Hello! I have bilateral elongated styloids and calcified ligaments.
I just did a consultation with Dr. Dewan to check into hyoid bone syndrome and she mentioned my hyoid bone is very close to my neck. She suggested doing surgery to reduce the hyoid and detach the calcified styloids in the process. She also mentioned that I could possibly get steroid and Botox injections to help instead of surgery. I’m hesitant to go the injection route as it isn’t permanent, I have borderline osteopenia, and I had a bad reaction to Botox in the past (dry eyes, weak eyelid movement, and double vision).
I think some folks here had surgery with Dewan for hyoid bone reduction with good results, but I don’t think anyone has seen her for Eagle. I had some questions maybe some of you could answer:
Will reducing the hyoid and detaching by the calcified ligament address the the ES as well? I thought the styloid had to be reduced as well?
Do any doctors (like Hepworth) also address hyoid issues during ES surgery? Or, am I looking at two separate surgeries?
Could the ligaments be causing the hyoid to be drawn closer to my neck and therefore by removing them it would solve the problem without having to reduce the hyoid? (She didn’t mention that it was incredibly elongated, just that it was close to my neck and reducing it would help).
For those of you who have had surgery with Dr. Dewan: was it to treat ES or your hyoid? How was your experience?
I would never do botox personally. You are just injecting poison into your body. Even if it was to work, it in only a temporary situation and its pretty much just a band aid.
@LittleBird - I’m really glad you saw Dr. Dewan already. You’re off to a good start!
We have members who did not have elongated styloids but did have calcified stylohyoid ligaments separate from their styloids which were causing their ES symptoms. It sounds like that is what Dr. Dewan noticed in your case.
My question is, will she detach the calcified s-h ligaments & remove them or will she detach them from the hyoid bone & leave them in your neck? If she plans to remove them entirely plus shorten the greater horns of your hyoid, you should get good symptoms reduction over time. However, if she would only separate the calcified ligaments from the hyoid & leave them in your neck, you’re likely to continue to have ES type pain until those ligaments are removed, too. Recovery for ES &/or HBS surgery takes a number of months because the affected nerves are very slow to heal thus having surgery will not be a quick cure for your pain. Many of us have trod the long road to successful recovery from ES surgeries, & some from HBS surgeries, but have been happy with the results in the end.
Dr. Cognetti in Philadelphia will do both at once, I believe, but you would need to have a consult with him to confirm that. He will do virtual consults so you wouldn’t have to travel to see him initially.
This is an excellent question! It’s possible that your calcified s-h ligaments could draw the hyoid closer to your spine & having the ligaments removed might release your hyoid to settle into a better position. From reading the experiences of our members who’ve had HBS surgeries, I think having the ligaments removed would be an easier & potentially quicker recovery option for you. If your hyoid symptoms continued to bother you 6-12 months later, then it would be time to consider HBS surgery. Can you message Dr. Dewan to ask her this question, or if you asked her, what was her reply?
As far as I know, everyone on this forum who’s been to Dr. Dewan for surgery saw her for hyoid resection.
@a_catindisguise is our most recent member to have surgery with her. She’s posted her experience fairly extensively in several different threads.
Thank you! You are always such a great help! From whatnot sounded like, she mentioned detaching the ligament from the hyoid bone and reducing the hyoid bone. She mentioned the ligaments would remain in my neck; not sure why she would choose to do it that way but I could ask.
My styloids themselves are slightly elongated (3.5 on the right. I was told two separate things about the left: one doc measured it at about 3cm. Another said it was normal.) There are pretty extensive calcified ligaments connected to both though.
If you’re ligaments are calcified then personally I would want them removed as well; if they’re left in as per my understanding of what you think Dr Dewan said, then they could still rub against nerves and cause symptoms. Doctors commonly detach ligaments and leave them in (mine were detached from the styloid process & then left in when the SP was removed) and this is find if they’re not calcified, but I don’t understand why a doctor would want to leave calcified ligaments in…
So I think you should hold fire for now, & see if there are any doctors who would do both styloids & hyoid bone shortening, plus remove the ligaments if you think that the hyoid is also a problem.
I would definitely ask why she would leave calcified ligaments in your neck vs removing them at the time of the hyoid resection.
Some sources consider 3 cm to be normal styloid length though the average length is considered to be 2.54 cm. If you’re a smaller person, then a 3cm styloid could be huge whereas for a very tall person, 3 cm might be considered more normal. Again, it’s not necessarily the styloid length (along with the calcified ligaments) that is the issue, it could be some other physical feature of your styloids that is causing them to contribute to the symptoms you have. We have a member who just had an almost normal length styloid removed because it had grown what looked like barbs on its sides. Fortunately, she saw Dr. Hackman who recognized the significance of the outgrowths from the styloid & was willing to remove it though it lacked significant excess length.
Again, I’d recommend consulting w/ Dr. Cognetti & possibly Dr. Hackman, who’s a bit closer to you, to get their opinions. I’d specifically ask if they think calcified ligament removal might free up your hyoid & allow it to move away from your spine into a more normal position. Calcified ligaments tether the hyoid & keep it from being able to move normally as it does when you talk, swallow, breathe, sing, cough, etc. I expect that’s why the clicking & pain occur during those activities - because the hyoid has been immobilized. FYI - Dr. Hackman does bilateral surgery i.e. both sides at once whereas Dr. Cognetti doesn’t, however, Dr. Cognetti has been mentioned as doing hyoid bone surgeries whereas Dr. Hackman hasn’t.