Can you tell anything at all from this x-ray?

General
1

Hi,

I’m yet to have my CT scan (which I’ll be having any way for use in the planning of an upcoming jaw surgery), but I just remembered that I do have a 2D dental x-ray.

I know this is far from ideal, but I’ve seen that sometimes the styloids are picked up on these. Unfortunately, I don’t think mine is wide enough to really show anything, but I do see a pointy thing on the left side of the image. I presume this is the styloid? And I think I see what is the stylohyoid ligament on the left there too, though I don’t know what appearance constitutes it being ‘calcified’. Thanks.

LG OPG
LG OPG1091×587 67.8 KB

2

Yes, I think that is your styloid, it’s not massive but a bit longer than average, and definitely quite angled which can cause symptoms. I can’t remember which side or both you had some symptoms on?

2 Likes
3

Interesting, thanks, Jules. The symptoms are on my left side, but I can feel the styloids in my tonsil area on both. Only on the symptomatic left side, though, can I feel the bone under my jaw angle, and when I press on that my tinnitus gets louder.

I assume we’re both looking at the same thing – the barely visible spike to the left of the midline of my teeth next to the jaw angle?

Below my jaw, I’m thinking this is the ligament? I couldn’t tell whether it was the ligament or my hyoid bone, but it is distinctly more visible than the one on the left side. I’ve been trying to compare it to confirmed cases of calcification/elongation on other 2d x-rays I’ve found.

4

I’m rubbish with techy stuff so can’t annotate it for you, but yes, the little spike level with the lower teeth. I think below the jaw is the hyoid bone process…

1 Like
5

I’ve just done some looking into this. I think the evident notch is indeed the hyoid bone process, but that the sharply angulated thing ascending up towards my styloid is a calcified stylohyoid ligament.

I found this image of someone with calcified ligaments and styloids. I think the hyoid bone itself represents the part that curves round that I’ve annotated indicated in blue, and then of course the red arrow is the calcified ligament.

Panoramic-view-at-the-first-visit-shows-calcification-of-both-stylohyoid-ligaments

My anatomy is different but I think I can pinpoint the same thing:

LG OPG
LG OPG1091×587 69 KB

Looking at normal dental x-rays, I don’t think you’re supposed to be able to see that unless there’s calcification.

Same sort of thing on another one I found:

rf
rf1958×1683 200 KB

2 Likes
6

@LG18 - Good job researching & finding your styloid & hyoid bone. I can annotate images, but I’m really bad at seeing the styloids in pano x-rays. @Jules excels at that though.

I want to note that the styloid process isn’t always distinct from a calcified stylohyoid ligament (as you outlined them in the final image you posted). Often the styloid seems to elongate along the path of the s-h ligament which begs the question: Is it actually the styloid process elongating or the s-h ligament calcifying from the tip of the styloid giving the sp the appearance of elongation when it’s actually just the ligament that has calcified? In the end it doesn’t really matter since the result is the same either way - pain & misery for the bearer of styloid elongation/ligament calcification in many cases.

2 Likes
7

Thanks for the reply, Isaiah.

What you say makes a lot of sense – it’s a conclusion I considered myself when looking into these x-rays in further detail and reading their associated papers. I wish my own X-ray was a bit wider, as then I’d get a better sense of the relationship between my styloids themselves and the ligaments.

I actually just got off the phone with my jaw surgeon – he says he can fit me in for my jaw surgery February 9th, and I’ll be heading down to his facility next week to get a full head and neck CT, so things should be much clearer then.

Given that most of the papers I’ve been reading regarding ES are written by MaxFax surgeons like him, my own ES situation is something I’ll be discussing with him in detail as it relates to my jaw surgery; it may be that he will remove them himself. He told me that while ES is pretty rare as we know, it’s fairly frequent that he sees patients with elongated styloids, though this has never been an issue for him when performing surgery.

He even postulated that having a heavy, calcified ligament may even have played a part in the recession of my lower jaw, in that if I’ve had it since childhood (I’m 27 now), the force of it pulling backward could’ve contributed to deformity.

I’m yet to discuss with him what I think is slight jugular compression (I get a bit of wooshing when I stand after laying down sometimes, and sometimes when I pick up something heavy), as that is something that slightly concerns me. I have pretty bad health anxiety all things considered, and I have to admit, the ‘what ifs’ have kept me up at night a bit lately – worrying that in having these big jaw movements, my styloid, already possibly slightly impinging my vein, will break during the surgery and stab into it creating a life or death situation on the operating table.

I’m probably – as I have characteristically done my whole life – overthinking it. He’ll know what to do to prevent any such event I’m sure, I just feel a little bit like a case study, as given the rarity of ES, I doubt anyone with it has been documented as concurrently having a double jaw procedure.

Then again, I’m distinct from pretty much everyone here on the forum in that my case is very mild. I don’t have any severe symptoms that affect my life significantly, and if it wasn’t for this slightly disconcerting wooshing, I don’t think it would be worthwhile investigating ES further at this stage in my life. I feel very much an ‘in-between’ case: not in the category of having ES as all the other poor members here would define it, but not exactly having asymptomatic styloid elongation either!

2 Likes
8

Great that you have your jaw surgery soon, & hopefully the CT you’re having will show everything clearer! Where will the jaw surgery be done?

9

As you mentioned, this scenario is most unlikely to occur, but I don’t think it unwise to be aware of possible negative surgical scenarios so you can discuss them with your surgeon & how he would prevent something like this happening during surgery so your fears can be calmed.

I love that your surgeon is “thinking outside the box”. What he postulates makes lots of sense. We have seen cases where ES is hereditary, & children whose parents have it, have also been diagnosed at young ages. The youngest we’re aware of on this forum was 7 or 8 when his symptoms began, but he wasn’t diagnosed for 3-4 yrs. As in your case, it took quite awhile & leaving no stone unturned.

2 Likes
10

Thanks, Jules, I’ll actually be having the surgery in California privately. I’ve done a lot of surgeon shopping and have finally found someone I trust, so it’s worth the travel!

1 Like
11

Thanks, Isaiah. Yes, I’ve consulted with a ton of surgeons, and there’s a distinct difference between who I’m going with and every other that I’ve spoken to.

He’s very much a problem solver, and he’s extremely passionate about what he does, but also very kind. It’s a combination of traits that made him the obvious choice.

I’ll document everything in detail here once things progress, in the event that it’s useful to anyone else. I’ll be having a 320-slice scan on his state-of-the-art CT scanner, so the images should be interesting.

1 Like
12

Will be interesting to see the imaging…a long way for you to travel, shame you can’t have ES surgery there too, but maybe you’ll get lucky & your jaw surgeon can so it!

1 Like