Beyond the Beak: Anticipation of Airway Difficulty in Eagle’s Syndrome

Eagle’s syndrome is a rare condition characterised by elongation of the styloid process or ossification of the stylohyoid ligament, which may result in facial or cervical pain, dysphagia, and restricted jaw movement. The normal length of the styloid process ranges from 20 to 30 mm; elongation can cause impingement on adjacent anatomical structures, leading to significant discomfort. Diagnosis is radiological, and symptomatic cases often require surgical intervention. A 38-year-old male presented with restricted mouth opening for six to seven months, along with sharp, intermittent pain triggered by eating and yawning. The pain radiated to the ear, neck, and back. He also reported two previous episodes of jaw locking that resolved spontaneously. Clinical examination revealed restricted and painful Temporomandibular Joint (TMJ) movements, deviation of the jaw to the right on opening, and bilateral hypertrophy of the masseter and temporalis muscles. Airway assessment showed Mallampati class II with slight limitation in neck extension. Imaging with Orthopantomogram (OPG) and Cone Beam Computed Tomography (CBCT) confirmed bilateral styloid process elongation, measuring 46.44 mm on the right and 48.13 mm on the left. The patient was scheduled for bilateral styloidectomy under general anesthesia. Multiple nasal intubation attempts were required due to poor laryngeal visibility, ultimately successful with the use of a bougie and a smaller Endotracheal Tube (ETT). Postoperative evaluation indicated that calcified stylohyoid ligaments may have contributed to the difficult airway management.