Superior Pharyngeal Constrictor Muscle Dysfunction

[Michael]

I want to share all the information I found on another condition quite similar to Eagle Syndrome: Superior Pharyngeal Constrictor Muscle Dysfunction.

I dug into the articles of Dr. Ernest and Dr. Shankland who discovered various pain syndromes originating from muscles close to the styloid process and stylohyoid ligament. To start off with, I urge everyone to read the following article by Dr. Shankland in which he compared five rare throat pain syndromes: Eagle Syndrome, Ernest Syndrome, Superior Pharyngeal Constrictor Muscle Syndrome, Hyoid Bone Syndrome and Carotid Artery Syndrome.

Anterior Throat Pain Syndromes Causes for Undiagnosed Craniofacial Pain.pdf (8.6 MB)

Superior Pharyngeal Constrictor Muscle Dysfunction is most often caused by traumatic injury. Basically, the muscle attaches to the ptyergomandibular raphe, which in turn attaches to the buccinator muscle (see picture below, note the close proximity to the styloid process). Shankland suggests that the ptyergomandibular raphe is permanently damaged after trauma, therefore causing pain in the attaching muscles.

In Shankland’s words: “The basic cause of this type of pharyngeal pain [is] tendonitis of the pterygomandibular raphe. Each time the patient swallows, biomechanical stresses, transferred into and through the raphe, ultimately stimulate nociceptive fibers in the muscle. Sicher stated that this tendinous structure, stretching from the pterygohamulus to the retromolar pad region of the mandible is greatly stretched when the mouth is opened wide. The innervation of this muscle is via the pharyngeal plexus, which is composed of branches of both the glossopharyngeal and vagus nerves.”

The pain is pretty similar to Eagle Syndrome: Throat pain, ear pain, jaw pain, and, as a result of tight muscles, neck pain, etc. Shanklands concludes: “Pain originating from the superior constrictor muscle is often misdiagnosed as Eagle’s syndrome, Ernest syndrome, a temporomandibular disorder, or glossopharyngeal neuralgia.”

Now, research on this condition is scarce and it might be a concomitant of Eagle Syndrome (because the muscle is simply extremely tight) or the actual cause of the pain (because the muscle and/or the ptyergomandibular raphe is damaged). I’m just speculating, but I thought it worth posting here. I encourage everyone to read the articles I’ve linked here as it might prevent you from undergoing an unnecessary Eagle surgery. It’s hard to distinguish between all those throat syndromes - local injections into the muscles and ligaments might determine the root of pain, though.

Additional literature and links:

https://www.practicalpainmanagement.com/pain/maxillofacial/superior-pharyngeal-constrictor-muscle-dysfunction
https://www.practicalpainmanagement.com/pain/maxillofacial/superior-pharyngeal-constrictor-muscle-pain

The Importance of Diagnosing Ernest: A Crucial Study

Hello, I found the most thorough study on Ernest Syndrome. It’s from the year 1987 and not free-to-view, but I decided to purchase and share it on this forum as it contains vital information about Ernest Syndrome, which is closely related to Eagle Syndrome. You’ll find the link down below, I’ll summarise the most important findings in this topic. Ernest Syndrome.pdf (1009.5 KB) Note: Research on this rare condition is scarce, so don’t take all the information for granted - especially the poss…

Do you have a tight ligament in your throat?

Hi everyone, I’m still trying to get to the root of my issues and have an important question. There is this pain condition called “Superior Pharnygeal Constrictor Muscle Dysfunction” discovered by doctor Ernest, who also discovered Ernest Syndrome (=hyperextension of the stylomandibular ligament). It is often overlooked and/or misdiagnosed as Eagle or Ernest Syndrome. Basically, there is a ligament in the jaw called Ptyergomandibular Raphe that is prone to tendinitis after trauma. It results i…

[Jules]

Thank you Michael; I think one of our other members was exploring something along these lines as she still has pain after surgery. She’s not been on recently though, so not sure if she had any treatment.

[Michael]

Hey, can you link me to her post?

Thanks,
Michael

[Jules]

It’s not coming up in the search, Michael, I’ll have a dig around & see if I can find it!

[Michael]

Update in case anyone reads this post in the future:

I got a cortisone injection into my Superior Pharyngeal Constrictor Muscle today (I wanted to exclude this as the root of my pain before I undergo Eagle surgery at the end of this month). At first, it made the pain worse, probably due to the needle piercing through the muscle. I didn’t get local anasthesia before. It’s now 6 hours after the injection and I do feel a little better: My jaw isn’t as painful, opening my mouth is slightly easier, and I can nod better. Globus sensation remains pretty much the same, albeit not as painful as it used to be. All in all, pain relief of about 20%. Don’t think this superior pharyngeal muscle is the actual cause, it’s probably just affected as the stylohyoid-chain is pretty close. Just guessing here, though. If the pain doesn’t get better the next days, I’ll go ahead with my Eagle surgery on 27 February.

Will update this regularly.

Thanks for reading,
Michael

[Jules]

It’s a good idea to rule it out before surgery, hope it continues to help a little! I guess the inflammation from ES is likely to affect tension in muscles all round the area. Not long til surgery then!

[Michael]

Definitely did! I feel a lot better today, 30% I’d say. This makes it easier to go ahead with surgery, kind of shows that this area is the cause for most of the symptoms.

[Michael]

Just wanted to update: The last days were up and down, but I generally feel that the burning sensation in my mouth got better, I can breathe more easily and my jaw isn’t as stiff and painful as before.

[Jules]

That’s good seeing as how you’re surgery is put back!