Navigation-Assisted Pure Endoscopic Transoral Styloidectomy for Recurrent Eagle Syndrome: A Pictorial Essay.

BACKGROUND: Complete resection of the styloid process at its skull-base origin is challenging in recurrent Eagle syndrome because of postoperative fibrosis, distorted anatomy, and proximity to the internal carotid artery (ICA). METHODS: Bilateral dissections of two silicone-injected cadaveric heads defined a pure endoscopic transoral trans-medial pterygomandibular corridor to the styloid base. The technique was applied in a patient with recurrent Eagle syndrome after previous transoral styloid shortening. RESULTS: Cadaveric dissections demonstrated a reproducible route to the styloid base through the parapharyngeal space using the medial pterygoid muscle, styloid musculature, and carotid sheath as key anatomical landmarks. Navigation guidance and Doppler localization of the ICA facilitated complete styloid base resection in the clinical case. Postoperative imaging confirmed complete removal, with sustained symptom resolution and no complications at 9 months. CONCLUSIONS: Navigation-assisted pure endoscopic transoral styloidectomy provides a reproducible and minimally invasive approach for complete styloid base resection in recurrent Eagle syndrome.