Hello, I wanted to know if Dr. Trevor Hackmann cuts the styloid process at the base and, at the same time, removes the stylomandibular ligament? Thank you very much
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I don’t know about the stylomandibular ligament being removed- usually all the attachments are detached from the styloid process and unless calcified, they tend to be left in & apparently get reabsorbed by the body. So if you’re concerned yours is calcified then it would be an idea to ask him specifically about that. As far as we know he removes the styloids as close to the skull base as is safe to do- actually alot of the experienced doctors do this too, it’s not always possible to remove them right at the skull base if the nerves are too close, so often a little nub is left.
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Hello, this is what he replied 
. Thanks a lot.
Oh dear, that’s a tricky decision then, but at least he was honest and not offering you false hope 
What are the symptoms you still have that you’re hoping another surgery will help resolve?
You previously posted the picture below which shows severe compression of your IJV by your C1 vertebra & possibly soft tissues that can’t be seen. There are also significant collateral veins which have developed due to the IJV compression. It shows a thick, short styloid & section of calcified stylomandibular ligament (SML). The one above shows a much shorter & less thick styloid & no SML. Are both pictures the same side of your body? If so, is the one above after your last styloidectomy/SML resection?
Because your IJV compression appears to be caused by C1, & possibly scar tissue or other soft tissue, it is likely still quite compressed since it appears that your styloid wasn’t involved in the compression. Therefore, getting another styloidectomy won’t help resolve the symptoms you still have if they have a vascular basis vs irritated nerve basis.
Would you please post 3D images of both the left & right sides so I can compare them. Pictures of each side that show your styloids, veins & arteries would be most helpful.
Hello, I’m completely lost because my symptoms are primarily neurological, and I can constantly feel that bone behind my tonsil—I think it’s the stylomandibular ligament. I don’t have any vascular symptoms—or at least I don’t think so. Constantino tells me the compression is on the right; Axon says there’s no compression of the jugular vein—and neither do Hackmann or Osborne—whereas Aghayev tells me there is compression on the left. My major symptoms are pain when swallowing, trigeminal nerve pain, jaw pain, and muscle pain in the neck. Thank Isaiah
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I don’t know if you would be able to feel the stylo-mandibular ligament from behind your tonsils, as it’s more behind the ear, I would think that it’s more likely to be felt beside your jaw bone?
It would show up in imaging if it’s calcified I would presume, and I can’t see it in the image you posted above?
@Jordan, Is the image you posted of your left side or right side?
My other thought about what’s causing your nerve pain is that you’ve developed a lot of scar tissue from the styloidectomies you’ve already had & that may need to be cleared out to take pressure off the nerves that are causing your current symptoms. It would be worthwhile to ask Dr. Hackman if that’s a surgery he would do if you were to go to him & if he sees scar tissue as the possible problem & not your styloids.
Another possibility is, with your styloid(s) cut as short as in the picture you posted yesterday, your IJV(s) may have decompressed naturally w/o C1 needing to be dealt with as the IJVs had the room they needed to re-open. If you do still have IJV compression, it could also be caused by scar tissue that’s developed from your previous styloidectomies.
Unfortunately, I think it will take an exploratory surgery to figure out what is irritating your nerves, but my gut feeling is it’s not your styloids but soft tissue which doesn’t show up on the imaging. Have you by chance had your tonsils removed?
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Hello Isaiah, I wanted to know if Dr. Hepworth managed to treat you? I’m thinking of making an appointment with him; I think that would reassure me. Thanks.
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@Jordan - Dr. Hepworth did my IJV decompression & revision styloidectomy surgeries. He did help me as that surgery stopped the progression of my hearing loss & stopped my vertigo episodes.
The wait to see him is long, & typically a consult with one of his NPs is first before getting to meet with him, however, since you’re outside of the US, you may be able to work something out so you can talk to him w/o the NP meeting first. I’m not sure what the current office policies are in that regard. Some members have had to come here from Europe to meet with Dr. Hepworth then come back again for surgery just so you know in advance what might be required.
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Hello again, Isaiah. How have you been since then? Are you able to live comfortably? Thank you very much for your time.
@Jordan - I have been doing well since my surgery w/ Dr. Hepworth. He & I both hoped the surgery would help restore hearing loss that I have in my left ear, but it didn’t. It turns out a surgery I had in 2019 to try to stop the hearing loss progression is the cause for the hearing loss that remains, so there is nothing to be done about it. I now wear a hearing aid which is helpful. As I said before, the surgery Dr. Hepworth did for me did stop the progression of my hearing loss so I am not completely deaf in my left ear. It also stopped the vertigo episodes I was having.
I am back to doing all the activities I used to do & without feeling significant vascular or nerve symptoms.
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Thank you very much; I’ll try to get his opinion, then—even though it’s still very expensive… Thank you from the bottom of my heart.
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