Follow up with ENT in 4 days after unsuccessful op 5 months ago

General
1

Hi everyone.

I'm going back to see my ENT in a few days for a follow up after having the right stylohyoid ligament removed 5 months ago. The ENT did this as a conservative approach even though the styloid process on most sides were shown to be enlarged on CT and the right one (where all of my symptoms are) can be felt through a home that was left in my right tonsillar fossa after a tonsillectomy 15 years ago.

The op didn't help with my main symptoms of right tongue deviation, A LOT of right sided neck and shoulder pain (and instability - it is dropped about 1 inch), irritation at the back of the throat (feels like it is bruised and sensitive - like a feeling of it being very dry, almost itchy) from near the styloid on the right side down to the back of the hyoid, and quite bad tinnitus in both ears.

What operation has done is give me a bunch of new symptoms:

By far the worst is that my swallow has felt very weak on the right side since the operation. This sometimes turns into a lump sensation and I feel like I have to strain to swallow.

There is a pronounced muscle that sticks out when I swallow with any force - see photo. This seems to get a lot more prominent when my swallow feels weak - like a compensatory mechanism. Sometimes a sound and feeling like cartilage is rubbing together on the right side.

All of the muscles around the surgical site still feel very weak. Some of the weakness feels like comes from below the hyoid – below where the surgery was. I also ache/pain at front of neck on side of adam’s apple and near scar (next to hyoid/thyroid) where the vessel is. It feels very tight in the area

My tongue feels weak and my jaw aches on the right side when I eat sometimes.

My left TMJ has started clicking and my thyroid cartilage clicks back to the right into place a few seconds after swallowing sometimes which is quite annoying.

The scar itself seems to have completely severed that platysma and I get a very tight feeling in the area. When I tense my neck muscles, the scar bunches up under my chin - see photo. Not sure if this is normal or not and whether I should consider seeing someone - perhaps a plastic surgeon? to see about whether a scar revision might help.

Now I don't really know what to do. I had 4 years of trying to find anyone in Australia that would even acknowledge that I had Eagle's syndrome. When I spoke to the ENT a couple of weeks after the op, he hinted that he might consider shortening the styloid (maybe 1-2cm) via intraoral approach if I really want him to. He is quite conservative due to the risk of nerve damage in the area which I can appreciate. He said he would not perform another external operation due to the scarring. I could possibly find someone else who would do it given the time, but having such a poor outcome from this surgery has made me very cautious. Now I really wish I had gone for the external approach to remove the styloid straight up as was suggested to me by one of the members of this forum, but I can't turn back time.

A few questions:

Has anyone else had these problems after removal of the ligament?

Do others have the same sensation with their external scar? Did it get better with time?

Has anyone had a second surgery via external approach? Has this complicated things as far as the scar goes?

Has anyone had a muscle sticking out next to the hyoid, either before or after surgery?

Any other advice is greatly appreciated.

Thanks,

Mark

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2

Mark, I had a second surgery via external approach {both were external} and scar tissue wasn't an issue.

My advise however would be to travel as far as you have to to find someone with Eagles experience.

3

Thanks Heidemt. Short of travelling to the US or Europe which is not really feasible for me, I don't think it is likely I will find anyone with much Eagle's experience. I have tried very hard.

4

Aussie, I'm sorry. You're stuck in a crazy predicament. In my opinion, it's really important to get as much of that styloid out as possible. Before I had my second external surgery on my right side, the doctor had me get an MRI to see how much scar tissue was there. It showed there wasn't much at all and then he agreed to proceed with a second external surgery. So maybe if you ask your doctor about an MRI, he could see if any scar tissue was there.

I remember reading somewhere on the forum that scar tissue doesn't develop that much until a certain amount of time after a surgery. I can't remember, but I think it was around a year, so I would think you'd be ok for another surgery.

Even if the doctor still wants to do an internal surgery, try to convince him to take out as much as possible.

5

I should add that I have been a strong proponent for having an external surgery and having all the styloid removed. But I recently found out that even though my two revision surgeries were external, the doctor actually missed quite a bit of styloid on each side. So now I don't know. I don't know if an external surgery is necessarily better than an intraoral one. I still believe what I've been told in that with an external surgery, it's possible to remove more of the styloid. But - I guess in the end, the main thing is to get as much of the styloid out as possible - no matter how they do it. .

6

Thanks again Heidemt. Sounds like good advice. I will push him to tell me exactly what his plans are. If he says that he won't try to get it all out, I will try to find another surgeon for a further opinion.