Chronic oropharyngeal pain and medical nomadism in an Eagle's syndrome patient: a case report

Abstract

Background: Elongation of the styloid process associated with oropharyngeal pain and dysphagia is known as Eagle's syndrome, a condition whose pathophysiology is still a matter of debate. Given its low prevalence and complex symptomatology, this syndrome is often misdiagnosed, leading to chronic pain and medical nomadism. A 51-year-old woman of African origin with 3-year history of left-side oropharyngeal pain and worsening dysphagia consulted several health professionals. Medical and surgical treatments, including a sinus surgery and the extraction of three healthy teeth, did not improve her symptoms. Evaluation in an orofacial pain clinic revealed an asymmetrically elongated styloid process. Surgical shortening of the elongated styloid process provided complete pain relief and recovery of normal swallowing function.

Conclusion: Based on this case report, the pathophysiology of Eagle's syndrome is discussed, and the need for specific follow-up in a subpopulation of patients with asymptomatic styloid process elongation is highlighted.

Keywords: Case report; Mechanical allodynia; Medical nomadism; Orofacial pain; Styloid process.

Fig. 1

Orthopantomogram: teeth #25, #28, and #38 were extracted. Radiopacity (dotted arrow) is visible distal of #37, suggesting a residual root of #38 as a result of incomplete surgical treatment. Note that both styloid processes (solid arrows) are prolonged, but the left one was more prolonged and voluminous than the right

Fig. 2

Dental cone beam computed tomography. A Right side: asymptomatic, B Left side, in which the styloid process corresponds to type II of Langlais’s classification; a superior mineralized segment is joined to an inferior mineralized one by a single pseudo-articulation that is located above the inferior border of the mandible