Eagle syndrome and orofacial pain

Abstract

Američki otorinolaringolog Watt Weems Eagle je prvi opisao stiloidni sindrom 1937. godine. Stilohioidni sustav čine stiloidni nastavak, stilohioidni ligament i mali rog jezične kosti na svakoj strani. Embriološki, ove anatomske strukture imaju svoje porijeklo od Reichert hrskavice drugog ždrijelnog luka. Eagleov sindrom ili sindrom stiloidnog nastavka je stanje u kojem produženi stiloidni nastavak ili kalcificiran stilohioidni ligament uzrokuje povremene boli u vratu, osjećaj stranog tijela ili neki drugi oblik retromandibularno-cervikalne boli. Sindrom se javlja poslije tonzilektomije ili traume, kada ožiljkasto tkivo ispod tonzilarne udubine pritišće i isteže kranijalne živce V.,VII., IX, i X. U odraslih stiloidni nastavak je dug oko 25 mm s vrškom koji se nalazi između vanjske i unutarnje karotidne arterije postranično od zida ždrijela i tonzilarne udubine. Dijagnozu je moguće postaviti kliničkim pregledom, palpacijom tonzilarne udubine, pri čemu se javlja bol i rendgenskim metodama. Najčešća snimka je ortopantomogram, a zlatni dijagnostički standard za stiloidni sindrom je trodimenzionalna rekonstrukcija, kompjuterizirana tomografija (CT). Ukoliko se konzervativnom terapijom (primjenom anagletika, antikonvulziva, antidepresiva i lokalna infiltracija anestetika i steroida) ne dovede do poboljšanja stanja, preporučuje se kirurško liječenje, odstranjenje stiloidnog nastavka. Procjenjuje se da je učestalost izduženog stiloidnog nastavka u općoj populaciji 4%. Stoga proizlazi da je učestalost stiloidnog sindroma u općoj populaciji 0.16%.The stylohyoid syndrome was first described by American otorhinolaryngologist Watt Weems Eagle in 1937. Stylohyoid system consists of styloid process, stylohyoid ligament and small horn of the hyoid bone on each side. It is generally accepted that, embryologically, these anatomical structures originate from the second branchial arch or Reichert`s cartilage. Eagle's syndrome or styloid process is a condition in which an elongated styloid process or calcified stylohyoid ligament causes occasional pain in the neck, foreign body sensation or some other form of retromandibular-cervical pain. The syndrome can develop after tonsillectomy or trauma, when scar tissue under the tonsillar fossa compresses and stretches cranial nerves V, VII, IX, and X. In adults, the normal styloid process is approximately 25 mm long with a tip which is located between the external and internal carotid arteries, lateral to the pharyngeal wall and the tonsillar fossa. Diagnosis can be made by a clinical examination and palpation of the tonsillar fossa, during which pain is felt by the patient and with radiographic methods. The most common methods used in diagnosis is orthopantomograph, but a diagnostic gold standard for styloid syndrome is a 3D- reconstruction, computerized tomography (CT). If conservative therapy (application of analgesic, anticonvulsants, antidepressants and local infiltration of anesthetic and steroids) does not lead to improvement, Eagle`s syndrome can be treated surgically, to remove the styloid process. It is estimated, that the prevalance of elongated styloid process in the general population is 4%. It therefore follows, that the incidence of styloid syndrome in the general population is about 0.16%