Modified Craniocervical Approach for Resection of the Styloid Process in Patients with Eagle's Syndrome.

 Surgical treatment of Eagle's syndrome remains the mainstay of treatment. Palsy of the marginal mandibular branch of the facial nerve is the most significant complication encountered in transcervical resections, due to direct compression during the approach. We proposed a modification of the craniocervical approach to the jugular foramen to resect the styloid process avoiding the marginal mandibular branch and subsequent palsy.  This is a single-center retrospective cohort study.  The research was conducted at a tertiary medical center.  From November 2008 to October 2018, 12 patients with Eagle's syndrome underwent treatment using our modified approach.  Demographic data, type of Eagle's syndrome, symptomatic side, size of the styloid process, clinical outcomes, and complications were analyzed.  Mean size of the styloid processes was of 3.34 cm on the operated side (2.3-4.7 cm) and 2.98 cm on the other (2-4.2 cm). Intraoperative facial nerve irritation occurred in one case. Resection of the entire styloid process was achieved in all cases. Eight cases experienced complete improvement, three cases had a partial response, and one case failed to improve. There were no cases of recurrence. Two patients presented transient postoperative auricular paresthesia. There were no cases of mandibular branch palsy, nor any other complications in our series.  Our modified transcervical approach is effective in avoiding the marginal mandibular branch of the facial nerve, avoiding postoperative palsy.