Transoral Resection of Stylohyoid Ligament
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Author: Tyler McElwee
Published:
Specialties: Head and Neck Surgery, Otolaryngology
Schools: Emory School of Medicine
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Eagle’s Syndrome, also known as Styloid Syndrome, is defined by the presence of an elongated, misshapen, or calcified stylohyoid ligament. It is characterized by pain localized to either side of the throat, odynophagia, and referred otalgia. Transoral removal of the stylohyoid ligament consists of transecting the stylohyoid ligament to release tension and result in improvement of pain.
Procedure
o Ipsilateral tonsillectomy should be performed prior to surgery
o Tonsillar fossa mucosa is incised to reveal the superior constrictor muscles
o Superior constrictor muscles are incised to access the stylohyoid ligament
o Stylohyoid ligament is skeletonized with a Curved Allis and a periosteal elevator
o Surrounding parapharyngeal is retracted to prevent injury
o Kerrison rongeur is used to transect the styloid process superiorly
o Remaining in vivo portion is smoothed with rasp
o Superior constrictor muscle is reapproximated with absorbable suture
Indications
o Elongated (>30mm), misshapen, or calcified stylohyoid ligament with associated symptoms
Contraindications
o Mechanical trismus (<30mm)
o Coagulopathy
Instrumentation
Setup
Tools necessary include Colorado bovie, curved Allis, periosteal elevator, Yankauer suction, Kerrison rongeur, rasp, and 3-0 Vicryl sutures.
Preoperative Workup
o Panorex film can provide view of elongated stylohyoid ligament with or without calcification
o CT neck without contrast can be used for both confirmation of diagnosis and view of patient anatomy
Anatomy and Landmarks
o Tonsillar fossa
o Superior Constrictor Muscles
o Stylohyoid ligament
Advantages/Disadvantages
o Advantages of transoral resection compared to transcervical resection: no external scar, no risk to marginal mandibular nerve, lingual nerve, skull base structures
o Disadvantages of transoral resection compared to transcervical resection: increased recovery time, limited inferior extent of resection
Complications/Risks
o Injury to carotid artery
o Injury to glossopharyngeal nerve
Disclosure of Conflicts
o Injury to carotid artery
o Injury to glossopharyngeal nerve
Acknowledgements
o Emily M. Barrow, MD (Otolaryngology Resident)
References
1. Myers, E. 2009. Operative Otolaryngology: Head and Neck Surgery. Chapter 25, Transoral Removal of Elongated Styloid Process.
2. Colby CC, Del Gaudio JM. Stylohyoid complex syndrome: a new diagnostic classification. Arch Otolaryngol Head Neck Surg 2011;137:248�¢ï¿½ï¿½252.
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