Day 11 Post-op Left sided stylohyoid ligament surgery - Photos

Sorry I’m just now posting my experience (thus far) since my first surgery. Prior to my surgery I decided to stay off the forum and the ES FB page as I was having a lot of anxiety from it. I had been trying to postpone my first ES surgery in order to do some egg retrieval cycles first. I did one cycle that was canceled before retrieval due to my bloodwork showing I had already maybe started ovulating and so we’d miss the eggs (we were very sad). So then after that I started experiencing more issues with ES, most notably a clicking when I swallowed, which was very unnerving. As well as a couple times it hurt very badly. So I decided to do my surgery on July 18th (my first one I had postponed from June to try egg ret.).

I asked to have the smallest tube (for adults) for intubation to avoid vocal cord issues (which I still did get on day 3, and I basically lost my voice and went on vocal rest). I also told the doctor about the degenerative issues in my c5-c6 and c6-c7 for neck positioning during surgery. Dr. Donovan was very nice, and the whole team was really caring and great during the surgery and the day of and the day after.

My doctor saw me again day 3 post op just to check on me. Also because he was going out of town all this week. So on day 7 I saw a stand-in doctor to have my tape removed and stitch taken out. However, Dr. Donovan had planned to see me and do that on August 4th. But I was ready to have the tape off and because I wanted to talk to a doctor about the pain I was having in the back of my head/neck.

I am day 11 post op today. I had my left side stylohyoid ligament (the most problematic side and the most calcified) removed via extraoral surgery by Dr. Donovan at Baylor in Houston, TX. at St. Lukes Hospital. (Donald T Donovan, MD, FACS | BCM)

Apparently, my stylohyoid ligament was deeper than expected. The platysma muscle was cut (which apparently is normal to get to it), and mine was “well-established” to get to the ligament. The ligament was about 4cm long and pretty much fully calcified. I stayed the night in the hospital for observation with the drain tube.

Immediately it was apparent that my tongue on the left was swollen. Apparently the muscle on the right was pushing on the left as the left is currently damaged. Also I can’t pull my left lip down. My right side seems to pull down extra far now, probably because it’s stronger and I can’t tell if I’m pulling the left side down. The doctor said the lip will probably be the longest wait to heal at about 3 months. So my smile isn’t normal. My tongue has gotten somewhat better and I can eat a little better (using my tongue while eating) since right after post-op. Thankfully, I don’t have any numbness anywhere. I can feel my full tongue and my lip. I just can’t control my lip very well/at all on the left side to smile normally. And my tongue seems to get “tired” on the left throughout the day with talking a lot.

But one concerning thing I’ve had beyond those things, is since about day 5 or so I’ve been getting a bad tension type headache on the back of my left head where it meets my neck. I’m hoping it’s just from the tight muscles due to surgery (and not permanent occipital neuralgia–please I need to not get too nervous about that prospect), but every time I lie down on my back or try to sleep it hurts. It aches. I’ve tried a muscle relaxer which maybe helped slightly? Last night I was able to sleep fairly well (without a muscle relaxer or pain killer), but I have to turn to my left, then to my right side, throughout the night. As it hurts to lie on my back or one side too long. When I wake up though, my right side (where I still have a ligament) feels a little sore.

Also the pain seems to be connected to my swallowing. When I swallow it still hurts sometimes in the left tonsil area. It feels maybe tight? And I can sometimes feel a pain when I swallow on my left side tonsil as if it’s connected to the back of my head. It’s very odd.

The stand-in doctor I asked about this when I was having my stitch removed, and he thought the back of head/neck pain is because I’m holding my head/neck in a certain way to compensate or doing something that could be making it hurt.

I’ve also now become more anxious and aware of my right side ligament being there. And wondering how long I should wait to have that surgery done. I’m also trying to fit in some cycles of egg retrieval first ideally (I’m 38 and don’t have any embryos made with my husband).

