A Case Report of Anesthetic Challenges in a Patient with Eagle Syndrome

Résumé

Elongation of the styloid process (ESP) was described by Pietro Marchetti in 1652 but it was not until 1937 that the clinical symptomatology of Eagle Syndrome (ES) was characterized by the otolaryngologist Watt Weems Eagle. The normal styloid process is defined as 2.5 to 3 cm although there are some reports of lengths up to 4 cm. Radiological ESP or calcified stylohyoid ligaments are relatively common but symptomatic ES remains rare and is often misdiagnosed with distinct perioperative challenges due to upper airway distortion which may make intubation difficult and vascular compression (stylocarotid syndrome) which may cause transient ischemic attack, stroke or dissection. Symptoms ranging from dysphagia and odynophagia to syncope and neurologic deficits require vigilance as demonstrated in our case of a 25-year-old male who presented with a 12-month history of intermittent analgesia for cervical pain and sensation of a foreign body in the pharynx, diagnosed with ESP and planned for styloidectomy at Hawassa University Comprehensive Specialized Hospital. This case highlights the need for a comprehensive and multidisciplinary approach to successful perioperative management, including strict preparation for difficult airways following current guidelines, continuous neurological and hemodynamic monitoring to identify cerebral ischemia, multimodal analgesia for neuropathic pain, and a smooth, controlled extubation to avoid vascular injury. Furthermore, a detailed preoperative evaluation of nutritional status, medication history, and anxiety is essential, enhancing patient safety and achieving optimal surgical results in this diagnostically complex condition.

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