Here’s my cone scan from
2014, when my dentist first told me I had calcified ligaments. I didn’t have any (known) symptoms until this year. The scan without the bottom retainer is the new one from this year.
You certainly have some extensive calcifications on your ligament no wonder the doctor wanted to remove it. They also do seem to have the potential to cause irritation or compression to some of the nearby cranial nerves given their length. Any fall, or accident or strenuous activity that move these calcified ligament has the potential to negatively impact the blood vessels as well.
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Don’t many people have calcified ligaments with out ES? I guess I mean where they don’t ever have any issues or pain? I had the old scan taken in 2014 and really had no known issues until this year. And the pain I first had while at the gym I wonder if it could’ve been from my submandibular gland. That pain has stopped now. But I do think if it is from the ligament, that when I fainted with Covid around Christmas, that I could’ve hurt it then. OR from the inflammation after Covid and then food poisoning and then going back to the gym.
I don’t think mine is vascular, due to the CT, an ultrasound, and a carotid ultrasound. But I definitely get nerve things I never had before, etc.
Well stylohyoid ligaments are not meant to be rigid and should be able to move/stretch with neck and swallowing in the case of Stylohyoid ligament. Technically speaking, all ligaments are made up of fibrous connective tissue that does not contain any calcium. For example, imagine if your knee ligament can’t move or bend. What this does is make the whole leg inflexible and walking becomes impossible without dragging the whole leg, similarly when stylohyoid ligaments are calcified they become rigid and might be harder to move without moving the whole hyoid. Secondly, as the calcifications continue they can grow potentially bigger and closer to blood vessels/nerves, particularly carotid arteries/jugular veins as they are not that far away from the area. Many cases are seen here and are also documented in many studies.
Here is an example of Stylohyoid ligament calcification causing pseudoaneurysm. I am not saying this is like yours since I have not seen your CTs but to show you how CLOSE They are to the blood vessels. This only shows carotid arteries and does not show the Jugular Vein.
Source Study : Eagle syndrome presenting with external carotid artery pseudoaneurysm - PMC
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My sore throat was like a tonsillitis sore throat, & I had it off & on as I recall (my first surgery was in 2014). I had a lot of symptoms that came & went. I had trouble w/ choking on food but most often when I drank fluids. My lymph nodes under my jaw ached & felt enlarged to me though no doctor ever commented on them. Nearly all my symptoms went away over the course of ~2 years - some after the first styloidectomy & the rest after the second one. My surgeries were 9 mos apart thus the ~2 yr healing span.
Your ligaments are VERY LONG & from what I can see of the left, the ligament calcification makes your styloid look elongated, too. Hopefully your surgeon will remove the calcification at least back to the normal styloid length & will smooth the tip where he cuts the calcified ligament off the styloid. As KoolDude said, the s-h ligaments (all ligaments for that matter) need to be at least somewhat mobile to allow movement or to stabilize the areas in the body to which they connect. In the case of the hyoid, calcified stylohyoid ligaments “tether” the hyoid bone so it can’t move as it needs to when you talk, swallow, breathe, cough, burp, sing, etc., & that causes pain & other problems.
When I started exercising at 2 weeks post op, it was too soon & symptoms really flared. I did a 15k running event 6 weeks after my first surgery & had to walk the second half because I felt like my throat was swelling closed - definitely too soon after surgery. As far as weights go, I think the two month mark was when I was able to start that up again, but gradually. I couldn’t pick up where I left off prior to surgery. Now I am able to do everything I did before my ES surgeries except run, & that’s because my hips wore out from too many miles on my feet over the years (bad hip genetics definitely contributed there). I long distance hike & walk now.
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This sounds very familiar. May I ask, after you had your first side removed, did you feel lopsided or did it cause imbalance? I don’t want to worry about yet another thing since I can’t control it, but I’m hoping all will be well between the two surgeries.
Thanks for this info. I’m asking the surgeon about making sure to smooth it out and to cut it down if it is long. Btw, it’s so odd to me that I had these for so long then just one day they start bothering me.
Thank you for all this info too. I for sure will take it super slow after surgery in regards to exercise. How soon were you able to go on walks? I walk every day. I stopped running a long time ago (I used to run cross country and I’ve done a sprint triathlon). But I’d love to figure out how soon I’ll be able to do nice walks again. And then of course someday I’d like to be able to work out (with and/or without weights) again. I’ve lost pretty much all my muscle weight.
