Extraoral Unilateral Surgery 1/5/15

Hello all! I am newly diagnosed (last week) but have been dealing with symptoms for almost 2 years. CT showed left side is about 4cms and right side is 3cms. I was completely unprepared for the diagnosis and offer for surgery, so don't remember anything else that was said beyond "we can fix this, but there's going to be a scar". Oh and he did say that we could try to go inside but in his experience (20 procedures) he prefers external and make sure the scar heals nicely. But I didn't ask any other questions, when had I been mentally ready for this I would have had a long list. A little patient info about me--45 years old, female, athlete and active lifestyle.

I've had a very supportive family doctor when I first presented 2 years ago and subsequent visits (maybe 3 or 4 desperate attempts in the last couple of years), but he just couldn't find anything to explain my issues. He ordered CT, endoscopy, referral to ENT (same one who is doing the surgery) and MRI. I took prescription omneproxyl (even though they couldn't find reflux) and that helped for about 6 months. But the winter times have been the worst and this winter when it flared up 3 months ago, it was too ugly to ignore or quell with inappropriate prescriptions.

I was certain that I was going to die--a feeling like something large and gross is stuck in your throat , spitting phlem all over and getting dizzy when I'm running, terribly angry muscles on one side of your neck that do not get better with ice, chiropractor and/or massage, frequent stabbing pains in your ear and a feeling as if a large tool is inside my mouth pressing down on the left base of my tongue trying to push it down my throat CANNOT be good.

At first when it started 2 years ago, it was a pain along the entire sterno kleina mastoid muscle. My good friend is a dentist and told me not to worry, that it was just a pulled muscle. Last year my symptoms advanced to the entire left side of my neck, the base of my neck and stabbing pains into my ear. A CT was done and evaluated/positive for cervical degenerative disc (arthritis), but nobody said anything about my styloid process (this is the same CT used last week to show the elongated styloid). In retrospect, I had even thought that my pain was relating to muscular structures, so probably wasn't as CLEAR about my symptoms as I should have been. And, really, I hated complaining all of the time to my wonderful doctor--I thought he probably thought I was crazy. I'm sure he never knew the extent of my discomfort until last month's results of MRI showed only arthritis again. He said there's nothing we can do for that and I told him that I'm going to need some prescription pain killers than because I can't live like this. He told me that kind of pain is NOT my neck muscles or arthritis and sent me back to ENT--and told me to ask about Eagles.

The ENT did his palpitation thing and reviewed my CT and said I have ES. I was very excited to be diagnosed with something that wasn't going to kill me. But I was leary, I asked him--are you sure I don't have cancer? He held my shoulders, looked in my eyes and said, you don't have anything else. This is what you have and it's going to get better. After that I pretty much zoned out in a blissful state for the rest of the appointment. I do remember telling him that I didn't care about the scar, because I had thought of cutting my own throat open due to the pain--to try to get whatever is in there to come out (I would not really have done that but I did imagine it a few times).

However, after my MRI apt (2 weeks before my ENT apt last week), my doctor had Rxd me Celebrex. And last week I had the least amount of pain I can remember in months. So that got me thinking, should I just continue Celebrex, should I have let the ENT explain other pain management instead of cutting him off telling him surgery was my route. Does anyone have experience with this?

Unless I cancel, he's going in tomorrow extraorally. I'm really concerned that maybe I don't have to have this surgery (I've had plenty of other ones, but come on this one is really close to some major life blood areas) and jumped too quickly when offered the apple. I do trust my ENT who is performing the surgery . . . in fact from what I've read, it's really rare to have a doctor in a relatively small Midwest town with 10 surgeries under his belt. He's done both internal and external and prefers external . . . I want to be compliant with his preferences. Scars are not the end of the world, feeling this pain all of the time has definitely altered my life much more than a scar will. Course he told me he's done 10 surgeries when I asked him, so maybe that means at least 5 . . . still pretty good with this rare of a surgery.

Anyway, I'm just having last minute freak out syndrome now :). I'm going to Central America for a month at the end of January. I will be backpacking through Nicaragua, canoeing up the Jungle in Honduras and staying in tents and stick huts and then spending a week in Guatemala on a house build project (again sketchy hygiene conditions). Seriously, should I have just gotten a shot??!! My rationale brain says it's ok to do the surgery . . . I don't want this pain to deal with while I'm gone, I'd rather have a wound dressing to deal with--but what if I have nerve pain or worse as complications? Anyone out there who can offer some reassurance . . . as really I'm 99% sure I'm going through with the surgery.

Last note of interest, my brother is an ER doctor for about 15 years. He had never heard of this and had to do the same research as me to advice me. His advise was to get the surgery, in whatever method that the doctor recommends. I'm not normally one to be online a lot with chatting and blogs, even FB is limited for me -- I like to be active outside and quiet inside; however, if there are other people going through this and have not been diagnose, I want to be a little bit loud in the hopes that awareness of patients and doctors continues to increase.

