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Open Access Highly Accessed Case report

Trigeminal neuralgia post-styloidectomy in Eagle syndrome: a case report

John William Blackett1, Daniel J Ferraro1, John J Stephens2, Joshua L Dowling3 and Jerry J Jaboin1*

Author Affiliations

1 Department of Radiation Oncology, Mallinckrodt Institute of Radiology and Siteman Cancer Center, Washington University Medical School, 4511 Forest Park Avenue, Saint Louis, MO 63108, USA

2 Division of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, MO 63110, USA

3 Department of Neurological Surgery, Washington University Medical School, 660S. Euclid Avenue, Campus Box 8057, Saint Louis, MO 63110, USA

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Journal of Medical Case Reports 2012, 6:333  doi:10.1186/1752-1947-6-333

Published: 2 October 2012

Abstract

Introduction

Eagle syndrome is a condition characterized by an elongated (>3cm) styloid process with associated symptoms of recurrent facial or throat pain. In this report we present a case of Eagle syndrome exhibiting the typical findings of glossopharyngeal nerve involvement, as well as unusual involvement of the trigeminal nerve. Notably, this patient developed a classical trigeminal neuralgia post-styloidectomy.

Case presentation

A 68-year-old Caucasian woman presented with a 25-year history of dull pain along the right side of her throat, lateral neck, and jaw. Her symptoms were poorly controlled with medication until 15 years ago when she was diagnosed with Eagle syndrome, and underwent a manual fracture of her styloid process. This provided symptomatic relief until 5 years ago when the pain recurred and progressed. She underwent a styloidectomy via a lateral neck approach, which resolved the pain once again. However, 6 months ago a new onset of triggerable, electric shock-like facial pain began within the right V1 and V2 distributions.

Conclusions

Eagle syndrome is distressing to patients and often difficult to diagnose due to its wide variability in symptoms. It is easily confused with dental pain or temporomandibular joint disorder, leading to missed diagnoses and unnecessary procedures. Pain along the jaw and temple is an unusual but possible consequence of Eagle syndrome. An elongated styloid process should be considered a possible etiology of dull facial pain in the trigeminal distributions, in particular V3.