Treatment of Eagle syndrome

Eagle syndrome is treated either by controlling the pain with medication and injections, or by surgery to remove the part of the styloid process, or calcified stylohyoid ligament, that causes the symptoms. The operation is called styloidectomy. In a systematic review of published case reports, symptoms cleared in 91.8% of patients after styloidectomy and in 64.3% after medical treatment1. No randomized trial has compared the two.

Choosing a treatment

The choice depends mainly on the form of Eagle syndrome and how severe it is.

• Classic Eagle syndrome with mild symptoms is often treated with medication first. Surgery is considered when symptoms persist or affect daily life.
• Carotid involvement, especially after a dissection or stroke, needs medication to prevent clots, and removing the styloid process prevents recurrence more reliably than medication alone23.
• Jugular compression with raised intracranial pressure is usually treated surgically, often with a wider operation than styloidectomy alone. See jugular compression.

Medication and injections

The medicines used for Eagle syndrome include painkillers and anti-inflammatory drugs, medicines for nerve pain such as anticonvulsants and low-dose antidepressants, and corticosteroids45. Injections of local anesthetic or steroid into the tonsil area near the styloid tip can relieve pain for a time, and relief after an anesthetic injection also helps confirm that the styloid is the source of the pain56.

Medication controls symptoms without changing the anatomy that causes them. In the 2024 review of published patients, 81 of 123 treated without surgery (65.9%) improved or recovered7. Symptoms recur more often after medication alone: among published patients with vascular complications, 47.2% of those treated first with medication had a recurrence, compared with 2.5% after styloidectomy2.

Styloidectomy

Styloidectomy shortens the styloid process by removing the part that presses on the throat, nerves or vessels, together with any calcified segment of the stylohyoid ligament. It can be done in two main ways.

Through the mouth

In a transoral styloidectomy, the surgeon reaches the styloid through the tonsil area at the side of the throat. There is no visible scar and the operation is usually shorter. The surgeon has a more limited view of the surrounding vessels and nerves, and an opening into the throat carries a risk of deep neck infection5. In a series of 58 patients treated through the mouth, complications were minimal and none developed a deep neck infection6.

Through the neck

In a transcervical styloidectomy, also called the extraoral or external approach, the surgeon reaches the styloid through a cut in the upper neck below the jaw. This gives a direct view of the styloid, the carotid arteries, the jugular vein and the nerves, at the cost of a scar and a slightly longer operation5. Minimally invasive versions use a smaller cut. In a 2024 series of 84 patients treated this way, 94.2% had a significant reduction in pain, 97.1% rated the operation a success, and all were satisfied with the appearance of the scar8.

Endoscopic and robotic surgery

An endoscope can give the surgeon a magnified view during either approach4. Transoral robotic surgery (TORS) uses a surgical robot through the mouth. In a US series, 6 robotic and 15 transcervical operations gave similar rates of improvement; three patients had complications after the open approach and none after robotic surgery, and robotic patients tended to have shorter stays (0.7 against 1.2 days), although the differences weren't statistically significant9.

Which approach is better?

The evidence doesn't settle it. A 2019 systematic review found cure rates of 84.2% for the cervical approach and 73.7% for the transoral approach in published series. In those series the transoral approach had no reported complications, and the cervical approach caused temporary facial weakness in 1.2% of patients. In published case reports, the approach made no significant difference to cure rates, and complications occurred in 4.3% after transoral and 16.3% after cervical surgery1. A 2024 meta-analysis came to the opposite view on safety, finding the highest complication rate with the intraoral approach10.

In practice, the choice depends on the length and position of the styloid, whether the carotid artery or jugular vein is involved, the person's anatomy, and the surgeon's experience. When the vessels are involved, the approach through the neck lets the surgeon see and protect them.

Results of surgery

Most published patients improve after styloidectomy. The figures below come from reviews of case reports and from single-center series, which tend to report successful cases, and they define success in different ways.

Some symptoms respond better than others. In the Hardin series, neck and jaw pain predicted the greatest relief and headache the least11. In the Bargiel series, the foreign-body feeling in the throat and pain on swallowing were the symptoms most likely to disappear completely, while longer styloids and a longer wait between the first symptoms and surgery went with more symptoms and slower recovery8.

One side or both?

An elongated styloid is often present on both sides when symptoms affect only one5. Surgery is usually directed at the side causing symptoms. Jugular compression is different: it is often present on both sides, and 13 of 14 patients in one surgical series had both veins decompressed13.

Treatment of the vascular forms

For the carotid form, treatment combines medication to prevent clots with removal of the styloid process; the vascular Eagle syndrome page describes the evidence. For jugular compression, the operation often removes the tip of the C1 transverse process as well as the styloid1413; the jugular compression page covers surgery, stenting and their results.

