Stylocarotid syndrome: An unusual case report
A 24-year-old male patient referred to the department for opinion regarding radiating head and neck pain. Patient's complaints were on and off pain over neck region radiating to shoulders and arms for the past 5 years, headache and giddiness on the side to side neck movements, difficulty and pain while swallowing, and foreign body feeling in the throat. Previous history of any surgery and trauma was unremarkable. On examination, all third molars were completely erupted in proper occlusion and no abnormal finding was present on temporomandibular joint (TMJ) examination, but tenderness was present bilaterally in tonsillar fossae region on palpation. There was no evidence of any palpable mass in neck. Based on clinical findings, presumptive diagnosis of neuralgic pain and elongated SP (Eagle's syndrome) was made. Patient was preceded with a panoramic radiograph, which revealed bilateral elongated SP [] and TMJ morphology was also normal. After evaluation of panoramic radiograph, patient was subjected to computed tomography (CT) scan to obtain accurate information about SP including its length and direction as superimposition of several anatomical structures, distortion, and magnification are the drawbacks of conventional radiographs. Coronal section of CT scans showed bilateral elongated SP reaching upto the hyoid bone []. Right lateral view showed segmentations present along the elongated SP and left lateral view showed uninterrupted elongated SP [Figures and ]. 3D-CT reformatted image better defined anatomy and measurements were done using a software tool which gave length of 6.8 cm on left side and 6.7 cm on the right side []. Serum calcium and phosphorus levels were within normal limits. So after seeing imaging findings, confirmative diagnosis of Eagle's syndrome was made. Since the patient had persistent pain and giddiness, however, possible causative factor for giddiness could be impingement on carotid arteries, surgical removal of bilateral elongated SP was planned and was done through extra-oral approach on left side and intraoral approach on the right side after performing tonsillectomy. Approximately, 4.5-5.0 cm of the segment was removed on both the sides []. Patient was observed and was relieved of the symptoms after 1 week. Post-operative CT scan was advised after 40 days []. Patient was completely symptom free after 2 months and is under regular follow-up.