Introduction: Eagle Syndrome is a prolongation of the styloid process or calcification of the stylohyoid ligament causing symptoms such as throat pain, otalgia and foreign body sensation. (1) This diagnosis is often overlooked given the vague constellation of symptoms however it is an important differential to bear in mind, with some case reports describing sympathetic chain and internal carotid artery compression resulting in Horner Syndrome. (1) Case Report: A 69 year old man presented to the ENT outpatient department with a six month history of unilateral neck pain, difficulty swallowing and deep left ear pain. Examination revealed an asymmetrical oropharynx and a tender palpable stylohyoid ligament. CT and MRI scans were performed showing extensive left sided Eagles Syndrome measuring 10cm with a pseudoarthrosis of the stylohyoid. Literature Review: Normal length of a styloid process ranges from 25-30mm with most cases of Eagle Syndrome measuring 52mm. (2) In the literature, descriptions of stylohyoid pseudoarthrosis are limited to a few case reports. (1,2) Aetiology is proposed to be either related to trauma or a transformation within the stylohyoid ligament. (1) Treatment consists of conservative management with anti-inflammatory medications and steroid injections or surgical excision by either intraoral or extraoral approach. (1) References: 1.de Ruiter RD, Treurniet S, Bravenboer N, et al. Eagle syndrome: tissue characteristics and structure of the styloid process. JBMR Plus. 2024 Aug 29;8(10):ziae115. doi: 10.1093/jbmrpl/ziae115. PMID: 39347481; PMCID: PMC11427825. 2.Costello D, Salmon J, Milford C, Pretorius P. A rare cause of Horner syndrome. J Laryngol Otol. 2010 Aug;124(8):925-7. doi: 10.1017/S0022215109992544. Epub 2010 Jan 6. PMID: 20053310.