Eagle-Sterling Awl Syndrome: Symptoms, Treatment and Removal of the Hyoid Bone

Awl-sublingual syndrome or Eagle-Sterling syndrome is a set of symptomatic manifestations, caused by deformation of the stylohyoid ligament and altered position, shape and size of the styloid appendix.

In most cases, the pathology is one-sided. Treatment is conservative, sometimes it may be necessary to remove the hyoid bone.

Anatomical implications

Even given the fairly widespread prevalence, Eagle syndrome is not a fully understood pathology, according to about which the relevant research is still underway, and the diagnosis is rather complicated and non-standard.

Considering oral cavity anatomy, then the location of the stylohyoid ligament is the area where the cranial and hyoid bones (the process of the latter) are connected.

If the styloid process lengthens (bends), the stylohyoid ligament is calcified, and the bone element, located under the tongue, or rather its horns, are lengthened, then all these factors contribute to an increase in pressure on the sleepy artery. This contributes to the appearance of a clinical picture characteristic of the disease.

Causes and risk factors

Symptoms of stylohyoid syndrome do not arise by themselves, but are the result of another pathological condition that occurs in the oral cavity. Among them:

• curved or elongated styloid process;
• ossified stylohyoid ligament;
• fusion of the styloid ligament and process;
• fusion of the hyoid bone and stylohyoid ligament;
• spasmodic stylohyoid muscles with yawning or prolonged maximum opening of the mouth.

The risk group includes people over 40 years old.

Varieties of the syndrome, symptoms

Given the exact location of pathological changes, there are 2 types of Eagle's syndrome, which have their own characteristic symptoms:

1. Subulate-pharyngeal.
2. Subulate carotid.

In the first case, the endings of the corresponding nerve are irritated as a result of curvature of the styloid process. This causes painful symptoms in the area of ​​the tonsillar cavity. In the latter area, this process can be palpated.

The severity of pain symptoms varies depending on the degree of changes and can be insignificant or increased. A person has a feeling of finding a foreign object in the pharyngeal region at the time of swallowing food and saliva. Painful symptoms often radiate to the tonsils, sublingual, cervical and ear regions.

With the styloid-carotid type of syndrome, elongation and divergence towards the styloid process provoked by an increase in pressure on the carotid arteries, and this causes an irritating effect on sympathetic plexus.

Unpleasant symptoms appear in the section where this artery is supplied with blood. The styloid carotid syndrome is characterized by persistent pain in the frontal and ocular regions.

Differential diagnostic series of measures

First of all, the doctor collects information about the prescription of the occurrence of unpleasant sensations, the nature of their manifestation, factors preceding the development of the syndrome. Also, concomitant dental diseases are taken into account, which will determine the most effective method of therapy.

The patient is referred for a consultation with an otolaryngologist, neurologist, oncologist, therapist. Among the diagnostic measures, the following procedures are prescribed:

• orthopantomography facial bones;
• X-ray examination of the temporal region and cervical region;
• computed tomography;
• ultrasound examination of the carotid and vertebral arteries;
• rheoencephalography of the bone elements of the head;
• electromyography.

If the diagnosis is confirmed, appropriate therapy is prescribed.

Treatment methods

Eagle syndrome is treated with conservative or surgical removal of the hyoid bone. The choice of technique depends on the degree of pathological changes.

Conservative

To eliminate pain symptoms, anesthetic agents are prescribed, for example, Pentalgin or Analgin. If these are ineffective, blockades are performed with corticoid drugs of an analgesic nature (Novocaine, Lidocaine, etc.). Among the sedatives are Valerian, Novopassit, etc.

In combination with drug therapy, physiotherapeutic procedures are carried out. Among them are phonophoresis with Analgin or Hydrocortisone, ultrasound exposure.

With pathology, phonophoresis procedures with medicinal substances are more often used. The technique consists in the impact on a specific area of ​​ultrasonic waves and therapeutic agents in complex, which allows the latter to quickly penetrate the skin than in the case of their standard application.

Among the contraindications for phonophoresis:

• acute skin disease;
• acute inflammatory process in the affected area;
• tumor-like neoplasm of a malignant or benign nature;
• pathology of any internal organ of a severe course;
• advanced hypertension;
• 2nd and 3rd trimesters of pregnancy.

Surgical intervention

If conservative therapy methods are ineffective, surgery is prescribed. Partial removal of the altered process may be necessary. During the operation, the crown of the hyoid horn is removed.

The operation can be performed in two ways:

1. Vnerotova. Operational manipulations are carried out through an incision made on the skin in the cervical region. This will allow easier access to the affected area.
2. Intraoral. This technique is rarely used due to possible trauma near the located endings of nerves and vascular bundles. An intervention is prescribed if the styloid process is large.

In most cases, it is the surgical method that is used in the treatment of the disease. This is the only way to completely eliminate pain symptoms, and medications suppress it only for a certain time.

There are no specific preventive measures for stylohyoid syndrome. To reduce the risk of negative consequences, it is important to consult a doctor promptly if alarming symptoms appear.