But my dentist saw something…

General
1

Hello there! I found and joined your forum primarily to figure out a next step. As of today though, I’m not even sure if this will become a part of my story!

My journey with pain began about a year ago with a pinched cervical nerve and symptoms of whiplash for no obvious reason. My GP connected me with PT and took my pain seriously, but he admitted he was stumped. The pinch resolved within a couple of weeks, but the muscle spasms, painful turning of the neck, and headaches never did.

So, all these months later: done with PT, learning to work out with pain, several traction devices around my house and Advil daily, two X-rays and one MRI in the books… I opted for many months to just do what I could from home, and assume my GP was out of ideas. I started experiencing other symptoms that I assumed were related to the neck issue, like my tongue going a little numb, a crazy long dizzy spell, insomnia, ear pain. I didn’t bring them up because, well, I dunno. When you’re a hot mess and your doctor is stumped, sometimes your just out of ideas?

So this Fall I resolved to give my doc a call again. He referred me to a spine specialist and an ENT. I saw the spine specialist recently and she mentioned cervical stenosis and arthritis, and began with an occipital nerve block and suggested I research tricyclic pain med. The block helped a little. I have a follow up with her in a couple of weeks and will meet the ENT next week.

So, after all that random info, why am I here??? Well, I went to see my dentist for bi-annual checkup and mentioned jaw pain. He ran a fancy X-ray to look at the joints and saw something he said he hadn’t seen since dental school. “I think you have Eagle’s Syndrome”

I sent the images to my spine doc and ENT. I log on here to see what doctors even consult regarding this, and I begin to see some familiar stories. But much more than that, I begin to read that this might actually be a fix for my pain. And it sounds less daunting than spinal fusion or nerve ablation. But here’s the kicker - my spine doc got back to me yesterday and said she looked at my previous MRI (I don’t think she looked at the dentist’s images) and “didn’t see any evidence of an enlarged styloid process”.

I can’t imagine why the dentist would see something he considered an anomaly, then the spine doc also look and say everything looks normal. Is that situation at all relatable to any of you?

I know you all cannot figure this out for me. I just wanted to start there. Maybe I’ll be a novel case of Faux Eagle, ha. At the very least, I have gained a lot of vicarious relief from all of your stories.

Thanks for listening!

2

Hi @Starfish,

My knee jerk response to what your spine doc said is - ES is not easily seen on an MRI because the MRI highlights soft tissues which can block the view of the styloids, in part or fully. A CT scan of the area from skull base to hyoid bone is the best way to look for styloid elongation.

Since a CT is an x-ray on steroids, it makes sense that your dentist could see your styloids (he probably gave you a panoramic x-ray) & suggest ES as a diagnosis. Many of our members have been diagnosed by their dentists when no other doctor had a clue. Some ES doctors will actually use the nerve block technique to help diagnose ES, but the injection needs to be given in the tonsillar fossa (in your throat) or using ultrasound guidance through the neck in the area near the skull base. In some cases, the patient gets tremendous symptoms relief for a few weeks, & in others, it makes the pain worse. Either scenario can indicate the presence of ES.

To confirm your dentist’s opinion, the symptoms you describe are often seen w/ ES - neck/head pain w/ head turning, headaches, dizziness, tongue numbness, insomnia & ear pain. The crazy long dizzy spell could indicate that you have vascular compression when your head is in certain positions, but it could also just be nerves being pinched.

If you can get a copy of your dental x-ray & post it here, we can give our non-medical opinions as to what we see. That could be helpful for you.

We want your relief to be real not vicarious! I think your dentist is on to something!

3

I actually left a message this morning w/ my dentist to see if I could get one or two images for myself - that would be fun and I’d be glad to share them with you all. I remember you mentioning to me that a CT scan is gold standard, but now I understand.

I’m also confused about the difference between an enlarged styloid process vs. a calcified stylohioid (sp?) ligament. My dentist told me it appeared as if my ligaments have become calcified, but the MD only mentioned her opinion of the processes. Is that not two different potentials to investigate?

Thanks for your encouragement, as always, @Isaiah_40_31 !

4

@Starfish,

Styloids don’t typically enlarge, but they do elongate. In some cases they can become very thick, but usually the issue is length & other physical features such as how curved, twisted or pointed they are. The age old question is whether it’s the styloid itself that elongates or whether it’s the stylohyoid ligament that calcifies starting from the tip of the styloid process, giving the SP the appearance of elongating (which in essence is what happens).

