Styloid-carotid artery syndrome.A 42-year-old commercial pilot was placed on medical leave because of frequent episodes of syncope syncope
Effect of temporary impairment of blood circulation to a part of the body. It is often used as a synonym for fainting, which is loss of consciousness due to inadequate blood flow to the brain. that occurred when he turned his head to the extreme right lateral position. The patient's partner said that these syncopal syn·co·pal
Of or relating to syncope. episodes were accompanied by jerky movements that resembled seizure activity. The patient would regain consciousness as soon as his head became realigned in the midline. As his symptoms increased in severity and frequency, he began to experience transient episodes of blindness in his right eye.
The patient was seen by a neurologist, who ordered computed tomography (CT) and magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. (MRI) of the nead and neck with contrast; the MRI demonstrated no abnormalities. Magnetic resonance arteriography arteriography /ar·te·ri·og·ra·phy/ (ahr-ter?e-og´rah-fe) angiography of an artery or arterial system.
catheter arteriography and magnetic resonance venography Venography Definition
Venography is an x-ray test that provides an image of the leg veins after a contrast dye is injected into a vein in the patient's foot. showed that the circle of Willis circle of Wil·lis
A roughly circular anastomosis that is located at the base of the brain and formed by the anterior communicating artery, the two anterior cerebral, the two internal carotid, the two posterior communicating, and the two posterior was patent, as were the internal and external jugular veins bilaterally. However, computed tomographic (CT) angiography demonstrated that the styloid styloid /sty·loid/ (sti´loid) resembling a pillar; long and pointed; relating to the styloid process.
n. processes were elongated and the stylohyoid ligaments were calcified Calcified
Hardened by calcium deposits.
Mentioned in: Heart Valve Repair bilaterally (figure 1). In addition, the lumen of the right carotid artery appeared to be narrowed by 50% as a result of its tortuous course around the calcified ligament.
[FIGURE 1 OMITTED]
The patient was taken to the operating room for surgical resection. Intraoperative neurophysiologic monitoring detected no signs of abnormal brain activity. He successfully underwent a transcervical resection of approximately 5 cm of the elongated right styloid process and calcified ligament without complication (figure 2). His postoperative course was uneventful, and his syncope resolved.
[FIGURE 2 OMITTED]
In 1937, Eagle and Durham described 2 cases of post-tonsillectomy pharyngeal pain that had been caused by an elongated styloid process; this condition is now known as Eagle's syndrome. (1) In 2002, Prasad et al described their experience with 58 cases of Eagle's syndrome over a 10-year period. (2) All of their patients had presented with a chief complaint of pain, and their diagnosis was based on palpation palpation /pal·pa·tion/ (pal-pa´shun) the act of feeling with the hand; the application of the fingers with light pressure to the surface of the body for the purpose of determining the condition of the parts beneath in physical diagnosis. of the tonsillar fossa, a panoramic x-ray, and a positive lidocaine infiltration test. All of these patients underwent resection via a transoral approach. The longest styloid process excised measured 3 cm.
In 2000, Bafaqeeh subclassified Eagle's syndrome into two types: its classic form and an entity he called styloid-carotid artery syndrome. (3) Our patient's presentation, diagnosis, and treatment more closely resembled styloid-carotid artery syndrome than classic Eagle's syndrome. On presentation, his primary symptoms were syncope and associated neurologic manifestations, including blindness, that had been caused by not only an elongated styloid process but by a calcified stylohyoid ligament, as well. On axial CT, the extent of calcification of the stylohyoid ligament was not well appreciated, nor was its close association with the carotid artery. However, the association was clearly demonstrated on the sagittal reconstruction of the CT angiography. In view of the extent of the calcification and its proximity to the carotid artery, a transcervical approach was favored over the transoral approach.
Special recommendations for the diagnosis and management of patients with styloid-carotid artery syndrome include sagittal CT angiography with reconstruction when clinical suspicion is high, intraoperative neurophysiologic monitoring, and a transcervical approach to resection.
(1.) Eagle WW, Durham NC. Elongated styloid processes. Report of two cases. Arch Otolaryngol 1937;25:584-7.
(2.) Prasad KC, Kamath MP, Reddy KJ, et al. Elongated styloid process (Eagle's syndrome): A clinical study. J Oral Maxillofac Surg 2002;60:171-5.
(3.) Bafaqeeh SA. Eagle syndrome: Classic and carotid artery types. J Otolaryngol 2000;29:88-94.
Sofia Avitia, MD; Jason Hamilton, MD; Ryan F. Osborne, MD, FACS FACS Fellow of the American College of Surgeons.
Fellow of the American College of Surgeons
fluorescence-activated cell sorter.
From the Department of Otolaryngology--Head and Neck Surgery, Charles R. Drew Dr. Charles Richard Drew (June 3, 1904 – April 1, 1950) was an African-American physician and medical researcher. He researched in the field of blood transfusions, developing improved techniques for blood storage, and applied his expert knowledge in developing large-scale University of Medicine (Dr. Avitia and Dr. Osborne), the Osborne Head and Neck Institute (Dr. Hamilton and Dr. Osborne), and the Head and Neck Cancer Center, Cedars-Sinai Medical Center (Dr. Osborne), Los Angeles.