the stylomastoid foramen and lateral to the jugular foramen and carotid canal.  Just medial to the styloid process in the internal jugular vein.  With the stylohyoid ligament it forms the small horn of the hyoid bone.


Our patient had intraoral resection of the styloid process on the R , but on the L it was very deep and had to be done transcervically.  He returned to the ED with bleeding from the mouth three days later.  His incisions were found to be intact and he was bleeding from a lesion over the adenoid pad thought to be related to his nasal intubation. Hemaderm was applied and the bleeding stopped.

Moffat DA, Ramsden RT, Shaw HJ. The styloid process syndrome: aetiological factors and surgical management J laryngol Otol. 1977 Apr 91(4) 279-294.

Lindeman P. The elongated styloid process as a cause of throat discomfort. Four case reports. J Laryngol Otaol.  1985. May 99(5) 505-8.

Kumar P , Rayamane AP, Subbaramaiah M. Sudden death due to eagle syndrome: a case report. Am J of Forensic Med Pathol.  2013 sep. 34(3)

Chase DC, Xarmen A, Bigelow WC. Eagle’s syndrome: a comparison of intraoral versus extraoral surgical approaches. Oral Surg Oral Med Oral Pathol. 1986 Dec 62(6) 625-9.