Sir, I write following the excellent chapter on chronic orofacial pain by Professor Tara Renton (BDJ 2017; 11: 826–836).

In the short section on glossopharyngeal neuralgia, she states that management is similar to that for trigeminal neuralgia. However, my experience has been that some with this rare condition show calcification of the stylohyoid ligament on the affected side and that this can be visible on an OPG radiograph, supplemented perhaps by CT. This is known as Eagle's Syndrome. Furthermore, their pain can usually be alleviated by resection of the calcified ligament, in effect now a bone.

This operation is relatively simple to do under GA via an upper neck incision parallel to the anterior border of the sternomastoid muscle. Dissection is straight forward by displacing the muscle posteriorly and bluntly going down the gap (a finger can be helpful here). This takes the operator straight to the 'bone' which is easily palpated. Key neck structures are easily avoided. Upon opening the periosteum, the calcified structure can be resected with bone rongeurs, after which the wound is closed in the normal way. Any OMFS surgeon with experience of parotid gland surgery would be able to do this.

There is also an ENT approach intraorally via the tonsillar fossa with the aid of an operating microscope but it is potentially more hazardous.

Medical management as per trigeminal neuralgia should be tried first in case surgery can be avoided; it may need to be continued for a while post-operatively.

I have done this operation only a handful of times in a career in OMFS over more than 30 years, so it is infrequent.