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      Application of surgical navigation in styloidectomy for treating Eagle’s syndrome

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          Abstract

          Purpose

          The present study aimed to evaluate the feasibility, accuracy, and clinical effect of intraoperative navigation for resection of elongated styloid process (ESP) in Eagle’s syndrome.

          Patients and methods

          Twelve patients with Eagle’s syndrome with clinically and radiologically established diagnoses of ESP were included in this study. Preoperatively, all patients accepted three-dimensional computed tomography scan, and their skulls’ digital imaging and communications in medicine data were inputed into the navigation system workstation to make a virtual surgical plan in advance. During surgery, the intraoperative navigation was performed to excise the ESP accurately for both intraoral (without tonsillectomy) and extraoral approaches following the virtual plan. Postoperatively, the amount of bleeding, duration of operation and hospitalization, and the length of resected styloid process (SP) were measured and compared with those cases that had traditional styloidectomy without the help of surgical navigation (SN). A simple visual analog scale questionnaire was also used to assess patients’ satisfaction and the surgery effect after 3 months.

          Results

          In total, 17 SPs from 12 patients were precisely resected by intraoral parapharyngeal approach and small cervical approach with the aid of SN. No severe complications occurred in any patients. The length of resected SPs was 21.93±14.26 mm. The average amount of bleeding and duration of operation were 22.50±8.54 mL and 40.35±11.81 minutes, respectively, which were all less than with traditional styloidectomy. The visual analog scale analysis showed that the discomfort in all patients was relieved, while ten patients’ symptoms were improved greatly, and two patients had some improvement.

          Conclusion

          The higher accuracy of surgery, lesser amount of bleeding, decreased duration of surgery and hospitalization, absence of complications, and improved subjective symptoms indicated that SN is an effective and minimally invasive surgical procedure suitable for resection of ESP for treating Eagle’s syndrome.

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          Most cited references 21

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          Elongated styloid process (Eagle's syndrome): a clinical study.

          Elongated styloid process can be a source of craniofacial and cervical pain and remains a diagnostic challenge to many. The aim of the study was to determine the symptomatology and various criteria for the diagnosis of an elongated styloid process and its management. Our clinical study consisted of 58 patients with elongated styloid process who had symptoms of vague cervicofacial pain and presented to our department during a period of 10 years. Special emphasis is given to palpation of the tonsillar fossa, lidocaine infiltration test, and orthopantomography. Minimal complications and zero incidence of deep neck infection were noted. All of the patients were managed surgically through the intraoral approach, which was found to be a safe procedure. Copyright 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:171-175, 2002
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            Eagle's syndrome: embryology, anatomy, and clinical management.

            Eagle's syndrome refers to a rare constellation of neuropathic and vascular occlusive symptoms caused by pathologic elongation or angulation of the styloid process and styloid chain. First described in 1652 by Italian surgeon Piertro Marchetti, the clinical syndrome was definitively outlined by Watt Eagle in the late 1940s and early 1950s. This article reviews how underlying embryologic and anatomic pathology predicts clinical symptomatology, diagnosis, and ultimately treatment of the syndrome. The length and direction of the styloid process and styloid chain are highly variable. This variability leads to a wide range of relationships between the chain and the neurovascular elements of the neck, including cranial nerves 5, 7, 9, and 10 and the internal carotid artery. In the classic type of Eagle's syndrome, compressive cranial neuropathy most commonly leads to the sensation of a foreign body in the throat, odynophagia, and dysphagia. In the carotid type, compression over the internal carotid artery can cause pain in the parietal region of the skull or in the superior periorbital region, among other symptoms. Careful recording of the history of the present illness and review of systems is crucial to the diagnosis of Eagle's syndrome. After the clinical examination, the optimal imaging modality for styloid process pathology is spiral CT of the neck and skull base. Surgical interventions are considered only after noninvasive therapies have failed, the two most common being intraoral and external resection of the styloid process.
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              Intraoperative Image Guidance in Neurosurgery: Development, Current Indications, and Future Trends

              Introduction. As minimally invasive surgery becomes the standard of care in neurosurgery, it is imperative that surgeons become skilled in the use of image-guided techniques. The development of image-guided neurosurgery represents a substantial improvement in the microsurgical treatment of tumors, vascular malformations, and other intracranial lesions. Objective. There have been numerous advances in neurosurgery which have aided the neurosurgeon to achieve accurate removal of pathological tissue with minimal disruption of surrounding healthy neuronal matter including the development of microsurgical, endoscopic, and endovascular techniques. Neuronavigation systems and intraoperative imaging should improve success in cranial neurosurgery. Additional functional imaging modalities such as PET, SPECT, DTI (for fiber tracking), and fMRI can now be used in order to reduce neurological deficits resulting from surgery; however the positive long-term effect remains questionable for many indications. Method. PubMed database search using the search term “image guided neurosurgery.” More than 1400 articles were published during the last 25 years. The abstracts were scanned for prospective comparative trials. Results and Conclusion. 14 comparative trials are published. To date significant data amount show advantages in intraoperative accuracy influencing the perioperative morbidity and long-term outcome only for cerebral glioma surgery.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2016
                12 April 2016
                : 12
                : 575-583
                Affiliations
                [1 ]The First Brigade of Students, The Fourth Military Medical University, Xi’an, People’s Republic of China
                [2 ]State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Cranio-facial Trauma and Orthognathic Surgery, School of Stomatology, The Fourth Military Medical University, Xi’an, People’s Republic of China
                Author notes
                Correspondence: Lei Tian, State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Craniofacial Trauma and Orthognathic Surgery, School of Stomatology, The Fourth Military Medical University, 145 West Changle Road, Xi’an 710032, People’s Republic of China, Tel +86 2984 776109, Fax +86 2984 776097, Email tianleison@ 123456163.com
                Article
                tcrm-12-575
                10.2147/TCRM.S103039
                4835116
                27110119
                © 2016 Dou et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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