Ernest or Eagle's syndrome, a problem similar to temporo-mandibular joint pain, involves the stylomandibular ligament, a structure that connects the styloid process at base of the skull with the hyoid bone. Symptoms of Ernest syndrome, in decreasing order of occurrence, are: temporo-mandibular joint and temporal pain, ear and mandibular pain, posterior tooth sensitivity, eye pain, and throat pain (especially when swallowing). Treatment of Ernest syndrome, which is successful about 80 % of the time, includes a soft diet, use of an intra-oral splint, physiotherapy, medication and injections of local anesthetics at the insertion of the ligament.

There are anecdotal reports that radiofrequency thermoneurolysis is effective in treating symptoms of Ernest syndrome. However, these studies lack scientific rigor and the claims of effectiveness have not been validated in the peer-reviewed medical literature.

Surgical treatment of Eagle's syndrome includes styloidectomy (removal of the elongated portion of the styloid process). Mupparapu and Robinson (2005) stated that Eagle's syndrome refers to pain and discomfort in the cervico-facial region resulting specifically from the elongated styloid process. Surgical shortening may be the only treatment that will alleviate the patient's symptoms.

Scope of Policy

This Clinical Policy Bulletin addresses Ernest or Eagle's syndrome (stylomandibular ligament pain): treatment with radiofrequency thermoneurolysis.

Experimental and Investigational

Radiofrequency (RF) thermoneurolysis (also known as RF ablation, RF neurolysis, RF thermoablation) is considered experimental and investigational for the treatment of Ernest or Eagle's syndrome because the effectiveness of this approach in treating this condition has not been established.