I finally got my CT scan images and was able to load them into RadiAnt DICOM Viewer. I know this may sound silly but having my CT scan means so much to me… proof that this wasn’t “postpartum” or being a “hypochondriac”.
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Great job with the 3D conversion, @lsheep! It is very gratifying to see what’s causing all the pain, anxiety & other symptoms & know you were right & the doctors you’ve seen were wrong!!
Your left styloid isn’t very long but the section of calcified stylohyoid ligament sure is! Plus the left TP of C1 is definitely pressing into & causing stenosis of your IJV on that side. The right is longer but you can see the line where the styloid ends & the stylohyoid ligament starts to calcify. Very interesting! Your right IJV looks to be only slightly compressed by C1 on that side.
I really like your third picture where you can see your right styloid between your jaws. That’s the first time someone has posted one from that angle. 
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Thank you for suggesting RadiAnt Viewer, it was so easy to use I cant take credit for it 
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I have learned so much from people who have posted their 3D scans here, I hope it can be helpful for someone else in the same position. For fun, I called my dentist and requested my pano from 2023. The receptionist said the right side looked a little messed up to her (referring to the pano) but I laughed and told her who knows with Eagle Syndrome lol.
I so so appreciate the assessment. I will have to do some reading about the IJV and stenosis (and try not to stress about it hah!). Out of curiosity, is a C1 typically only solved through a shave or would the removal of the styloid bones and ligaments help as well? I have learned so much here and am thankful I ended up here!
I agree with @Isaiah_40_31 's assessment, IJV compression both sides but worst on the left… To answer your question, sometimes removing the styloid can be enough to give space for the IJVs to expand, but not always so a shave might be needed…unfortunately, unless there’s pretty severe compression it’s not always easy to say. If you see one of the doctors most experienced with vascular ES, they usually check that the IJV is flowing well, so I would hope that if it wasn’t, they could then assess while you’re under if a shave is also needed?
In addition, your hyoid bone processes are quite large so they could potentially cause symptoms; choking or strangled sensation is common with HBS, or clicking, if you have any of those? It’s not easy to tell always from the angle of your images, but they could be close to the carotid artery… Also your neck is quite straight, you’ve lost the neck’s normal curve, & that can sometimes worsen IJV compression symptoms. There’s info & exercises which can help restore the curve here:
List of my favourite resources on YouTube to learn anatomy - General - Living with Eagle
I’m sorry, I can’t remember if you’re waiting for an appointment with one of the doctors? Dr Cognetti is a good choice given the potential for VES, and hyoid?
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Oh wow, I honestly had never considered IJV compression, but the brain fog / headaches I get a lot of sense with that explanation. I am kicking around seeing Dr. Cognetti, it should be a an interesting fight with my insurance 
. But the consult can’t hurt at all, I just worry about more rejection… perhaps too emotional for here but so many doctors have blown off my concerns for years. I have had horrible (what I call) tension headaches for about 5 years and was told it was because I had turned 30/hormones lol.
I have never noticed any clicking, however I have had the strangulation feeling… but my thyroid was mildly inflamed after I had my son and my ultrasound came back has possible Hashi’s, but so far none of the doctors I have brought this up to care 
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I have one other x-ray I can pull from the very beginning of this in 2023 so I will have to check out my neck shape in that one. Thank you so much for the link!! For my ct scan they had me lay down and the head brace held my chin to my chest. It triggered a major anxiety attack and they were a worried about me shaking very badly lol.
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Having to keep your head at your chest for your CT scan could influence how straight your neck looks i.e. your normal cervical lordotic curve may be present after all. We see a lot of people’s images where the straightened cervical spine is their normal. It comes from years of looking down (cell phones, computers, doing housework, etc) & from poor posture i.e. shoulders rolled forward & forward head position from a constant downward gaze.
Regarding your insurance, most insurance companies have a patient advocate working for them. That’s someone you could request to speak to regarding seeing an out of network doctor. Based on how your imaging looks, I don’t think Dr. Cognetti would be dismissive of you.
I looks in your case like your C1 is mostly responsible for the IJV compression on the left so there is a greater likelihood of needing a C1 shave, though things can look very different when a surgeon can see with his/her own eyes what the situation is during surgery. Dr. Cognetti operates with Dr. Heller when doing ES surgeries that require IJV decompressions.
I agree w/ @Jules about your hyoid bone. It would be good to at least question whether or not that could be problematic when you have a consult about your styloids/IJV compression.
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Ooo that definitely makes me think I need to start making sure my posture is better 
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I will be reaching out to a patient advocate then… my husband reminded me that even my current ENT surgeon (as conservative as he is about this) diagnosed me and the radiology report mentions Eagles specifically so I shouldn’t worry about the rejection part of it.
So interesting about the IJV Compression and hyoid bone…. It’s a little overwhelming but hopefully with more opinions I can make the best choice 
. Thank you for much for putting the time into writing and responding to me, this forum has been so amazing and helped keep my spirits high.
