Abstract
Objective
Eagle syndrome, categorized into classical styloid syndrome and stylocarotid syndrome,
presents challenges in determining the optimal surgical approach for styloid process
(SP) resection. While intraoral resection suffices for many cases, especially classical
styloid syndrome cases, stylocarotid syndrome sometimes demands a transcervical resection
due to its intricate spatial dynamics. We describe a step-by-step procedure for modified
transcervical resection using a supra digastric muscle approach (SDMA) for SP, emphasizing
anatomical precision.
Methods and Results
The approach is described in the case of a 60-year-old woman with acute cerebral infarction
from left internal carotid artery dissection. Employing carotid artery stenting, we
identified SP elongation as the underlying cause requiring transcervical resection
to avoid stent damage. The operative procedure involves meticulous dissection via
a linear skin incision, exposing key anatomical structures such as the sternocleidomastoid
muscles, digastric muscles (DMs), and the transverse process of the atlas. Surgical
corridor via supra DM space is an invaluable technique, offering the shortest distance
to the SP without compromising nearby nerves. The SP, covered by muscles and ligaments,
is carefully stripped off, enabling its amputation near the temporal skull base. The
entire procedure is performed under a microscope to preserve surrounding nerves.
Conclusion
The SDMA is a simple and safe technique, offering enhanced anatomical precision and
minimizing the risk of nerve damage.
Keywords
stylocarotid syndrome - elongated styloid process - transcervical resection - supra
digastric muscle approach
