This chapter, dedicated to the technique of open transcervical styloidectomy (OTS), aims primarily to describe the advantages and disadvantages of the cervicotomic approach to treat Eagle syndrome. First described by Loeser and Cardwell in 1942, OTS is today one of the two surgical options available for performing a styloidectomy, in contrast to the transoral technique. The OTS technique is typically offered after conservative treatments fail and is suitable for patients willing to accept a neck scar. The procedure provides the surgeon with a clear view of the surgical field, making it easier to manage complications such as bleeding. This chapter will therefore analyze the surgical technique, including the various cervicotomic incision options and technologies to be employed, the associated complications such as postoperative pain or neurovascular damage, and our personal case studies on the subject. The chapter will conclude with a review of patient outcomes from an original study conducted across several hospitals, highlighting the success rates and factors influencing surgical outcomes, such as preoperative symptom severity.