TransOral Robotic Surgery (TORS) for Eagle´s syndrome

Eagle’s syndrome arises from an anomalous calcification of the stylohyoid ligament, leading to the anatomical elongation of the styloid process. While this condition is generally considered an anatomical variation in asymptomatic individuals, it may manifest with diverse symptoms attributable to the presence of a rigid structure in the upper neck. Common manifestations include swallowing disturbances, pain, and a sensation of a foreign body. Additionally, vascular symptoms may arise due to compression of the major vessels in the neck.

Surgical resection is the primary treatment for Eagle’s syndrome. However, this procedure is performed in proximity to critical structures such as the internal carotid artery, internal jugular vein, and lower cranial nerves in the retro-styloid space, which poses a risk of severe complications, including the potential for mortality.

Traditional surgical approaches, conducted through the neck, required the retraction of the vessels to access the styloid process safely. But yes, vital structures were controlled under direct visualization.

Transoral approaches have faced criticism for their limited visualization of the surgical field and reduced maneuverability, potentially jeopardizing neurovascular structures. Adding a potential risk of deep space neck infection (which has not been described, as far as I know…). For many years the transoral approach has been the approach of choice for may surgeons (including the one writing).

With the advent of Transoral Robotic Surgery (TORS) there is no longer room for criticism. It addresses these concerns by offering a minimally invasive approach with exceptional visual control and dexterity. TORS allows to access to the elongated styloid from anterior and medial, avoiding the exposure of the retro-styloid space. Actually, surgery is quite straightforward. See how it is done.