Rare Presentation of Eagle’s Syndrome as Bell’s Palsy (P7.023)

Abstract

BACKGROUND: Eagle's Syndrome is caused by elongated styloid process or ossification of the derivations of the second brachial arch, resulting in cervical, facial, and pharyngeal pain and dysphagia. It is usually diagnosed by clinical history and confirmed with imaging study. Bell’s palsy as a presentation of Eagle syndrome is rare and has not been reported thus far. OBJECTIVE: We describe a case of Eagle’s Syndrome presenting as Bell’s palsy and glossopharyngeal neuralgia CASE: 40 year old male who presented to the Emergency Department with a 1 day history of left sided facial weakness. He had a 1 year history of odynophagia with one episode of excruciating left side neck pain which resolved with NSAIDs. At presentation to the ED, there was significant flattening of the left forehead and nasolabial fold, and sagging mouth corner. There was no sensory disturbance over the ear. He denied otalgia, dysgeusia or dysacusis. CT of the neck with contrast showed a calcified left stylohyoid ligament. The brain MRI showed mild ill-defined enhancement at the left stylomastoid foramen and at the lateral soft tissues adjacent to the proximal styloid process (Images 1 and 2). Given the clinical presentation of the left sided glossopharyngeal neuralgia, Bell’s palsy and the calcified stylohyoid ligament on imagning, the patient was diagnosed with Eagle’s Syndrome. He was treated with steroids and the Bell’s palsy improved over the weeks. Left styloid process resection was performed without complications. CONCLUSIONS: Our patient presented initially with glassopharyngeal neuralgia and later developed Bell’s palsy. Involvement of the facial nerve can be explained by irritation of the extra-temporal part of the facial nerve by the calfied ligament, when it comes out from the styloidmastoid foramen. Further absence of dry mouth, otalgia, dysgeusia, dysacusis and no sensory disturbance over the ear suggest involvement of extra-temporal component of facial nerve.

Disclosure: Dr. Rosales has nothing to disclose. Dr. Gandhi has nothing to disclose. Dr. Lugo has nothing to disclose.