I sent my Styloid Protocol CT scan and report to Dr Samji last week and received an email yesterday stating that I do qualify for surgical intervention. I just called and scheduled my phone consult with Dr Samji for July 24th. I’m trying to put together a list of questions to ask during the consult and would like suggestions so I don’t forget anything important. My report said my left styloid is 4 cm and my right is 5 cm. Most of my pain is on the left but I’ve started to notice an increase in pain on the right side over the last couple of months. I had a styloidectomy performed on the left intraoraly about 2 years ago on the left side but the Dr only took a tiny portion of the the tip off because he said it was right on my facial nerve. I got no relief.
Dr. Samji did my bilateral ES surgeries. He decided which side should be done first based on how they SPs looked on the CT scan. Sadly, the one he felt should go first was NOT the one that was causing me tons of pain. In retrospect, his decision was best as the first to go was causing vascular symptoms which I was glad to be rid of. With two elongated styloids, it’s hard to sort out which non-pain symptoms are caused by which side. Only surgery reveals that
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Now that I’ve said all that, ask him which side he’d choose to do first & ask why. I wouldn’t spend a lot of time discussing symptoms as he’ll tell you he can’t be sure they’re caused by ES, & he can’t promise they’ll go away. History (as in posts on this site over the years) demonstrates that there are many “common” ES symptoms but there are a whole bunch that seem unique to each individual. More often than not having the styloids & ligaments removed (which Dr. Samji does) resolves the symptoms over time. If you have any specific concerns about surgery, you can talk to him about that. He is very engaging & will give you the time you need to discuss your concerns. He may even help direct the conversation.
Something that to my knowledge hasn’t come up in these discussions is why people often feel asymptomatic in the first day or two after surgery then there is a resurgence of symptoms which leaves the patient feeling discouraged & sometimes fearful that the surgery hasn’t been a success. The answer is that during surgery, besides anesthesia, you will be receiving anti-inflammatory meds via IV. These stay in your system for awhile post op thus giving the false message that you have been instantly cured. As they wear off & the surgical site begins to swell, new pressure is put on the sensitive nerves, vascular tissues, muscles, etc. that were disturbed during surgery & thus pain returns. As the body heals & swelling decreases, so will the pain & ES symptoms. This can take from 2 weeks to a year depending on how quickly your body heals. Most of your ES symptoms will likely be significantly less 6 weeks to 2 months post op.
Another thing to note is that if you have bilateral ES, it’s not uncommon for the remaining side to flare up & be more problematic after the first side is removed. I guess it just doesn’t want us to forget it’s still there. 
Not really a question to ask, but just to say if your first surgery was intra-oral, it may be that as Dr Samji operates externally, he’ll have better visibility & access to the styloid, so hopefully will be able to take more off for you. He’ll monitor nerves as well when he operates, so will only remove as much as he can do safely, he won’t want to risk damaging your facial nerve.
I think the normal questions we’d suggest to be asking are already answered because you’re seeing a very experienced doctor - like intra-oral or external surgery, which side first, monitoring nerves, smoothing off the tip left, or not breaking the styloid… He knows what he’s doing!!
Hope that the consult goes well, & that you don’t have to wait too long for surgery.
Thanks Jules.
[quote=“eaglesnest, post:1, topic:3674, full:true”]
I sent my Styloid Protocol CT scan and report to Dr Samji last week and received an email yesterday stating that I do qualify for surgical intervention. I just called and scheduled my phone consult with Dr Samji for July 24th. I’m trying to put together a list of questions to ask during the consult and would like suggestions so I don’t forget anything important. My report said my left styloid is 4 cm and my right is 5 cm. Most of my pain is on the left but I’ve started to notice an increase in pain on the right side over the last couple of months. I had a styloidectomy performed on the left intraoraly about 2 years ago on the left side but the Dr only took a tiny portion of the the tip off because he said it was right on my facial nerve. I got no relief.
[/quote]
I was finally able to get a 3d rendering from my CT scans. I’ve attached the anterior (front) view.
Was it taken after your surgery? If so, you can see why you’re getting pain both sides!
Yes, my surgery was done a couple of years ago, this CT scan was done on 6/18/18. This is the scan Dr Samji had requested. It took me awhile, but with the help of the 3D Slicer instructions provided by “Snappleofdiscord” I was finally able to see the styloid processes. The one on the left (right in the picture) is the one I had the surgery on and is the one giving me most of my problems. You can see that the Dr who did the surgery didn’t remove much of it. It also looks awful fat to me which could be why it’s causing so much trouble. I haven’t yet figured out how to see the ligaments yet. I can only spend so much time on the computer before my headaches and neck pain make me quit.
Wow eaglesnest, that’s quite a set of fangs you’ve got going on there! So happy for you that you are about to kick those things to the curb! From looking at my pan-am radiograph, mine both look about that long but not nearly as thick!
WOW WHEE!! You have one thick styloid! The other one is impressive, too! Having those spikes removed should make a HUGE difference in your life. Dr. Samji is amazing. I hope your phone consult w/ him goes well. Please let us know when you have a surgery date set.
I think that the ligaments would only show if they’re calcified?
Yes, unfortunately those “fangs” have been sucking the life out of me for years. I’m really hopeful that Dr Samji can resolve this for me so I can start enjoying life again.
I had my phone consult with Dr Samji yesterday afternoon and I’m scheduled for my surgery (left side) on August 27th. Dr Samji was very good at explaining what he would be doing and most likely why my previous intra-oral surgery was unsuccessful. It’s going to be a long month waiting and hoping for good results. Now I have to make my travel and lodging arrangements. Hopefully getting closer to relief.
That’s really good news that he’s happy to do a revision surgery! Hopefully the time will go quickly for you…
Thanks Jules.
I’m excited that there’s “a light at the end of the tunnel for you”! I’m sorry you’ve been through this surgery before though.
Thanks so much. I’ll look into the area and place you mentioned. I’m about to leave on a 6 hour drive for a family wedding this weekend. Luckily my wife will do most of the driving. I wish I would’ve found this site a couple years ago. It might’ve saved me the intra-oral wasted surgery. The Doc only cut the tip off for fear of damaging the facial nerve.
Pat Prudhomme
So glad you had a good talk w/ Dr. Samji. He monitors the cranial nerves so is aware of what’s happening w/ them during surgery. Even if there is nerve irritation, it generally heals over the course of several months to a year.
Glad your wife will do the driving to the wedding. I hope you feel good enough to enjoy the festivities.