Hi and welcome to the site!

Your story sounds similar to a lot of us- mis-diagnosed, people thinking we're mad and hypochondriacs, etc.!

I'm now thinking of having surgery because of the pain- I have recently had good pain relief with new medication, and then I think should I keep on it, and put off an operation. But others have found that they have had permanent nerve damage, so even once the styloid is removed they are still in pain. It's a dilemma... but read through previous discussions on recovery times if you have time, as this trip sounds mighty strenuous to be doing so soon after an op! Could you put off having the op until afterwards if you're dead set on doing the trip?

Where are you from? Who is your ENT? I am newly diagnosed also and you have asked a lot of good questions! From everything I have read, I think this type of trip could be a bad idea so soon after this surgery. I hope others can give you some sound advice.

Hi. Wow, you've been really lucky having nice supportive doctors. The only real cure for eagles is surgery. People usually do fine after surgery and it's great you've got a surgeon with some experience. External surgery is usually considered the most effective for several reasons. You can look back at prior discussions if you are interested in that. It's an easier recovery too. I was able to easily go back to work 2 weeks after my last two external surgeries. Make sure you tell the doctor to take as much of the styloid out as possible.

The only thing that concerns me is your trip. Does the ENT know about it? I guess you could bring antibiotics with you in case of an infection. It doesn't sound like you're going to be in a very sterile environment. But maybe a couple weeks out of surgery you don't have to worry about it. Does your brother think it's ok? If the docs think it's ok, then I'd say go for it.

One option would be to take celebrex while on the trip and have the surgery when you get back. But again, if the docs think it's ok, then I would think it should be ok.

Do what you feel you need to do. I am an active 46 year old diagnosed at the end of November. Every day I think "today is the day my ES isn't going to hurt." Next week we are going from DC to Pittsburgh to see an experienced doctor who will probably leave the decision to have surgery up to me. Part of me still feels like I have a choice, but today at a museum I turned my neck a weird angle to read a quote on the ground and I felt a horrible pinch inside my neck. I feel like I might as well take care of it now because surgery is only going to get more difficult as we get older and I am really tired of being uncomfortable. Good luck, I think whatever you decide will work for you.

I think you should definitely have the surgery. My only concern is your trip. A trip like that so soon after surgery is going to be difficult. That I can promise you. The hiking and over doing it will put lots of stress on your body and surgery site and will push things back and you won’t have appropriate care nearby if anything goes wrong :confused: Can you do the surgery after your trip?

Thank you everyone! I have thought about nothing else all day. I am close to Manhattan, KS and will give out my doctor's information if the surgery is successful :). The ENT does know that I'm going south for a month in less than hygienic conditions and seems to think it will be fine. Even though I kind of explained what I'll be doing, I'm not sure he's grasping that kind of a "vacation", but he at least knows it's happening. The ENT also thinks I'll be fine to return to work one day after surgery and will only have to modify my activity for about a week. My brother, the ER doc, thinks it will be enough time for healing before travel as well. I know that is best case scenario, but I like to think I'm pretty resilient.

This condition is really aggravating--and I guess I'm willing to take the risk and have the surgery done tomorrow. I hope that I don't regret it . . . but I'm also worried about regretting it if I don't have it done and have a lot of issues while gone. It is a big risk, and if I'd hadn't gotten my hopes up for having "normal" return to my life (albeit some pain in incision site and some change in facial muscle useage for a couple of months while nerves heal).

I will keep everyone posted and hopefully it will be all positive.

Hi Charmion,

I realize you won't be likely to read this before your surgery, but I like several other commenters think your trip will be too much too soon after your surgery. I am 58 yrs old & also an athlete. I ran long distance for the last 4 years & gave it up this past year because of back problems (which now I recognize may be related to having bilateral ES). I had my first surgery on 11/17. My ENT surgeon said that I absolutely should not exercise for 2 weeks post-op & no strenuous exercise for 2 months post op as it would slow my healing. The first 2 weeks post op are critical for down time & strict adherence to a regular pain meds schedule. I came home w/ anti-nausea meds (which I didn't need), antibiotics, steroids & Percocet (oxycodone). Because I feared the narcotic, I started trying to space out the doses on day 4 post surgery. It was a GIANT mistake. When I re-read my doctor's notes, I saw that days 3-4 are the worst for post-surgical pain & swelling. Always stay ahead of your pain. Never wait till you're hurting to start taking your pain meds. Playing "catch-up" is difficult.

