Eagle syndrome: an unforgettable cause of atypical cranial nerve neuralgias and facial nerve palsy—a case series

Abstract Background Eagle syndrome (ES) is a rare entity caused by elongation of the styloid process or calcification of the stylohyoid ligament, leading to compression of surrounding anatomical structures. This can result in a variety of symptoms, including atypical cranial neuralgias and, in rare cases, cranial nerve palsy. Due to its nonspecific presentation, ES is often misdiagnosed as more common conditions such as trigeminal neuralgia or temporomandibular joint disorders. Case presentation We report two cases of ES with distinct clinical manifestations. The first case involves a 41-year-old female with chronic headache and facial pain with allodynia that progressed to left-sided peripheral facial palsy. Cervical Computed Tomography (CT) scan with 3D reconstruction revealed an elongated styloid process with narrowing of the pre-styloid space. The second case describes a 24-year-old female who presented with Ludwig’s angina and a history of intermittent unilateral headaches and facial pain that were resistant to pain medication. A cervical CT scan incidentally identified an elongated styloid process. Both imaging results identified ES as the cause of these atypical pain presentations. Both patients initially received conservative management, with one patient later undergoing surgical treatment and achieving significant pain relief. Conclusions These cases highlight the need for clinicians to consider ES in patients with atypical and treatment-resistant cranial neuralgia or facial nerve palsy. Diagnosis relies on a combination of clinical findings and imaging, with 3D CT reconstruction as the gold standard. Increased clinical awareness are crucial for timely diagnosis and management.