Eagles syndrome and ponticulus posticus?

Any other folks out there with both elongated styloids and ponticulus posticus?

study shows there is a possible connection between the two - or at least people that have one are more likely to have the other

they found both bilateral loops and elongated styloids with my xrays

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Well, that might explain why your symptoms are so severe, bmcdiddie! I am really sorry that you have two rare things going on - one at the front of your neck & the other on the backside. I’m really glad this was discovered now as it might make a difference as to the order of the surgeries you need i.e. maybe the PP surgery should come first? I realize that’s a doctor’s call. I read a little about PP, & it sounds like it’s not as uncommon as ES but still pretty rare. I hadn’t heard of it before you brought it to our attention.

Thank you for posting the link to the article about the possible relationship between PP & ES. There’s always more for us to learn!

I am not sure if PP needs surgical attention, just showing a possible connection. First would like to start with styloids :slight_smile:

Have you also seen this?

One of our members, Christy, had ES surgery but it didn’t help much; she went on to be diagnosed with Arcuate Foramina Bridge, which sounds similar. Here’s a link which has a mention & a link to her info…
ES Information: What Else Could It Be? - Welcome / Newbies Guide to Eagle Syndrome - Living with Eagle

I’ve added your research paper in to that category too, thank you for it & the info, I hope you’re able to get to the bottom of what’s causing what…

thank you it appears foramina bridge is another name for it. I am curious what she did for follow up if eagles did not help her symptoms. I have been complaining about Canadian healthcare regarding eagles but it may be possible that the source of pain and symptoms is not eagles alone. however no one really wants to do a deep dive on it … hoping for answers soon

and this one sees no correlation. which to believe?

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If you send her a private message she may be able to update you, although she’s not been on for a bit…

Too many doctors are skittish when it comes to unusual diagnoses that they’ve only read about in a text book. It sure would be nice if they’d come alongside a patient who needs their support & encouragement & help that person find a specialist who does know something rather than tucking tail & running the other way (i.e. being dismissive).


Yes, I have just found I have both the little loop at back of C1 and also calcified L stylohyoid. Any thoughts on treatment?

If you can afford to travel to the US & pay out of pocket for surgery, Dr. Hepworth in Denver, Colorado, or Dr. Costantino in White Plains, NY, would be your two best options.
I don’t know what their private pay fees are, but there are additional costs to having surgery here i.e. for the surgery center/hospital & for the anesthesiologist plus medications so it won’t be inexpensive.

IJV compression can be caused by the styloid/C1 but can also be caused by nerve, scar tissue, or muscle compression. During surgery the cause of compression is determined. Sometimes styloidectomy alone is enough to allow the IJV to reopen, but often the TP of C-1 needs to be shaved a little. If a nerve or other scar tissue is the cause then there are other techniques used to deal with those. If the IJV doesn’t reopen once decompressed, venoplasty is often tried & if that fails, then a stent can be placed but there have been very mixed results w/ stenting, & it shouldn’t be attempted prior to the cause of compression being dealt with.

I hope this info is helpful.


@Dave , the very first step is to figure out what the effects of
a) elongated styloid process
b) “loop” (aka ponticulus posticus, aka kimmerle malformation, aka Arcuate foramen)

are IN YOUR CASE. Everything else is just sheer speculation until it’s seen on the radiological images, and jumping into the surgery may do more damage than good in case your symptoms come from different source than two above, e.g. possible neck instability, spinal cord compressions or vertebral artery insufficiency.

The immediate assumption that any of them are the cause of your issues is baseless without seeing the evidence on proper radiological imaging and matching with the symptoms.

@Isaiah_40_31 , sheer presence of these two things mentioned above doesn’t automatically mean any IJV compression.

@vdm, @Dave had mentioned he was diagnosed w/ IJV compression in a PM.


Aah, I see! I thought it was just a speculation based on the panoramic pic. My apologies! :slight_smile:


Thanks vdm,

Are there any tests that you know of that will show the relative contribution of each of these aspects (ie PP and ES) to dysfunction? I’ve had a doppler on external arteries of the neck using a doppler, and apparently they look fine.