Thanks for sharing your story with me. Im so glad you’re now back to a great place where you can do so much (aside from the running which I get!).
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This is very scary and makes me want to get the ligaments out sooner. I haven’t had an angiogram. The pressure I felt when working out was very intense and scary, but the doctor thinks it was likely my submandibular gland.
It was not meant to scare you but to illustrate the proximity of these calcifications to major blood vessels. I do not think you have the symptoms of Carotid irritation or you would have tons of vascular symptoms. You need to get them out one way or the other before they can cause serious issues but you need to consult on it with your doctor.
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Thank you for sharing it. I am dealing with a lot of anxiety around this. I already have been dealing with anxiety, panic disorder, and agoraphobia for years. I understand why you’d share this—it’s important to know. This does make me want to get the left side out on my scheduled surgery a week from today so I can start the healing process and then get the right side out as well. The surgeon had said at least 6-12 weeks before removing the second side. I know the egg retrieval is time sensitive as well, but the peace of mind of knowing I have one less calcified ligament possibly pushing on things will help me get to the egg retrieval. I’m thinking if I get this one side removed and feel a lot better, then I’ll do an egg retrieval cycle between getting the right side ligament removed. But of course I’ll have to see how it all goes.
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That is a pretty long calcification of your ligament, no wonder you’re getting symptoms! I don’t want to worry you any further, but sometimes the other side does flare once one side is removed, just so you know what to expect!
I was able to go for quite long walks a few days after surgery, walking’s really good when you feel up to it, but we are all different, so some people have taken longer to recover. Surgeons have different methods, & depending which nerves are being irritated by the styloids, or are close & need moving, so this can make pain & recovery different for all of us.
As well as asking about shortening the styloid & smoothing the tip, it might be an idea to ask if your doctor monitors nerves during surgery, to ensure they’re not put under too much stress.
Hope you have peace with which ever decision you make 
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I didn’t feel any sense of imbalance after my surgery. My situation was different than yours in that my left styloid was the most symptomatic ie causing the bulk of my pain & oddball symptoms, but my surgeon insisted on removing my right styloid first because it was thicker & growing more straight down. A month or so after it was removed my left side began causing even more symptoms which got worse over time.
My surgeon required 6 mos between surgeries & a week before my second surgery was scheduled, I had a cycling accident w/ a head injury which caused my surgery to be put off 3 months longer. I was devastated as I had been counting the hours till my second surgery. Needless to say it did get done & was actually quicker to recover from than the first one.
My surgeon suggested starting to take walks the day after surgery - three 10-15 min walks/day for the first week then increase as desired. As Jules said, walking is good. It helps get the blood flowing which helps w/ recovery.
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@SRR can’t tell you what to do. But can tell you my story. My symptoms started in March '18. Took two years for diagnosis. My original symptoms are MUCH better now. Not completely gone, but much better. Of course, now I have different symptoms that Dr. Hepworth says may be attributable to my Eagle. My surgery is scheduled for two weeks from tomorrow. My doctor brother has been encouraging me to postpone. But I have elected to move ahead, for several reasons. One, because Dr. Hepworth says it is warranted, and I figure I have to put my trust in someone, and it’s him. Two, because he books out close to a year in advance, so if I give up this coveted slot and then change my mind, I’m back to the end of the line. Plus I’ll be older, and have no assurance Dr. Hepworth will even be practicing still. Three, I want to find out how much of my problem is this styloid, so I can move on to find other causes for that which doesn’t resolve (TOS, May Thurner, etc.) Fourth, I want to get on with my life, be able to see a chiropractor and adjust my neck without concern, etc. So, for all of those reasons, I’m looking forward to being on the other side of this shortly!!
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@SRR - Just checking in to see how your surgery went. Please remind me who did your surgery (sorry if you mentioned it, & I forgot). I hope you’re doing well post op. Remember that the worst post op swelling occurs from about days 3-5 so that’s when pain will be the worst. Keep the ice going & stay on schedule w/ pain meds during that time. I hope all is well with you.
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Sorry I’m just now responding! I decided to stay off the forum and the ES FB page as I was having a lot of anxiety from it.
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.
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 may do a separate post, too. 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. 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 since right after post-op. 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, 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. Also, it 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.
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).
I think maybe I should make a separate post about this? But 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 (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.
Thanks!
*Oh also, 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.
Also, I’d say my pain is maybe worse now (?) 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.
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.
UPDATE POST: Day 11 Post-op Left sided stylohyoid ligament surgery - Photos
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