Eagle syndrome: from neck pain to vagal episode: report of two cases

Purpose: Eagle syndrome is a rare symptomatic clinical and radiological entity. It is characterized by an elongation of the styloid process or calcification of the stylohyoid ligament, and it typically causes head and neck pain, odynophagia, otalgia, or headache. Observation: The first case dealt with an elongation of the left styloid by 46 mm, and the second case dealt with a calcification of the right stylohyoid ligament at the lesser horn of the hyoid bone. In both cases, cervical rotation caused a vagal episode by the compression of the carotid arteries. Both cases were treated surgically, the first with an intrabuccal procedure and the second by cervicotomy. Both patients have shown no postoperative recurrence of their symptoms. Conclusion: Eagle syndrome, although rare, should be considered when patients describe pain symptoms with no identified etiology in the head and neck area. A simple additional diagnostic procedure such as a computed tomography (CT) scan or an orthopantomogram can easily show a long styloid process or calcified stylohyoid ligament and their anatomical relations, in particular, any vascular relations. The use of piezosurgery decreases intraoperative risks in the mastoid cut of styloid process.