When I was originally diagnosed, the ENT told me I had calcification of the stylohyoid ligament yet when I saw my CT results, all I saw were two very long styloid processes (at that point, I knew nothing about the s-h ligaments which run from the tips of the styloids to the lesser horns (aka cornua) of the hyoid bone. In more rare cases, the styloids remain normal length (2.54 cm/1 inch) & the stylohyoid ligaments calcify from the hyoid bone end toward the SPs. This is also considered to be ES though many doctors will not diagnose it as such & don’t believe it causes similar symptoms. We know better…just ask one of our members who’s had that version of ES!!

I hope this answers your questions. I also hope your dentist will share some x-ray pics w/ you so you can share with us! :blush:

1 Like
5

I was diagnosed at a dental clinic through a panoramic x-ray, so I would trust yours! Hopefully you can get copies of yours…the definition of ES is elongated styloid processes &/ or calcified stylo-hyoid ligaments which cause symptoms, so it does sound a possibility for you. As Isaiah says, the styloids aren’t very visible with an MRI, & many doctors aren’t knowledgeable about ES, so we often suggest that when you have your next appt with the spine doctor or ENT, that you take the images with you, and also copies of research papers which support your case- ones that mention symptoms like yours, or general info about ES, how a CT is good for diagnosing etc. If they still don’t diagnose you then try to push for a CT. (There’s links to research articles in the Newbies Guide Section)
I hope that this helps and you can get somewhere with the docs soon!

1 Like
6

Thank you @Jules ! I will know lots more this time next week, and will keep you all posted!

2 Likes
7

Perrett Eagle Images
Perrett Eagle Images1620×1620 202 KB

Hello again @Isaiah_40_31 and @Jules ! ENT appt. is pushed back one week b/c of a cold, but my dentist sent me a still frame of the images he thought indicative of Eagle’s Syndrome. I can’t tell, really, how long mine are compared to normal styloid processes. Can you?

1 Like
8

Those look about 3.5 on the left and 4 cm on the right to me. Mine are 5 cm on each side and go down past C2. Definitely elongated, and not much space between the C1 vertebra and the styloid on the top right sagittal view. Definitely possibly for vascular compression in that area.

9

Wow, @coldbear , that’s more than I could have discerned. Do you know what the brighter structures are, heading downward beside each process?

10

It’s a cut through the jaw…

11

Would be really greAt, if you could get a CT/ CTV to have a look at possible vascular engagement!

12

Ah, @Eaglefatigue , I see now. And yes, that would be fun to see!

13

Hi Starfish,

I annotated the sagittal view to show the space between the styloid & C-1 in case you were unclear what was being talked about.

I don’t know how to measure your styloids accurately based on a picture, but I will say both look thick at the skull base, long & pointed - all features that would cause problems. If you plan to see Dr. Hepworth, he can request a CTA for you to look at your vascular situation & if it appears the IJV is compressed, he’ll send you for further testing.

Here’s the marked image:

Perrett Eagle Images
Perrett Eagle Images1620×1620 203 KB

14

Oh, I had no idea what i was looking at in that bottom left image. Thank you for clarifying, @Isaiah_40_31. I’m in the Springs (hour south of Denver) and have an appt. with my husband’s ENT. I don’t know yet what experience he has with this (though I’ll admit I was deflated when his PA told me she’d never heard of Eagle’s Syndrome). I will certainly know what questions to ask now, about the potential significance of these little icicles on my headaches and pain.

1 Like
15

Headaches can be an indicator of vascular compression. It does NOT bode well that the ENT’s PA is unfamiliar w/ ES. Any ENT who is practiced w/ ES will have a PA who knows about it. Dr. Hepworth is THE go to doc for people w/ ES in CO, especially w/ vascular compression, as he is one of the most experienced vascular ES doctors on our list. He stopped taking new patients at the end of last year, but I recall recently reading that he’s making appts for new patients about 3-4 months out now. It would be a good idea to call his office & schedule a consult so the waiting time isn’t even longer for you. From what everyone who’s seen him says, he’s worth waiting for.

1 Like
16

Well then, I’ll give his office a call and see where they’re at! Thanks again, @Isaiah_40_31

1 Like
17

They do look really nasty & spikey! Normal styloids are only visible as a little stump so they’re definitely elongated! I hope that you’re able to get on Dr Hepworth’s list :smiley:

1 Like