Transoral Styloidectomy Approach: A Systematic Review and Enhanced Endoscopic Approach

BACKGROUND: Synthesize transoral styloidectomy approaches, highlight advantages, disadvantages, surgical outcomes, and describe an improved endoscopic transoral technique. METHODS: A systematic review of peer-reviewed articles was conducted on November 11, 2025 in PubMed, Embase, the Cochrane Library, and Medline. RESULTS: Of the 204 articles screened, 45 met inclusion criteria. Four transoral approaches and four visual enhancement techniques were described. Surgical success rate was 94% with no intraoperative complications and a postoperative complication rate of 6.3%. The length of resected styloid averaged 2.91 ± 1.33 cm (range: 1-6 cm). Mean operative time was 47 ± 22 min. Median follow-up time was 6 months (IQR: 3-12 months). CONCLUSION: Transoral styloidectomy is safe and effective for the treatment of Eagle's syndrome. An enhanced endoscopic approach with indocyanine green (ICG) fluoroscopy and neuromonitoring improves intraoperative visualization and helps identify critical vascular structures, potentially reducing the risk of inadvertent injury.