I must say that I have not strictly followed my doctor's advice & went back to pilates & working w/ a trainer close to the 2 week post op mark. I'm going to walk/jog a 15K race in San Francisco a week from today (which I'm unprepared for) & am doing so w/ some trepidation. I'm obviously not as adventurous as you are, but I can't just sit around either. I'll be a day short of 8 weeks out from my surgery next Sun.

If you do go on your trip, one thing I will advise is try not to do any weight lifting above your shoulders or anything that causes you to tense your neck muscles, No breath holding when straining, etc. I guarantee you'll feel it for a measureable time afterward, & it will set your healing back. Nerves to the right side of my tongue were wrapped around my right styloid so I came away from surgery w/ no motor control of the right side of my tongue. My doctor promised full function will return in 2-4 months. This problem has made it challenging to talk & eat. My speech is improving, but I'm still finding it easier to eat blender meals than real food. As far as I know, there's only one other person on this forum who's had a tongue issue, so I think this side effect is very rare.

First bite syndrome (http://www.sciencedirect.com/science/article/pii/S1879729613000021) is another problem which can develop. I don't have a feel for how many people experience this post-op, but you'll know if you develop it, & I guarantee you'll want to take a pain med specifically for nerve pain w/ you on your trip if you acquire FBS. Celebrex is great for arthritic/joint type pain but isn't designed for nerve pain. The recommended drugs are Neurontin or Amitriptyline.

I hope you fly through recovery, have no nerve damage & no FBS (it's the worst!!). Your trip sounds totally amazing. Wish I was going with you!

Isaiah 40:31


Charmion Harris said:

Thank you everyone! I have thought about nothing else all day. I am close to Manhattan, KS and will give out my doctor's information if the surgery is successful :). The ENT does know that I'm going south for a month in less than hygienic conditions and seems to think it will be fine. Even though I kind of explained what I'll be doing, I'm not sure he's grasping that kind of a "vacation", but he at least knows it's happening. The ENT also thinks I'll be fine to return to work one day after surgery and will only have to modify my activity for about a week. My brother, the ER doc, thinks it will be enough time for healing before travel as well. I know that is best case scenario, but I like to think I'm pretty resilient.

This condition is really aggravating--and I guess I'm willing to take the risk and have the surgery done tomorrow. I hope that I don't regret it . . . but I'm also worried about regretting it if I don't have it done and have a lot of issues while gone. It is a big risk, and if I'd hadn't gotten my hopes up for having "normal" return to my life (albeit some pain in incision site and some change in facial muscle useage for a couple of months while nerves heal).

I will keep everyone posted and hopefully it will be all positive.

Thank you ALL for your advice and support, it is really appreciated! I did it, went through with the surgery yesterday. I was trying to back down until the very end because of nerves about the actual procedure and concern about travel, but knew it my gut it was the right thing for me. so had to go with that.

My surgery wasn't until the afternoon and the morning really sucked, recommend to others to wait a few extra days for a morning surgery so there is less obsessing pre surgery. Not having anything to eat or drink after 6am was tough for me too. I was so nervous this time (unlike other surgeries) that I literally fell apart with the pre op nurse who handled it very well, with lots of caring and a prompt dose of valium with a little bonus swig of water :). The pre op nurse also gave me Zantec and some sort of anti nausea pill, both which were genius and worked like a charm.

I had one last talk with my doctor before going under the knife. I told him that I really trusted him and like him (he has great bedside manner), but was sorry that I had previously cut him off before he told me about pain management and also was not sure he understand the extent of my trip to South America. I also asked how much he was taking out.

He said that pain management is very beneficial to some people, but normally it requires visits every few months or so--and is a little of an experiment to see what works for how long on which patients . . . so surgery was a good call if I want a more confident outcome.

He also said that he was not concerned in the least that I would be healed enough for a 30 day trek/bus/boat/build in Nicaragua, Honduras and Guatemala in a little over three weeks.

He said that he would take out as much as possible so that it won't "grow back", even though that has never happened to any of this patients in the last several years. So apparently he thinks they can grow back (reference some other discussions).

I also asked him if I could give his name out to others who may be looking for a good ENT. He's not cocky in the least, so think this probably embarrassed him a bit. He did say that not everyone looking for this surgery is a good candidate and that if anyone would request his services, he would review all of the information (including a CT, presentation of symptoms, other methods tried, duration of issues and overall patient history). HIs name is Dr Eric Purdom, Manhattan, KS. His partener, Dr Ben Pease, also does these surgeries I think. Dr. Purdom also does facial plasty, and from the looks of my incision--this is another benefit of going with him (its much smaller than I thought it would be).

