I saw Dr. Annino today. He said based on my CT scan w/ contrast from 2020, my styloids appeared normal length but that the lower portion of the stylohyoid ligament was calcified on each side. He said calcification of only the lower part of the stylohyoid ligament would not cause my symptoms, it would cause symptoms if was higher up to the styloid process. He is reviewing a more recent CT scan I had in January this year and will call me. He said it is unlikely it will show anything. I’m so confused and discouraged. How can the ligament be partially calcified at the bottom but not the entire length of the ligament? If a ligament is calcified at any part, wouldn’t that cause symptoms? Could things have grown/calcified in the last 4 years since 2020? He was very nice, but I’m disappointed I keep getting no answers or relief.
We’ve had a several members who’ve had ligament calcification either from the hyoid upward toward the styloid or midway along the line of the stylohyoid ligament who have been symptomatic & who had good symptoms resolution once that calcification was removed. Calcification anywhere along the stylohyoid ligament can cause symptoms but doesn’t always. Getting a second opinion from another experienced ES surgeon would be a thought.
The calcification can happen anywhere along the ligament as @Isaiah_40_31 says, we’ve had some members with small calcifications all along the ligament, they look like dashes or grains of sand on the CT & can still cause symptoms. It’s a shame Dr Annino couldn’t help, but worth trying to see someone else, or doing a video consult with one of the other doctors on the list?
Sending you a hug 
Do you have any links to patient experiences/posts with normal styloid length but calcified ligaments? Traveling isn’t an option for me. I wish there was someone else I could see in the area. 
Do you know of any doctors that do virtual visits? Or maybe anyone else locally on my area? Traveling isn’t an option. I’m so discouraged
@SewMomma was one of our members who had calcified ligaments but normal styloids. She hasn’t been on here for several years but you can read her posts by clicking on the magnifying glass image in the upper right & typing her screen name in the search box. Another one was @Shanef89.
I actually have exactly what you describe, my SH ligaments are actually calcified from the hyoid up. My styloid process on my left is longer than my right, but I do not know the lengths. Just from the consult with my doc, I dont think my right is too much longer than normal, from his explanation, but the left is long, but not extraordinarily long. The calcification appeared to go halfway up on the right and partially on the left. But, these are all my interpretations from the doc walking me through the scans. Anyway, all of symptoms are on the right side, the side with the more calcification, which is not the side with the longer styloid process. Though, I do have tinnitus on my left side and didnt realize it could be a symptom of ES until after my diagnosis. My doc, Dr. Suen, only removes the calcification portion of the ligaments and doesn’t touch the styloid process. I currently have my surgery scheduled for 4/19 just to get on the books and to have the calcified portion of both ligaments removed. However, I am getting a second opinion, hopefully next week, just to make sure Dr. Suen’s approach his right. Dr. Suen did reassure me that the surgery would resolve my symptoms.
There is a good chance that getting the calcified ligaments removed will give you some symptoms resolution & it’s possible it will be enough that you won’t need to have your left styloid removed especially because it sounds like it’s not very elongated.
I’m glad you’re getting a second opinion. Please let us know what you learn from that doctor.
Dr. Suen is very experienced & has been doing this surgery for some years so his forecast of your outcome is hopefully based on his experience with other patients for whom he’s done this surgery.
I’ve put your surgery date on my calendar so I can pray for you especially that day unless your date changes.
I have discontinuous calcification of both ligaments and my left styloid process is 32mm and my right is 35mm. I saw Dr Jonathan Hughes (London, UK) and he said he could do the surgery if I wanted but he wasn’t convinced it would solve my symptoms. Since then, I have realised that I am pushing my lower jaw forward as an unconscious habit, my dentist called it “posturing” and along with that I also push my tongue forward. I also need my top wisdom teeth out because they are growing slightly outward and I’m having a good chew in the inside of my mouth (I never feel myself doing this but there is lots of evidence of it happening). I have a theory that because I can’t close my teeth together properly because of this, I might be habitually pushing my lower jaw forward, causing a lot of pain and mimicking ES. I’m having the wisdom teeth out on 8 April, so we’ll see if anything improves after that. Stress and anxiety (I’m a very anxious person) can also cause the jaw/tongue thrusting. I’ve been keeping an open mind about what it might be because I really hate having surgery so if I can avoid the ES surgery then I will. My symptoms if this helps:
Pain under chin, random spots of sharp pain
Headaches that come from the hyoid bone backwards to the base of the skull
Tightness of the jaw, particularly right side
Weird “pain” or sensation in front teeth upper and lower
Not being able to feel my breathing through my nose, nose feels too open, this makes me over breathe and at its worst causes panic attacks
Pain that starts in the hyoid and goes down to my chest on the left
Stuffiness or pressure feeling in my head
Slight double vision on and off
Vertigo when my symptoms flare up
I was annoyed at first with my diagnosis because it wasn’t as clear cut as other people on here, some people have huge styloids or really thick calcification, and mine is nothing like that, yet similar symptoms. I think it’s important to still explore other possibilities where it’s not so clear because the surgery is pretty major and comes with its own risks. I want to be sure that my symptoms will disappear and I won’t just inherit more symptoms on top of the ones I already have. Hope this is helpful.
@Skatkat I totally understand you want to go with the least invasive surgery to see what helps, I had what I thought were wisdom teeth issues (jaw pain, pain behind my ears, ear ache…) & my wisdom teeth stick outwards too. A dentist told me I needed all 4 out, I questioned this with a second opinion & was told none of them were needed to be removed, so didn’t have it done. I did later have more toothache& had some treatment , but that turned out to be from the Trigeminal nerve & all to do with ES… following the surgery for ES the old symptoms I’d put down to the wisdom teeth have gone. Not trying to talk you out of the wisdom teeth removal but just bear in mind it may not be the only answer
Thank you, I definitely have to have my upper wisdom teeth out because they are causing issues but the dentist wasn’t convinced it would solve all of my problems. However, it will be one thing ticked off the list and if the symptoms persist then that gives me more reason to believe it’s ES. At the moment I feel a bit lost because it’s not as definite as other peoples diagnosis.
I agree with you starting w/ the least invasive surgery prior to going for a more invasive one. It goes back to these health challenges being like layers of an onion w/ the outside layers being less complex than the inner ones. I hope having your wisdom teeth removed goes far toward alleviating your symptoms, @Skatkat.
I have short styloids with no calcifications. I have vascular outflow obstruction. It’s the angle, distance and thickness that also needs to be considered.