1) When is external incision recommended over internal?
2) Why do some doctors remove the entire styloid and others just excise the end?
3) How common is it for styloids to "grow back"?
Any thoughts would be appreciated. Thanks!
1) external if there is a vascular involvement (pressing on arteries) also may be preferred by some docs because there is a better view and lower risk of infection
2) ?
3) ?
1) The external vs internal approaches are strictly based on doctor preference as far as I understand. The external approach is safer as there's less likelihood of cutting an important nerve or nicking important vascular tissue. More of the styloid can be removed by the external approach than by the internal.
2) The amount of styloid removed is determined by several factors: doctor preference, approach (intraoral vs external) or nerve interference - example: I had only 1 inch of my right styloid removed though it had grown all the way to my hyoid bone. My ENT had planned to remove it to my skull, but the nerve for the motor control of the right side of my tongue was tightly wrapped around my styloid. In order to prevent permanent nerve damage, my doctor could only remove a portion of the styloid.
At the time of the styloid removal some surgeons (mine included) remove the stylohyoid ligament which, like your apendix, is something you can live without.
3) I can't say it's impossible for the styloid to grow back, but if the ligament has been removed & the styloid process has been cut back as far as possible, the chances of it regrowing are very slim.
4) Here's the link to the doctor list from this site: Eagles Syndrome Doctors.xls
Hope this info is helpful!
I would add that both approach are under general anesthesia. And that the external approach is more efficient to remove the styloid process. If the idea is surgery, which is more efficient and which is at once? Back to the operating room to touch up a first inefficient approach is not a good idea.
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Thank you everyone! This helps.
Ivy and Brazialian..... What you are saying makes sense. Certainly you would be able to remove more of the styloid and have more "control" of the operation with an external incision.
Isaiah 40:30... Did you have external? If your styloid progressed to your hyoid, did you have neuropathy/neuralgia? If so, did that subside with surgery?
Thank you again!
Yes, I had the external approach on my right side (11/17/14). I had some neuralgia but wouldn't say I had neuropathy till post op. I had intermittent ear pain, throat pain, skull pain, jaw pain, neck pain, etc. that many people on this site exhibit. I also had some other bizarre symptoms which have been reduced by surgery, but I still have my left styloid which is even longer than my right one was & which continues to cause pain & problems. It will be removed in May (my doctor won't do both at once & requires a 6 month wait between surgeries). After my surgery in May, I'll be able to more accurately answer how well surgery has resolved all my symptoms. FYI - having the tongue nerve wrapped around the styloid is not common & will be unlikely to happen to you. The normal possible side effect of surgery is a drooping lower lip on the surgical side (which also resolves in 4-6 months after surgery).
The main short-term results of my surgery are numbness along my jaw line on the right side, pain in & around my right ear, loss of motor control of the right side of my tongue (which makes speaking clearly & eating more challenging) & first bite syndrome. I have been reassured that these symptoms will all be mostly resolved by the 6 month mark as irritated nerves are slow to heal. I am seeing baby steps in the healing direction but would love to wake up one morning & feel totally back to normal. Patience is key in the world of healing.
In summary: Yes, I have less pain from having the right styloid & ligament removed, but I'm still healing. My doctor said, "This is a major surgery.", and even though I was skeptical, I now have to concede he was right.
minnesota, I hope you're able to get the information you want and need, to make an informed decision about how to proceed (that rhymed...) from the people on this website. Their perspectives, information & encouragment have been invaluable to me.
:)
Isaiah 40:31
minnesota said:
Thank you everyone! This helps.
Ivy and Brazialian..... What you are saying makes sense. Certainly you would be able to remove more of the styloid and have more "control" of the operation with an external incision.
Isaiah 40:30... Did you have external? If your styloid progressed to your hyoid, did you have neuropathy/neuralgia? If so, did that subside with surgery?
Thank you again!
Isaiah 40:31 you mentioned you doctor removed the stylohyoid ligament and I was wondering whether or not it gets removed all the way down to small horn of the hyoid bone ?
Isaiah 40:31.... Yes, I find this message board very encouraging! And thank you for your info. Frankly, I'm just grateful to have a diagnosis after so many months of unexplained pain.
I believe the ligament is removed from the hyoid to the point where the styloid is cut back. I will ask my surgeon when I see him in April to verify this. The object is to remove the route along which calcification can occur. Since my styloid could only be cut back 1 in (2.54 cm) & it extended to my hyoid bone, I assume my s-h ligament was cut from my hyoid bone to the tip of my styloid where it attaches.
tiagito78 said:
Isaiah 40:31 you mentioned you doctor removed the stylohyoid ligament and I was wondering whether or not it gets removed all the way down to small horn of the hyoid bone ?
I’m supposed to have surgery on the 19th of this month. My dr. Mentioned he wanted to do internal. I was told by my last dr. That external would be better due to having more access as well as less risk for infection. My other dr. Couldnt do the surgery because the hospital would not take my insurance. I want to talk to my dr. About doing the external approach, but i worry he will not be okay doing it since he already has a plan of internal removal.
Hi anichols,
You are definitely on the right track w/ your intention to speak to your surgeon about during your surgery externally. We do have many members who have had successful intraoral ES surgeries. The key is that the surgeon removes the styloid as close to the skull base as possible & removes any stylohyoid ligament calcification that may be present as well. This is possible intraorally but does require multiple incisions in the throat area which makes healing a bit slower & more uncomfy. If a bit of styloid is left behind, it must be smoothed off as sharp edges where it’s cut can cause other problems. Please make sure the new surgeon doesn’t just “snip off the tip” & call it good. We do have members who’ve had to have revision surgery when that was the type of surgery they received initially.
Finally, if you have any misgivings about the surgeon or his surgical approach, cancel the surgery & continue to pursue finding someone who takes your medical insurance & does surgery the way you want it done. If you have debilitating symptoms, there are medications that can help with those to tie you over to the time when you do have surgery.
I’m sorry your medical insurance made it impossible for you to see the original surgeon. I know that must be very frustrating.
Hi. I have been on Gabapentin, Carbamazepine, Steroids, antibiotics, etc. I am not sure what else they could try, but so far nothing has helped with the pain. I haven’t been able to talk to him about how I want my surgery done yet. I mentioned it when I went to my appointment, but he still is talking about doing it intraorally. I just hope when I’m able to get him on the phone he will agree to do it externally. He is located out of my state, so we are having to travel for me to have the surgery. My last Dr. had only done one surgery, but he did do it externally, and it was a successful surgery. I have heard of doctors just “snipping the tip” I am going to talk to him about that and make sure he’s planning to get to the base of the skull. If not then I suppose I will be finding another Dr. as I do not want to have more than one surgery. Thank you for responding!
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Here’s hoping you get to talk to the surgeon very soon so you know for sure which direction you plan to go i.e. surgery with him or find another surgeon who’s more to your liking. I’m glad you have thought this through, @anichols ere’s hoping you get to talk to the surgeon very soon so you know for sure which direction you plan to go i.e. surgery with him or find another surgeon who’s more to your liking. I’m glad you have thought this through, @anichols.
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