Abstract
Objective
This article aimed to Summarize our therapeutic experience with Transoral coblation assisted surgical approach used for treatment of Eagle’s syndrome.
Methods
sixty-two consecutive patients, from 2010 to 2015, underwent coblation assisted surgical treatment to remove elongated styloid process transorally. Outcomes were assessed in terms of intraoperative and postoperative complications, patients’ evolution and efficiency of treatment.
Results
The amount of bleeding was 1 ml ~ 4 ml, average 2.7 ml, unilateral operation time was 3 min to 10 min, average 6.2 min, bilateral for 7 min to 15 min, average 13.5 min. no bleeding and complications after operation. Pseudo membrane completely off the 14 days or so, the cure rate was 58.1%, the efficiency of 30.6%.
Conclusion
In order to get a good curative effect, we should pay attention to the accurate diagnosis, choose the appropriate way of intubation and mouth opening device, pay attention to the details of the operation, maximize the effect of coblation to achieve a more minimally invasive treatment effect.
1
Introduction
The terms ‘Eagle’s syndrome’(ES) or ‘Stylohyoid syndrome’ describe a series of symptoms caused by an elongated styloid process and/or the mineralization (ossification or calcification) of part or the entire stylohyoid ligament .The elongated styloid process syndrome can be treated conservatively or surgically . Conservative therapy includes analgesics and local corticosteroid or anesthetic administration . Surgical resection of elongated styloid process include transoral and transcervical approach. Usually, Transoral approach is more commonly used. Traditional transoral approach often demand performance of tonsillectomy before the incision of elongated styloid process.
However, for patients with no recurrent tonsillitis, concurrent tonsillectomy causes not only unnecessary damage, time consuming, but also the increased amount of bleeding.
In recent years, some literatures have reported some tonsil-sparing transoral surgical approaches to Eagle’s syndrome , which not only reduce unnecessary injury, but also shorten the operation time, reduce the amount of bleeding.
Coblation technology, whose operating temperature is 40 to 70 degrees, is a minimally invasive technique and has the characteristics of cutting, ablation, hemostasis and suction. According to the character of the minimally invasive treatment of coblation technology, we treated the Eagle’s syndrome by using coblation, with tonsil-sparing transoral surgical approach, achieved the minimally invasive aim, achieved a good therapeutic effect and accumulated a certain amount of clinical experience. The aim of this article is to describe the coblation assisted tonsil-sparing transoral approach, present the outcomes of our clinical work in patients with Eagle’s syndrome and summarize our clinical experience.
2
Materials and methods
A total of 62 consecutive patients (20 female and 42 male) with Eagle’s syndrome, ages 38 to 69 years (mean age = 52.3 years), with symptomatic elongated styloid process, who received surgical treatment between 2010 and 2015, were included. The diagnosis of Eagle’s syndrome was made on the basis of the following criteria:
- 1)
the symptoms of the patient;
- 2)
palpation of an elongated styloid process in the tonsillar bed as a hard bony spicule that aggravates the symptoms with local tenderness;
- 3)
temporary relief of symptoms on the infiltration of 1 ml of 2% lidocaine locally;
- 4)
radiographic findings that reveal elongated styloid process . A detailed medical history and complete physical examination were undertaken on all patients. Patients with certain diseases that may cause a sense of foreign body sensation in the pharynx, such as hypertrophy of lingual tonsil, were excluded. Among these, 18 cases were bilateral, 32 were on the right, and 12 were on the left, and there were 80 elongated styloid processes in total. None of the patients had a history of tonsillectomy. The preoperative symptoms are summarized in Table 1 .
Table 1
Patients’ Complaints.
Complaint
Number of Patients
Only Pain in the throat
12
Foreign body sensation in the throat
21
pain on changing head position
20
earache
4
Pain in lower right neck
2
Pain in the throat, worsen when changing the head position
3
The surgical procedures were all conducted under general anesthesia. The patient was nasal intubated. The neck was hyperextended and the mouth was suspended open. The procedure started with placement of the Davis mouth gag for better visualization of the surgical field. When we excised the left side of the styloid process, we chose the mouth gag which open to left side, and vice versa. Meanwhile, Davis mouth gag with proper length was carefully chosen. The protuberance of elongated styloid process was identified by digital palpation and then, the overlying mucosa and tonsillar tissue was incised by 5874# coblation, 7 grades for cutting, 5 grades for hemostasis, Until the tip of styloid bone exposed. A proper hollow ethmoid curette was set into the tip of the styloid process and pushed to the root along the direction of styloid process. While doing this, the adjacent tissues were constantly separated to allow visualization of the entire length of the styloid process. In this process, a needle holder was used to assist the ethmoid curette and applied to removed the elongated styloid process from the tip up to the base. Keep the original position of ethmoid curette unchanged, use the coblation to hemostasis until no active bleeding. The muscles and mucosa over the surgical bed were closed in a plain. The patients received intravenous Cefalotin 1.0 g half hour before the beginning of the surgery and every 8 h at the hospital for a period of 48 h. They also received an oral administration of Cefuroxime 250 mg every 12 h for 2 days as an outpatient. Good oral hygiene was maintained in the postoperative period. (See Fig. 1 .)
2
Materials and methods
A total of 62 consecutive patients (20 female and 42 male) with Eagle’s syndrome, ages 38 to 69 years (mean age = 52.3 years), with symptomatic elongated styloid process, who received surgical treatment between 2010 and 2015, were included. The diagnosis of Eagle’s syndrome was made on the basis of the following criteria:
- 1)
the symptoms of the patient;
- 2)
palpation of an elongated styloid process in the tonsillar bed as a hard bony spicule that aggravates the symptoms with local tenderness;
- 3)
temporary relief of symptoms on the infiltration of 1 ml of 2% lidocaine locally;
- 4)
radiographic findings that reveal elongated styloid process . A detailed medical history and complete physical examination were undertaken on all patients. Patients with certain diseases that may cause a sense of foreign body sensation in the pharynx, such as hypertrophy of lingual tonsil, were excluded. Among these, 18 cases were bilateral, 32 were on the right, and 12 were on the left, and there were 80 elongated styloid processes in total. None of the patients had a history of tonsillectomy. The preoperative symptoms are summarized in Table 1 .
Table 1
Patients’ Complaints.
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