What to expect after the operation, and its risks, are covered on the recovery and risks page.

References

1. Lisan Q, Rubin F, Werner A, Guiquerro S, Bonfils P, Laccourreye O. Management of stylohyoid syndrome: a systematic review following PRISMA guidelines. Eur Ann Otorhinolaryngol Head Neck Dis. 2019;136(4):281-287. doi:10.1016/j.anorl.2019.05.002 PubMed ↩
2. Thielen A, Brizzi V, Majoufre C, Nicot R, Schlund M. Eagle syndrome and vascular complications: a systematic review. Int J Oral Maxillofac Surg. 2025;54(1):31-42. doi:10.1016/j.ijom.2024.09.011 PubMed ↩
3. Klail T, Sachs L, Panos LD, et al. Styloid process-related internal carotid artery dissection: extensive literature review of diagnosis, treatment and outcomes (exemplified with a single-center case series). Neuroradiology. 2025;67(6):1355-1364. doi:10.1007/s00234-025-03616-y PubMed ↩
4. Badhey A, Jategaonkar A, Anglin Kovacs AJ, et al. Eagle syndrome: a comprehensive review. Clin Neurol Neurosurg. 2017;159:34-38. doi:10.1016/j.clineuro.2017.04.021 PubMed ↩
5. Cleveland Clinic. Eagle syndrome. Reviewed June 25, 2024. Accessed October 3, 2026. Source ↩
6. Prasad KC, Kamath MP, Reddy KJ, Raju K, Agarwal S. Elongated styloid process (Eagle's syndrome): a clinical study. J Oral Maxillofac Surg. 2002;60(2):171-175. doi:10.1053/joms.2002.29814 PubMed ↩
7. Hassani M, Grønlund EW, Albrechtsen SS, Kondziella D. Neurological phenotypes and treatment outcomes in Eagle syndrome: systematic review and meta-analysis. PeerJ. 2024;12:e17423. doi:10.7717/peerj.17423 PubMed ↩
8. Bargiel J, Gontarz M, Gąsiorowski K, Marecik T, Wyszyńska-Pawelec G. Outcomes of elongated styloid process syndrome treated with minimally invasive cervical styloidectomy (MICS): a single-center retrospective study. J Clin Med. 2024;13(21):6409. doi:10.3390/jcm13216409 PubMed ↩
9. Fitzpatrick TH 4th, Lovin BD, Magister MJ, Waltonen JD, Browne JD, Sullivan CA. Surgical management of Eagle syndrome: a 17-year experience with open and transoral robotic styloidectomy. Am J Otolaryngol. 2020;41(2):102324. doi:10.1016/j.amjoto.2019.102324 PubMed ↩
10. Ferreira MS, Miranda G, Almeida FT, et al. Complications in intraoral versus external approach for surgical treatment of Eagle syndrome: a systematic review and meta-analysis. Cranio. 2024;42(5):570-582. doi:10.1080/08869634.2021.2020995 PubMed ↩
11. Hardin FM, Xiao R, Burkey BB. Surgical management of patients with Eagle syndrome. Am J Otolaryngol. 2018;39(5):481-484. doi:10.1016/j.amjoto.2018.05.003 PubMed ↩
12. Held ME, Farsi S, Creighton ERW, Davis KP, King DL, Suen JY. Eagle syndrome presentation and outcomes in a large surgical case series. Laryngoscope Investig Otolaryngol. 2024;9(4):e1289. doi:10.1002/lio2.1289 Source ↩
13. Aghayev K, Demir H, Ozdol C, Comella Z, Vrionis FD. Bilateral circumferential internal jugular vein decompression for atlanto-styloid compression syndrome: report of 14 cases. Oper Neurosurg. Published online September 3, 2026. doi:10.1227/ons.0000000000002185 PubMed ↩
14. Fritch C, Voronovich Z, Carlson AP. C1 transverse process resection for management of jugular stenosis. Oper Neurosurg. 2020;19(2):E209-E213. doi:10.1093/ons/opaa032 PubMed ↩

Related pages

• Recovery and risks after styloidectomyRecovery from styloidectomy for Eagle syndrome: how soon symptoms improve, complications by approach, and why symptoms sometimes persist.
• Vascular Eagle syndromeVascular Eagle syndrome: how the styloid process can compress or tear the carotid artery, the link with dissection and stroke, and how it is treated.
• Jugular vein compressionJugular vein compression between the styloid and C1: how it happens, its link with intracranial hypertension, diagnosis, and surgery versus stenting.
• Eagle syndrome researchThe main studies on Eagle syndrome and jugular compression, grouped by question, with their size, design, findings and limitations.