Dr. Donovan did my surgery. He said although my surgery wasn’t out of the realm of normal, he did think it would go better for me. But my ligament was deeper than expected. He thinks he’ll have better ways to go about my right side. I have another post-op appt. next week on Aug. 4th.

There’s also another doctor who does intra or extraoral who took my tape and outside stitch out, Dr. Eddie Liou, N. Eddie Liou, M.D., F.A.C.S. | BCM

Any insight on how long it takes to stop having this headache (?) when I lie down, and sometimes throughout the day, (which didn’t start straight away–so I’m guessing either nerve irritated from super tight neck muscles), as well as how long it might take to get my tongue back to normal, and also my lip? Also any good stretches. I’ve been heating the back of my neck and that seems to help some. I’ve also been icing since I got home the day after surgery on my surgery site.

One thing I’ve learned is there’s not a lot of great post-op recommendations from the doctors. I should’ve maybe looked on here, but I have anxiety and didn’t want to make it worse/more stressful.

Until very recently I’ve been eating pretty much only soft foods or foods that didn’t require a lot of chewing. However, the last day or two I’ve started to be able to use my tongue more while eating, so that’s been a nice improvement.

Also, I’d say my pain is maybe worse now (?) than days 3-5 with the back of head/neck pain being near constant. Worse while lying down. I didn’t take pain pills very often except for the day I got home from surgery. And then more recently when I tried to see if it would help my head pain (it did one night but not the next). I can’t take NSAID’s due to possible allergy. I’d prefer not to take a steroid due to anxiety. So I have a muscle relaxer. Which I haven’t wanted to take very often. Also, I do take a daily anti-anxiety med for the last 2 months or so.

That being said, I know maybe it’s too early to know, but the ES nerve pains I was getting pre-surgery do seem to maybe be gone. I can now spit (when brushing teeth) without sharp nerve pains.

Now I’m excited to get the other side removed so I can really move on to healing. Right now I’m concerned that if I tried to work out again (not yet, of course) or do much stretching etc, that I may make my right side more irritated. It doesn’t really hurt the same way my left side did. It just feels like maybe there’s something there and some soreness sometimes.


Ligament removed:

Before surgery neck reference:

Before Surgery to give tongue reference:

Right after surgery tongue:

Throat before and after surgery (I had an orange popsicle):

Smile the day before surgery:

Smile the morning of surgery:

Another to show lip control before surgery:

Post-op smile:

Day after surgery right after drain tube removed:

Day 4 post op back of throat bruise (one side):

Day 7 post-op right after tape removed and before stitch removal (about 20-30 inside that will dissolve):

Post-op day 7 Stitch removed:

Post-op Day 11 throat:

Post-op Day 11 scar:

Post-op Day 11 smile:

Post-op Day 11 tongue:

Day 11 Post-op (this is what happens if I try to open my mouth in an ‘O’:

Tongue on July 3rd (before), Tongue day of surgery (July 18th), Tongue today (post-op, day 11)



How great that Dr. Donovan did your surgery & it sounds like he was pretty thorough. Your incision looks AMAZING for being only 11 days out from surgery, & your tongue seems to be making good progress as well. You did have a pretty long styloid & the deepness of it may make healing take a bit longer than you might expect.

To answer your questions, the tongue problem comes from the glossopharyngeal nerve being irritated during surgery. It often needs to be moved out of the way, & in some cases, the body’s response to that is for half the tongue to become temporarily paralyzed. That happened to me. I had full sensation of my tongue but no control of the right half of it after my right styloid was removed. It curved just like yours does, except to the right. I had a hard time talking normally for about 6-9 mos. & eating was a challenge for several months as well.

Your lip “droop” is from your facial nerve being irritated during surgery. This is not an uncommon post op symptom & does take several months to recover, but it almost always recovers completely.

Many people have a sore throat after ES surgery, & it’s usually from irritation due to a breathing tube that’s placed down your throat during external surgery but can also be the result of nerves irritated by surgery. It may take a several weeks to fully go away.

