Pathology
Endoscope-Assisted Resection of Elongated Styloid Process Through a Retroauricular Incision: A Novel Surgical Approach to Eagle Syndrome

https://doi.org/10.1016/j.joms.2017.01.016Get rights and content

Purpose

Conventional resection of the elongated styloid process is associated with large-scale tissue dissection and poor surgical exposure. The purpose of this study was to show the feasibility, efficacy, and safety of a novel surgical approach using an endoscopic technique to treat Eagle syndrome.

Materials and Methods

The authors implemented a retrospective cohort study composed of 133 patients undergoing endoscope-assisted styloidectomy (EAS) from June 2010 to August 2015 at a university teaching hospital. Outcome measurements included the length of the styloid process, blood loss, and duration of surgery. The simple verbal response scale for symptom relief, cosmetic appearance of the incision, and postoperative incision pain was used for the assessment of patients' subjective satisfaction.

Results

All patients underwent EAS without conversion to conventional surgery. One hundred seven patients (80.5%) achieved complete relief of symptoms, with 20 (15%) achieving partial relief. The residual length of the styloid process was 10.1 ± 4.4 mm. One hundred seventy-two incision sides (75.8%) had no pain during the postoperative evaluation. One side (0.4%) showed slight transient facial paresis and 4 sides (1.8%) presented transient ear numbness. The vast majority of patients (122 of 133; 91.7%) considered the cosmetic appearance of the incision to be excellent.

Conclusions

The results of this study suggest that EAS provides a viable surgical approach for Eagle syndrome in efficacy and safety.

Section snippets

Patients

From June 2010 to August 2013, 133 patients (227 sides; 53 men and 80 women; mean age, 48 yr; range, 20 to 78 yr) with Eagle syndrome underwent endoscope-assisted resection of an elongated styloid process at the Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University (Guangzhou, China). The patients met the following criteria: 1) a history of recurrent throat pain or foreign body sensation in the pharynx triggered or exacerbated by head rotation, swallowing, or chewing; 2) exacerbation of pain

Results

One hundred thirty-three patients underwent EAS. Ninety-four surgical procedures were bilateral and 39 were unilateral procedures. In total, 227 sides were treated. None of the surgeries required conversion to the open approach because of bleeding or technical difficulties. Operative durations of styloidectomy were 24.7 ± 6.7 minutes for 1 side and 50.2 ± 9.1 minutes for 2 sides. Bleeding losses were 6.3 ± 2.8 mL for 1 side and 12 ± 5.3 mL for 2 sides. At postoperative evaluation, 107 patients

Discussion

In general, surgical shortening is the mainstay treatment for Eagle syndrome.3, 4 Resection of the styloid process traditionally uses intraoral and transcervical approaches. The intraoral approach usually requires tonsil sacrifice. Access to the process through the oral cavity is limited and carries the risks of neurovascular injuries and inadequate shortening of the styloid process. In addition, the intraoral approach is a nonsterile surgical technique that could lead to a deep cervical

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Drs Chen, Liang, and Huang contributed equally to this work.

This work was supported by grants from the Sun Yat-Sen University Clinical Research 5010 Program (2010008).

Conflict of Interest Disclosures: None of the authors have any relevant financial relationship(s) with a commercial interest.

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