I don’t that surgery is controversial. A number of studies have confirmed that patients with styloid processes longer than 25 mm treated by surgical resection became asymptomatic after resection Patients with styloid processes longer than 25 mm were treated by surgical resection and in 93% of cases became asymptomatic after resection. There were no serious complications. Under 25mm not so much (about 50 - 50) There is a fairly recent new procedure that is amuch simpler technique for styloidectomy with an intraoral approach which can be used in local anesthesia that has similar results.
The main difficulty is that more often than not the symptoms (especially in cases where the styloids are less than 25mm) is the the symptoms are not directly caused by Eagles. The symptoms related to Eagle’s syndrome can be confused with those attributed to a wide variety of facial neuralgias and/or oral, dental and TMJ diseases Proper clinical and radiological examination and sound knowledge of mimicking pathology can help in diagnosing the disease.
Differential diagnosis includes but is not limited to Glossopharyngeal neuralgia, Superior laryngeal neuralgia, Occipital neuralgia, Sphenopalatine neuralgia, Nervus intermedius neuralgia, Cephalalgias migraine, Cervicogenic headache, Oromandibular disorders temporo-mandibular joint disorders, impacted, Unerupted or distorted third molar, Faulty dental prostheses, Sialolithiasis, Tonsillitis, Otitis Mastoiditis, Foreign bodies, Inflammatory and neoplastic processes in the oropharyngeal and esophageal areas to name a few. The Doc and his experience make all the difference in the world.
Because the intraoral approach is “so simple” lots of folks are doing it that prolly shouldn’t be. This is where the controversy comes from. Its pretty easy to look at an image call it Eagles and procede (often times) almost instantaneously with procedure when the issue was never Eagles in the first place.