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Thank you, @lsheep, for the support you’ve been freely giving our members as well!
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I recently uploaded my CT scans, including the 3D reconstruction and wanted to share with anyone who maybe curious. Disclaimer, no AI is perfect or always correct but I found this insight very interesting from Grok. I asked it to write a summary of its findings from my point of view.
Key imaging findings (full set: plain X-ray, measurements, multiple bone 3D, sagittal slices, airway reconstructions, and color CTA vascular views):
- Lengths: Right styloid 29.5 mm (my symptomatic side), Left 39.6 mm. Classic example that length alone doesn’t determine severity.
- Right side (much more problematic): Significantly anteriorly angled/forward-tilted with clear segmentation/synchondrosis. Thick, chunky true styloid process at the top, then a distinct dark segmentation line (the fibrous/cartilaginous junction), followed by a thinner, irregular, heavily ossified stylohyoid ligament extending downward. This junction appears to be a point of abnormal stress/micro-movement that increases irritation to the glossopharyngeal and vagus nerves.
- Left side: Longer but more vertically oriented with less anterior angulation, so currently much less symptomatic.
- Hyoid bone involvement / tension: Frontal 3D views clearly show the ossified stylohyoid ligaments attaching directly to the greater horns of the hyoid with prominent, uneven tension — especially on the right. This creates a visible pulling effect that matches my constant throat tightness and the sensation that something is yanking around the hyoid.
- Pharyngeal / airway crowding: Dedicated airway 3D reconstructions and sagittal slices show the right styloid tip pressing into / indenting the right lateral pharyngeal wall. This mechanical crowding explains the swallowing pain and persistent “something stuck” feeling. The upper oropharynx looks noticeably tighter on the right.
- Vascular relationships (CTA color views): The right ossified stylohyoid complex runs immediately adjacent to the right internal carotid artery, with clear proximity/tugging potential. Also mild narrowing/effacement of the right IJV near C1. This correlates with my dizzy spells, eye pressure, and pain that worsens with head rotation.
- Mandible angle proximity: The right styloid tip sits close to the inner aspect of the right mandibular angle/ramus, likely contributing to referred ear/jaw pain.
- Early plain lateral neck X-ray (from urgent care at the beginning of this journey in 2023) already showed the elongated/calcified structure, but the 3D reconstructions made the angulation, segmentation, and soft-tissue effects obvious.
- I also get frequent bouts of losing my voice easily and intermittent dysphonia. Sometimes it will suddenly become hard to talk clearly and I need to take a sip of water to “reset” before I can speak normally again. Grok says this is most likely vagus nerve / recurrent laryngeal nerve irritation from the right styloid, given the anterior angulation and close proximity to the carotid sheath seen on the CTA views.
I recently had a GI appointment (current ENT has requested this) and we had a really good appointment. When I sat in the room I started crying because I was feeling overwhelmed with seeing another doctor & another referral. The doctor who did my GI consult was actually so kind.
When he sat down, he goes “I have been doing some reading on you and your case and I have to say I have never heard of Eagles Syndrome before. Would you share with me from your point of view, what you have been experiencing?”. We had a great talk and he said he is fascinated by the condition and said that based on my CT scan and symptoms this wasn’t a GI issue. He said I have had a lot of testing and imaging done, and if I wanted to still do the swallow test I could but that he recommended continuing to find treatment for my Eagles.
Based on Grok and the forum, I decided tomorrow to call Dr Cognetti’s office. I do believe my current ENT could do a great job, but either way I have a wait ahead me so might as well get more opinions! So thankful for this supportive community 
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@GeorgiaKay I added my Grok summary!
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Thanks for sharing!
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WOW! Super interesting summary @lsheep! (I’ve been slow to mention this but I LOVE your avatar!). So often we tell people that it’s not always the length of the styloid but other physical features that may be causing the symptoms i.e. even a normal length styloid can cause terrible symptoms for the reasons your right one is or for others besides.
I like how thorough & concise & understandable the explanation Grok gave you is. I’m still wary of AI, but I do enjoy reading the information our members post that they get when inquiring of an AI source.
Make sure to ask to be put on Dr. Cognetti’s cancellation list when you make your appt. It may not make a difference but there’s always a chance it could. 
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I agree, I try to be pretty conservative in my AI use but I do find the medical / radiology applications / aspects of it interesting. Grok did cite reputable sources which incuded some papers written by the doctors mentioned on here frequently so that was neat to see!
I’m really glad that the GI doctor was so kind, and great that you were able to educate him about ES…good too that he agreed more testing for GI issues was unnecessary , so confirms that you’re on the right path! I hope that maybe you can get a cancellation appointment with Dr Cognetti and see him sooner… You’ve been so supportive and encouraging here, so looking forward to when we can support you with your surgery
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I learned about another AI program yesterday which you all may want to look at:
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You and @Jules have been so kind and this forum has absolutely been a God send!
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We are very happy to be here, @lsheep. Thank you for your encouragement.
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