Case presentation on eagle syndrome.pptx

Eagle syndrome information and a case related to it

1. Case presentation on eagle syndrome  Presented by :-  Keerthi.Neelufor ,  5th Pharm.D ,  Y17PHD0411 ,  HINDU COLLEGE OF PHARMACY Presented on :- 01/11/2021 Day :- Monday

2. Eagle syndrome It is named after the Watt Weems Eagle in 1937 It is also called as Elongated Styloid Process Syndrome or Styloid – Stylohyoid syndrome It is a rare disease It is a pain that is caused in the throat and the face It is estimated that 1 in 62,500 people will get this disease Women are 3 times more prone in getting this disease

3. causes It is usually caused by the elongated styloid bone or by the calcified stylohyoid ligament The styloid process is a short pointy bone just below your ear and the stylohyoid ligament connects to the hyoid bone in the neck According to GARD [ Genetic And Rare Diseases Information Center ] about 4 percent of population will have this long styloid process   Other causes may be like tonsillectomy It is mostly bilateral [ Both Sides ]

4. Pathophysiology Eagle Sir has considered tonsillectomy responsible for the formation of scar tissue around the styloid apex, with consequent compression or stretching of the vascular and nervous structures contained in the retrostyloid compartment (in particular, the glossopharyngeal nerve and perivascular carotid sympathetic fibers).  Eagle syndrome is also discovered in patients who have never been subjected to tonsillectomy.

5. The other factors may be like  The ossification of the stylohyoid ligament complex, causing contraction of the stylopharyngeal muscle and stretching of the XII cranial nerve The fracture and medialization of the ossified stylohyoid ligament, with incomplete repair due to continuous hyoid bone movements and formation of excessive granulation tissue  The ossification of muscular tendons leading to irritation of the structures nearby The abnormal length associated with abnormal angulation of the styloid process 

6. SYMPTOMS Pain usually on 1 side of neck or face [ Especially at Jaw ] Pain when swallowing or turning the head to 1 side  Globus hystericus Tinnitus Sore throat Ear ache Headache etc., 

7. Complications Headache Loss of balance Changes in vision Confusion Weakness Due to Pressure it can even lead to Stroke

8. Diagnosis Physical injuries to jaw Ear infections Physical examination  Radiology tests like x-ray Imaging tests like CT etc., 

9. Treatment Primary approach is through surgical i.e., styloidectomy It can be done either intraoral or extraorally If surgery is a risky option then the symptoms can be managed by  OTC or NSAID'S like Naproxen , Ibuprofen etc.,  Steroids Anti depressants like TCA's Anticonvulsants & anaesthetics etc., 

10. Patient demographics Name :- BN Age :- 28 years Gender :- Female Reg no :- 27754/10/21 Date of Admission :- 28/10/21 Department :- General Medicine

11. History of the patient Chief Complaints :-  Sharp , severe pain at both jaws radiating to ear since 4 months Ear ache , Difficulty in swallowing , increase in pain when turning the head & Having a feeling that something is struck in the throat No fresh complaints are reported in the hospital PMH – Nil  Past medication history - Rantac , Lyser-D , Pephene OBG history – 2 Children ( 1 boy and 1 girl and both are alive ) Social history – Nil Occupation - Farmer

12. Vital examination Pulse rate – 70 bpm B.P – 100 mm/Hg Temperature – 36.5 degree Celsius ( 98 degree fahrenheit ) SPO 2 – 99% RBS – 107 mg/dl

13. anthropometric measures Weight is 45 kgs Height is 5 feet 3 inches ( 160.02 cm ) Her BMI is 17.6 kg/ metre square ( Mild thinness ) Her BSA is 1.41 metre square PICCKLE signs are negative

14. Systemic examination CVS – S1 , S2 + ve CNS – Eyes opening - + ve , Pupils – NSRL RS – B/L AE + ve Abdomen – Normal

15. ASSESSMENT Provisional diagnosis :- Globus hystericus Final diagnosis :- Based on subjective data & objective data [ CT scan of neck ] obtained from the patient is assessed to have " Eagle's Syndrome "

16. Goals of treatment To reduce the pain To decrease the difficulty in swallowing To reduce her ear ache To provide symptomatic relief

17. PLAN OF CARE Medical Management Surgery was done on 03/11/2021 Procedures carried out – B/L Tonsillectomy and B/L Styloidectomy Mode of Anaesthesia – General Anaesthesia

18. S.NO VITALS DAY 1 DAY 2 DAY 3 DAY 4 1. Temperature [ in degree fahrenheit ] 98.6 98.6 98.6 98.6 2. BP [ mm/Hg ] 100/70 110/70 110/80 120/80 , 100/60 3. PR [ bpm ] 70 72 67 84 , 86 , 66 , 65 4. SPO2 [ % ] 99 99 99 99 , 98 ( RR – 22 cpm , 18 ) 5. RBS , FBS [ mg/dL ] 107 91 91 108 , 100 , 101 , 111 , 91 , 105 , 77 , 75

19. S.NO DRUGS GENERIC NAME DOSE FREQUENCY R.O.A CATEGORY DAYS 1. Tab Augmentin Duo Amoxicillin + Potassium Clavulanate 625 mg TID ORAL Aminopenicillin + beta lactam inhibitor D1-D6 2. Tab Lyser D Diclofenac + Serratiopeptidase  50/10 mg BD ORAL NSAID + Proteolytic enzyme D1-D6

20. After surgery S.NO DRUG GENERIC NAME CATEGORY DOSE FREQUENCY R.O.A DAYS 1. Inj Monocef Ceftriaxone Cephalosporins 1 gm BD IV D6 - D11 2. Inj Diclofenac Diclofenac NSAIDS BD IM D6 - D11 3. Inj Pantop Pantoprazole Proton pump inhibitors aa 40 mg BD IV D6 - D11 4. Inj Trapic Tranexamic acid Anti Fibrinolytic 5 ml ( 100 mg ) SOS IV D6 - D11 5. Syp Planokuf Chlorpheniramine maleate and Codeine Phosphate Anti tussive , Anti allergic and Analgesic 10 ml BD Oral D11

21. There are no drug interactions in the given treatment Patient counselling :- The patient was counselled to Reduce the jaw movements If any swelling or inflammation occurs then application of ice may be helpful Gently massage the area

22. Ct scan of neck :-  Mucosal thickening of b/l maxillary sinus with obliterated right osteomeatal complex Elongated styloid process b/l [ Right – 4.48 cm , Left – 4.41 cm ] Hb – 11.4 , 10.8 gm % [ 12-16 ] TRBC – 3.72 , 3.22 millions [ 4 – 6.2 ] PCV – 31.6 % ( 34 – 52 ) CRP – 28.4 , 41.8 mg/l ( Upto 6 ) X-ray etc.,