As far as the pain in the back of your head goes, I had also had that for awhile. I think the pain comes from the area where the styloid has been cut off. The styloid process grows from the mastoid process of the temporal bone, & it’s that area that the pain comes from. It should heal as your post op swelling goes down. You could also be correct that there is muscle tension caused by compensation your body made due to the elongated styloids.

Ice/heat are both fine to use at this point though ice might be slightly better because you still have significant swelling from surgery. Sleeping/resting w/ your head elevated to 30º is also very helpful in reducing inflammation after surgery. We recommend using a wedge pillow (~$25 from Bed Bath & Beyond) w/ additional bed pillows stacked on it or buying an adjustable wedge pillow which can be set to different angles of steepness. Sleeping with head elevation may help stop the pain at the back of your head & reduce your throat pain as well.

Recovery from ES surgery can be a 3 steps forward 2 steps back process i.e. you’ll have some good days where you think you’re finally over “the hump” but then some days will follow where pain flares up again when you become more active, & the cycle may repeat for several weeks to several months. The good news is that eventually, your pain will gradually go away & you’ll feel much better. Just remember this is a test of patience as it can take up to a year+ for nerves to heal completely.

Another thing that can happen for people w/ bilateral ES is the symptoms from the remaining side begin to flare up as the first side heals from surgery. It’s difficult to know which symptoms are caused by which side & symptoms can even “cross over” from one side to another. My suggestion for when you should have your second surgery would be to wait until your symptoms are impacting your life enough that you feel ready to deal w/ surgery again. Because of nerve damage risks, do not remove the remaining styloid unless it’s causing symptoms that are impacting your life significantly i.e. don’t get it removed “just because you know it’s there”. Most doctors will have bilateral ES patients wait 3-6 mos before operating on the second side. This gives the first side time to heal a bit first.

Listen to your body & continue to rest when it asks. Pushing yourself to get things done, too soon after surgery, can slow healing down. I’m glad for the improvements you’ve already seen. Anticipate many more! :hugs: :gift_heart:


Really glad that you’ve been able to have surgery, and that you have seen some improvements already, that’s brilliant! @Isaiah_40_31 has given you good advice about your tongue & she’s been through it! It’s hard not to worry, but anxiety will make you tense & that won’t help with healing & for your neck, so try to think positive and focus on what’s improved with surgery…it’s a bit early yet but once things have healed some gentle chin tucks (laying down & with your head supported on a thin pillow) might help. If you’re not already sleeping partly propped up it might help with any swelling that’s left. It’s not at all unusual to have trouble sleeping n one position…
I hope that you can put all this behind you soon & concentrate on the egg retrieval. God bless, gentle hugs & prayers :hugs: :pray:


Update: yesterday, day 12 post-op and that “nerve pain” came back after I did my nose saline rinse, clear throat, and spit. That’s the first time I’ve felt that pain since prior to my surgery. I was pretty sure it was gone. Now I’m confused what could be irritating the nerve if my ligament is gone. And I’ve been doing my nose saline rinse and my teeth brushing and spitting since after surgery (I didn’t do nose rinse the day of surgery) and I haven’t had the pain in almost two weeks. That’s the longest I’ve gone without it I’d say. But now I’m concerned about why and/or how it’s come back. And if that’s normal for that to happen and then it to go away again, hopefully for good?

It is normal for nerve pains to come & go while healing’s taking place, so try not to worry…nerves can be funny things as they heal, it may be you’ve overdone things a bit, easy done, sending you a hug :hugs:


I had surgery 5 days ago and my smile is the same as yours. This was my second styloid removed. I had the first one removed 9 weeks ago (8.2cm long) and no paralysis, so I was very surprised to have paralysis in face this time. All of the symptoms from this surgery are different. I know this styloid was turned different and not as long, but pains are totally different. My tongue roots hurt the first surgery, but no tongue problems with this one. The roof of my mouth in the very back has a lot of pain this time and a lot of bruising in neck area. All in all I am so glad to have both removed and looking forward to this being over. Keep me updated with your nerve problems, because I can really relate. Good luck with the pains and recovery. I hope you get your smile back soon.