So Post Op . . . I was not prepared for the pain I felt. Even though they gave me an oxycodin (or similar) right after surgery, it didn't make a dent. So they gave me a 2nd one which took forever (in terms of post op waiting--probably 15 minutes) to start working. So I really was fine after that, though walking into and out of the pharmacy and having friendly conversations with people in the pharmacy was a little sketchy. I ate applesauce and crackers and probably 4 glasses of water in post op--whatever they offered me--because I knew how important that was for my system given the trauma that it just faced. On the way home, my daughter stopped to get me an icecream (a little role reversal there) which went down fine. At home I wanted to take another Oxycodin, so ate some soup with crackers--thinking my stomach should be balanced out enough for more. Yep, just fine. Then I stayed up another 4 hours thinking I would take a double dose of Oxy before bed--however, I decided that I wanted to wake up in the morning with a clear mind so opted for plain old Tylenol instead. Woke up after 8 hours uninterrupted sleep very happy that my level of pain is really no worse than before I went in for surgery.

So I cannot speak to if the surgery resolved my issues. The operating site does hurt and in the same places it hurt before. I image that relief of symptoms or not will probably not be known for a few days while recovery is taking place in that area. My smile is a little off, but not so much it's anything but funny. Looking at me smiling makes everyone laugh, including me. It's just a big smile on one side of my face and not the other and really is comical. My full smile will be back in no time and I'm not worried about this at all.

I know that right now I"m in post op I survived and got this crap done happiness mode, and by tomorrow and Thursday things may turn glum . . . but I had to report and how great everything went so far for those of you that were wondering.

I will add a photo of my incision later today, a 1 week post op report, a 3 week report and a 3 month report--though I may need some reminding :).

Congrats! Thank you for the update and hopefully you will be well again in no time!

Glad it went okay, and praying for a swift recovery for you. Keep us posted!

Well you certainly sound more relaxed! Hope you continue to improve and keep us updated. I really appreciate the info about 'not everyone being a good candidate for surgery '. I never thought about that. I am newly diagnosed without a treating physician in sight! So by the time I get to a doc I don’t want to go through shots …etc. I would rather just get it resolved…but I understand the risks :frowning:


Day 1 Incision


this is the 1/2 smile that hopefully will be back to normal soon :) Day 1

You look GREAT!! Glad your surgery went so smoothly. If you continue to do so well, you'll be fine for your tirp. Just an FYI, my doctor said 2-4 months for nerve healing. Your smile may be crooked for awhile, but don't despair, it will return to normal in time.

Praying for your quick recovery!

Isaiah 40:31

Hey Charmion, you're looking good! I'm so glad things went well. Yes, nerves take their own sweet time to heal. Best wishes to you for a speedy recovery.

You look beautiful even with the crooked smile!

Thank you for posting...wishing you a speedy recovery...you are in my thoughts and prayers!!

It looks great! I think you'll be very happy with the results. Most of my symptoms were gone within in week or two. The only lasting thing I had after surgery was if I didn't get up in the morning and take a shower within an hour or so of waking I would get neck pain which would go into a migraine. It has now been a year after surgery and I just realized that no longer happens. My scars on my neck on both sides don't show at all. I was so happy with my surgery results. I hope yours goes as well. Enjoy feeling normal again.

1 week post surgery update as promised :). Today was the follow up with the ENT who performed the surgery. I found out that he removed over an inch of my left styloid. He said it was a very easy surgery for him as his first incision opened up right to the styloid, which was laying "on the jugular". The doctor released me to all normal activities that haven't already been resumed, which for me includes trail running, weights, mountain biking and yoga.

Summary of the last week . . . Days 1 through 5 were fine, but many ES symptoms were still present. I'm assuming that has to do with the surgery site was exactly the site that was presenting pain to begin with. I didn't take any prescription pain meds after the first evening of surgery and returned to work one day after surgery. I did, however, decide to take day 4 off work since I was feeling very tired. Also, days 1-4 were a little bothersome to talk for long periods. What was really alarming to me is that there wasn't significantly more pain after surgery . . . which means that apparently I had been conditioned to a high level of pain before hand and that cannot be good.

Day 6 after surgery was really interesting. For a few hours, I had absolutely no pain or pressure in my neck. I remembered what it felt to feel normal. Holy moly, that was really nice and I'm hoping for more. Then directly after that paradise, I began feeling shooting pain in my neck and numbness in my jaw. So I deduced I was either having a stroke or healing was beginning in earnest. Since I am writing this on Day 7, obviously the pain was nerves refiring and blood rushing in to heal the surgery site.

I don't have a full smile yet, but most of it is there. I still have a decent amount of pain (i.e., 3 Tylenol per 24 hours worth), but it is different than what I have been accustomed to feeling. There is a lot of hope now for me that this was the right call.

My ENT did remember that I asked if it was ok to give out his name (in our conversation pre-surgery) and told me today again that is was ok for me to do so. I think he's pretty happy with the result :). His name is Dr Eric Purdom, Manhattan, KS.

I will update again after returning from Central America the first week of March. Cheers! Charmion