A RARE CASE OF BILATERAL INTERNAL CAROTID ARTERY DISSECTION IN EAGLE SYNDROME: A MINIMALLY TRANSORAL SURGICAL APPROACH

F. Gallo¹ , S. Di Lascia² , F. Riva³ , F. Zingari³

¹ Maxillofacial Surgery Unit, Institute of Italian Stomatology, Milano, Italy
² Maxillofacial Surgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
³ Maxillofacial Surgery Unit, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy

Correspondence to:

Annals of Stomatology 2025 January-April; 5(1): 37-41
https://doi.org/10.69129/stomatol/2025v5iss1_6

Received: 28 November 2024 Accepted: 2 January 2025

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Abstract

Eagle’s syndrome is a condition associated with the elongation of the styloid process or calcification of the stylohyoid ligament, which is responsible for polymorphic head and neck symptoms, often resulting in delayed diagnosis. Two variants can be distinguished, as initially described by Eagle, the stylohyoid syndrome as a classic type and the stylocarotid syndrome as a vascular type; the latter can involve a dramatic evolution such as internal carotid dissection (ICD). The most commonly proposed curative treatment is styloidectomy, which allows complete resolution of symptoms in the great majority of cases and can be performed via a transoral or a transcervical approach. This paper aims to describe a rare case of bilateral internal carotid artery dissection (ICD) due to Eagle Syndrome and review available literature on the clinical features and treatment. We present the case of a 46-year-old male patient manifesting pharyngeal foreign body sensation, dysphagia, and neck and throat pain exacerbated by head movements, with evidence on CT scans of elongation of the styloid apophyses bilaterally in close proximity to the cervical portion of the internal carotid artery (cICA). Computer tomography angiography showed smooth bilaterally tapering of the mid portion cICA; therefore, ICD due to Eagle syndrome was diagnosed, and transoral styloidectomy was performed. In the literature, there are no cases of bilateral ICD derived from Eagle Syndrome treated with an intraoral approach.

Keywords: Eagle syndrome, internal carotid artery dissection, neck pain, parapharyngeal space, styloid process