I’d like to provide an update and encouragement to anyone still chasing diagnosis and treatment. I had a bilateral revision by external approach with Dr. Hackman in January following intraoral partial resections in 2011 (left) and 2025 (right.) Full history can be found in my January post.
At 4 months I’m doing quite well. I have a slight numbness around the incisions. They are barely visible, sort of blending in to my 59 year old face. My headaches and face pains are gone. My inner ears are occasionally sensitive and itchy perhaps due to nerves healing. I have occasional tinnitus but less frequent and painful than pre-op. The chronic aching in the left carotid has remained at bay with just an occasional small amount of pain if I speak a lot and get fatigued. It’s usually resolved by morning. My voice is getting stronger but it’s been extremely slow. I don’t know if it’s because my vocal cords are deconditioned from so little speaking for a year or if it’s from nerve injury. I no longer feel like my head is going to explode when I speak so that has made a huge difference in my overall condition mentally and physically. The quality of my voice is better in the morning and worse with use over the day. Sometimes I can’t produce sound but it’s usually very brief- 30 seconds at most. I no longer feel disoriented and doomed when turning my head back and forth such as during driving. This was an unnerving symptom that I mistook for normal aging. I’ve noticed marked improvement in cognition - also blamed that on aging. My biggest problem at this point is just my lack of strength and endurance after being too sick to exercise for so long. I trust my voice and fitness will return eventually.
The I feel so grateful to have been able to travel across the country to see Dr. Hackman and to have had an excellent outcome. If anyone has questions I’m happy to help.
Thank you for update! I’m so pleased that you’re surgery has helped with lots of your symptoms, it sounds as if you had Vascular ES but this has resolved those symptoms, so that’s good! I hope your voice does strengthen & improve with time, and your strength too, it is still early days only 4 months since your surgery…
Thanks for your encouragement to others
WOW! What a great & encouraging update, @Kiki67! I’m so glad your surgery w/ Dr. Hackman has made so many improvements in your symptoms. I bet by a year post op most everything will be gone & your voice will be stronger.
Work on your fitness level by baby steps as trying to jump back in with both feet may jumpstart some old symptoms which would need to heal all over again. As you said, stay persistent & patient even with exercise, & your body will respond. You were very ill for a long time so it will take time/patience to get back what you lost.
Thank you so much for sharing! This gives me hope. I’m so sorry you had to go through a revision after intraoral surgery, it’s so frustrating and discouraging when such an invasive treatment doesn’t work the first time:( but I’m glad you were able to ultimately get help.
Do you mind sharing more about the resolution of your headaches and facial pain and carotid pain? Did that resolve immediately after surgery or did it take time? I’m 2 weeks out from my first side decompression and trying to be patient
@Kiki67 - Dr. Hackman is such a great doctor, and I am happy that you had a positive experience with him. He really helped me. You may benefit from speech therapy at this point in the recovery process. The vocal cords do need exercise to regain full function and a professional speech therapist can help get that process started. It took several years and a series of visits with the speech therapist for my speech to improve, but it finally has gotten better. Seeing a physical therapist to help regain some muscle strength and balance also helped in my recovery. Getting the neck and shoulder muscles functioning normally takes some work. I still go to PT as frequently as insurance will allow. Wishing you the best and a smooth recovery.
@Carina: After my 2011 left intraoral surgery I never again had the unilateral crushing headaches. Resolution was immediate I believe due to my carotid being decompressed.
After my January 2026 bilateral revision, most notably the uncomfortable pressure feeling in my head was noticeably absent within days. The sharp nerve pains in my head and face took longer to disappear, perhaps a month. The aching in the front of my neck that I understood to be my carotid artery stopped constantly aching pretty quickly. From what Dr. Hackman said, releasing the scar tissue that was connecting the styloid remnant to the structures in the direction of my chin and neck is probably what improved the aching carotid artery. I wasn’t having anything I would describe as headaches during the last couple of years when I became symptomatic again. It was more like a feeling of hanging upside down too long.
Dr. Hackman believes that the intraoral approach can fail in the long term because of the propensity for the tissue on the styloid remnant to try to “reconnect” to the hyoid via scar tissue. In my case the carotid pain reappeared about 3 years after my first surgery. At the time of my second surgery my surgeon declined to address a left sided revision because of the excessive scar tissue. He could feel it both in my mouth and neck. He didn’t think it was safe for him to take it on. That is how I ended up consulting with Dr. Osborne and Dr. Hackman.
@Catmd Good advice! I’ve had a little speech therapy before my revision but my insurance ended its contract with the only clinic in my city and now I’ve lost my coverage because I couldn’t make it back to my job due to the voice issues. My employer wouldn’t allow breaks for vocal rest. I’m doing self guided vocal exercises.
The pain I was having in my upper back, shoulder, ribs, clavicle area has subsided and I’m working on strengthening so I can resume my sports. I’ll go back to PT after I get new insurance and pay off my surgery bills if I’m not back to normal by then.
@Jules Thanks for the early days reminder. I sometimes forget that what took years to develop could also take a while to resolve. My poor body… I’ve been dealing with this for 17 years.
@Isaiah_40_31 I did jump back in a little prematurely and my back reminded me I’ve been on the sofa for almost 2 years. I couldn’t stand up straight for a week . Now I’m trying baby steps.
So glad you are doing better! I am 2.5 weeks out and still having the carotid pain, it kept me up all night last night. But I think my thyroid cartilage is still pressing on my carotid, and I may have TOS causing issues as well. Going to get evaluated for that in July. Thanks for coming back to share your experience!
Good job, @Kiki67. You want to get back out on the water so do whatever it takes to get there!! It’s frustrating to have to start slowly once you’re feeling better. You’re strong & your endurance will return quickly once you start being able to workout again.
I hope you’re able to get a job that isn’t so voice dependent, at least not until your vocal cords are stronger. Your plan for moving forward sounds well thought out, too.
@Isaiah_40_31 I made it onto the river with my team this week and did about 7 miles of paddling. It wasn’t pretty but I did it! I had some pain in my carotid and my ears acted up but it was temporary. Worth it
AWESOME! @Kiki67!! Just a heads up not to try doing back to back longer paddling right now. Put some days between & gradually work back up to your regular schedule. I probably sound like a broken record, but I speak from experience.
. Now I’m trying baby steps.
