Eagle syndrome (ES) is a rare condition characterized by an elongated styloid process, which can lead to neuropathic and mechanical symptoms. Various transoral treatment options aim to address these symptoms without external incisions. One option, the lidocaine infiltration test (LIT), involves the temporary relief of symptoms through local anesthetic injection, although it is not considered a long-term solution. Transoral styloid out-fracture (SOF) involves the iatrogenic fracturing of the styloid process by applying digital pressure, with the goal of repositioning it away from critical structures. However, its efficacy is anecdotal and unpredictable, with limited documentation of outcomes. Transoral styloidectomy (TOS), first detailed by Eagle, is the more established surgical intervention. It involves shortening the styloid process to reduce mechanical stress on surrounding tissues. TOS is a minimally invasive, scar-free procedure typically performed under general anesthesia. It offers a direct approach to the styloid and reduces operative time compared to open surgery. However, the procedure comes with risks such as difficulty in intraoperative navigation, arterial bleeding, and potential infection. Effective styloid resection typically involves removing 2–3 cm of the bone, although complete removal may not provide better outcomes. Technological advancements like 3D imaging and piezoelectric devices have enhanced safety and precision during TOS. Complications such as transient pain, trismus, and swallowing difficulties are generally mild. While postoperative infections are possible, they are rare. The choice of transoral versus open surgery is guided by patient-specific factors, including the effectiveness of lidocaine testing and the necessity of avoiding cosmetic issues.