I’m really glad your surgeries are behind you @Cody. I hope your recovery goes smoothly & you begin feeling better very soon.

As you’ve read, the mouth paralysis can persist for several months but in most cases, it does gradually go away & your mouth will return to normal. It’s just takes time & patience. :blush:

@SRR - How are you doing now that some time has past since your symptoms flared up? I hope you’re noticing improvement every day. :hugs:

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Good that your 2nd surgery is over & done with! I hope now you can get on with healing & putting ES behind you…I had very different post-op experiences between my 2 surgeries as well. I hope that the pain & paralysis improves soon, praying for your recovery :pray:

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Day 36 post op update (just over a month) from having my left stylohyoid ligament (not the styloid process) removed:

I’m still healing, day by day. I ended up getting Covid last Monday and coughed a lot. I think that may have told some of my neck muscles to wake up. My tongue is almost completely straight–I think, except for one little area midway back. But it’s almost normal. My lip however is still not allowing me to smile normally. My scar is healing slower than expected? I think parts of it look like there’s going to be quite the crease. I’ve been putting vitamin E on it. And the last couple of days I think I might be having a little more salivation for some reason and trying not to drool out of the left corner of my mouth.

I have my 2nd ES surgery to remove my right stylohyoid ligament (not the styloid process–just like left) on 10/10. With a new CT scan ordered for late Sept.

I just took new photos to add, and looking at my tongue, maybe it’s not all the way back to normal. When I lift it, the area underneath doesn’t go up straight. But I do think it’s better overall.

Symptoms wise, every day seems a little different as it heals, and my right side (with the ligament still there) adjusts. The left side pain hasn’t been as bad as it was before (pre-op) (except for maybe that one time 1 week or so post op). I still have nerve pains occasionally, but nothing like they were before on that side. Now it’s more dealing with the tightness of the scar area and the area above the scar leading up to under my jaw/chin, where it feels like it’s extra tight and harder than the other (non surgery) side. Also, I can’t remember how long ago it started–but it wasn’t until after my last update–that I started getting first bite (I think only on surgery side). It’s not too bad. Sometimes if I open my mouth too wide I think it causes some pain/discomfort on non-surgical side. Also, while eating, since my left lip won’t move down on it’s own very far, sometimes I have to pull my lip down a little if I’m taking a bite out of something.

My right side symptoms have been on and off with how irritating they are. I’m hoping that since the Covid has cleared up and I’m not coughing, that it will not activate more. But I do often feel a pressure in there. And sometimes I feel weird nerve type pains, but not like the left side was. I also think as the left side comes back online, maybe it will change the right side some. For instance, since I can’t pull my left lip down when I smile still, it overcompensates on the right side and pulls it down further on the right, just to try to pull the left down. I think maybe doing that can bother the right side a little.

Has anyone had any luck with silicone strips helping to pull the skin together on the scar? Or any massage/movement/stretching tips (keeping in mind the right side is still there and I don’t want to make it worse) for the left side to help it heal?

I also have decided not to try to go back to working out (I just do walks) until after I’ve healed from my 2nd surgery. I haven’t worked out since April (ES pains started in Feb.) I am concerned that if I try to exercise (or even when/if I try to sing) that I may make the right side worse. And the earliest I can get in is on 10/10. Plus, I may try another round of egg retrieval in Sept. first. The 1st two cycles have been canceled, so hoping September goes better.


Thanks for sharing. Get well. Day by day


Thank you for the detailed update. Your healing journey sounds very positive. As @Michael123 said, “Day by day.” Take it one day at a time. Your tongue looks really good so progress has definitely been made w/ your glossopharyngeal nerve recovery. Your lip (facial nerve) is obviously being more stubborn about healing, but I still have confidence it will be much better in another 2-3 months (or perhaps longer). I’m sorry you got first bite syndrome but am glad it’s not too severe. It should also disappear eventually. The fact that your other nerve related symptoms have reduced is really a good sign & they should continue to minimize/disappear as time marches on.

