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Transoral Robotic Surgery: A Novel Technique to Treat Eagle Syndrome

Objective: 1) Report a novel surgical approach to perform a styloidectomy for Eagle syndrome. 2) Propose a new indication for transoral robotic surgery.3) Demonstrate improved exposure and visualization of a skull base region where critical neurovascular structures are at risk. Method: We report a case from 2010 of a 47-year-old woman presenting with unilateral vocal cord dysfunction, neck pain, throat pain, dysphagia, and odynophagia. Her symptoms, beginning after neck trauma, fluctuated with neck positioning. The diagnosis of Eagle syndrome was confirmed by CT, and a transoral robotic styloidectomy was performed. Results: When conservative management failed to improve the patient’s symptoms, a transoral robotic-assisted tonsillectomy, pharyngoplasty, and styloidectomy of her elongated right styloid process were successfully performed with the da Vinci surgical robot. Postoperatively the patient recovered well and reported significant improvement of her symptoms. To the authors’ knowledge a transoral robotic styloidectomy for Eagle syndrome has never before been described. The improved exposure and magnified visualization achieved with the transoral robotic approach represents a significant advent in a skull base procedure in which several critical neurovascular structures are at risk. Conclusion: Eagle syndrome is a rare diagnosis of unilateral lower cranial neuropathy (IX, X) secondary to irritation from an elongated styloid process. Traditionally transoral and transcervical styloidectomy procedures are performed. We propose that transoral robotic surgery provides improved visualization and exposure of a surgically high-risk region of the skull base.