Computed tomography evaluation of elongated styloid process and calcified stylohyoid ligament: Revisiting Eagle’s syndrome

Revisiting Eagle’s syndrome

Abstract

Background/Aim: Eagle’s syndrome (ES) presents with a wide range of symptoms resulting from the impingement of nerves and/or compression of vessels in the neck by an elongated styloid process and calcified stylohyoid ligament. Although the literature includes numerous case reports on ES, large patient series studies are limited. This study aims to provide a comprehensive analysis of ES, evaluate its consistency with existing literature, and report findings from 88 patients, representing one of the largest series to date conducted at a high-volume center specializing in head imaging.

Methods: A retrospective analysis was conducted on 8,509 patients who underwent computed tomography (CT) for various indications between 2019 and 2023. A total of 88 patients were diagnosed with ES. For each patient, preliminary diagnosis and gender were recorded.

Results: Out of 8,509 patients evaluated, 88 (1.0%) were diagnosed with ES. Of the 88 confirmed ES cases, 47 (53.4%) were female and 41 (46.6%) were male. It was determined that 3 of the 88 patients (3.4%) diagnosed with ES had a preliminary diagnosis of ES, while 96.6% did not have a preliminary diagnosis.

Conclusion: Establishing a strong preliminary diagnosis of ES, rather than identifying it incidentally on imaging, depends on a detailed knowledge of regional anatomy and the ability to correlate clinical symptoms with underlying anatomical structures. Of the 88 patients diagnosed with ES, 3 (3.4%) had a preliminary diagnosis—all of whom were women—while the remaining 96.6% did not. Our findings highlight a marked discrepancy between clinical suspicion and radiological diagnosis of ES. This gap underscores the importance of incorporating objective imaging into routine evaluation to improve diagnostic accuracy and prevent misdiagnosis.