As far as your incision goes, I think it looks amazing! There have been some great discussions about silicone patches for scar healing & the consensus is they really help. The hard areas you feel will likely resolve w/ time & gentle massage (you’re doing the right thing w/ the vitamin E oil). @Tjmhawk01 recommended a specific brand of silicone patches in this thread: Post op incision care recommendation to others

I hope your egg harvesting plans move forward. How frustrating that has continued to be delayed for you.

I’m glad your second surgery is coming up in the not too distant future. I think you’re wise to hold back on exercise until you’re recovered from surgery #2. Walking is a nice stress-reliever, will help keep you in shape w/o injuring your neck, & is a great all body workout if you walk w/ good upright posture (no slouching! :wink:). Please remind me again who did/is doing your surgeries. Finding “a ligament only” doctor is quite a feat!

Good job listening to your body. Try to do some lip exercises i.e. mouth contortions - make funny faces & assist the part of your lip that’s not working well to move into other positions. You can even try using a very soft toothbrush to gently brush your lip & the skin below it several times a day to help stimulate the nerve. Any gentle manual stimulation you give it will help.

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I am at Day 22 post op of my second surgery. My lip is also still not responding. It does not work for smiling. The lip gets in the way when I try to bite off food and I bite my lip a lot while eating. My scar area is still hard, hurts, and swollen some. It is still numb above the scar on both sides, but a lot of the symptoms are much better.
My first styloid surgery, 9 weeks before second, I did not have any facial paralysis. Each surgery has corrected different symptoms and I am hoping that all is corrected with time. Good luck with your second surgery.


Hi @Cody. I sent a couple of links for facial exercises & massage to SSR that may help stimulate your facial nerve & help your lip get back to functioning better. The links are below.

Since you had your surgeries pretty close together, your body is now working at healing both sides so it may be a slower recovery this time around because of that. Don’t be discouraged about your scar area as you’re really in early recovery still. It will take several months for the incision to recover & start disappearing. I’ve joked that my incision looked like a caterpillar on my neck around 21 days post op. It was really swollen, & the suture lines divided it into segments like a caterpillar has. It’s basically invisible now & was at about 4-5 months post op.

The good news is that you’ve noticed reduction in ES symptoms over all & over the course of the next year, you’ll notice more & more improvement in how you feel. It’s so worth the wait!

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Good that you’ve seen improvements, as @Isaiah_40_31 says you’ll still be healing so time for more improvements with the nerves…I hope that the egg retrieval can go ahead & wish you all the best for that :hugs: :pray:

Thanks for the exercises. Maybe they will help.

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I have been surprised at how long MY symptoms have taken to resolve, and I’m only 8 weeks out.

They put a lot of anti-inflammatory medication in there, and that helps for about 2 weeks, depending on your body. Then, for me at least, it has been a “3 steps forward, 2 back” process.
I have been told pain at the back of my head is normal, at least for me, because those muscles help move my eyes and they weren’t able to do their job pre-surgery. I have exercises to help me get them stronger. Until they are stronger I will have pain, especially after what I think of as a “busy eye day” (computer work, driving and that kind of thing)
Hang in there, if I can start to feel better so can you :slight_smile:


@tokenegret - three steps forward & two back is the way healing goes after ES surgery. I had pain at my skull base for many months after surgery, but it did come & go & eventually mostly went away. I still get it occasionally, but it’s momentary & only mildly annoying not disabling. :blush:


I’m almost 6 weeks out of surgery and definitely understand how patient we need to be. I hope all your symptoms resolve for you! Could you ever share the eye exercises with me? That would be so wonderful!


@tokenegret I am interested in hearing more about eye issues also. My residual issue after a year post-op is vision. Eyes aren’t working well together and I still have double vision. Been to several eye specialists with no resolution.

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