I have long term issues with neck pain and headaches on on the right side of my head. Turns out my right styloid is about twice as long as my left.
Also, my right tonsil is chronically enlarged and irritated. I can feel the styloid poking in behind it.
My goal is to be able to return to jiu-jitsu training (where people grab and twist my neck) and heavy lifting. Given that and the tonsil issue, which is likely to be the better surgery approach? Intraoral seems like a much tougher recovery, but it also seems likely to me that the tonsil should go anyway.
I have seen Dr. Karni in Houston but so far I am not impressed with his level of analysis. Based on what he said about my CT scan, I am not even convinced he was looking at the right patient.
I have the images but can’t seem to be able to embed them in a post?
Hi & welcome to the site!
Because this is your first post you wouldn’t have been able to upload images, I’ve altered that now so you should be able to upload them now…
Firstly ES can be caused by neck trauma, so it’s possible that BJJ has contributed to that; if you had surgery it’s worth considering whether you want to continue training if it could affect the other side. (As well as needing a long time to heal from surgery)
It could be that your tonsil has been irritated by the styloid poking it, & possibly if you had the styloid removed it might settle down. Having intra-oral surgery is a more painful recovery as you’ve said, is more likely to get infected, & as the surgeon doesn’t have as good a visibility they can’t safely remove as much as of the styloid, so it might not be enough to ease symptoms. With external surgery, more of the styloid can be removed so there’s a greater chance of the surgery being successful, & the surgeon has better visibility of nerves & blood vessels, which makes it less risky. But we don’t know for sure if your tonsil will settle down…
Here’s a link to the doctors list as it sounds as if you want a second opinion: Doctor Lists – no discussion - Symptoms and Treatments / Doctor Information - Living with Eagle
You can search for any of the doctors names in the past discussions to see what members have had surgeries with them, for example several people saw Dr Nathan Hales not that long ago. We also have a list of questions that you could ask doctors before you decide:
How many ES surgeries have they done and what was the success rate?
Whether they’re going to operate externally, or intraoral- through the mouth. Whilst some members have had successful surgeries with intraoral, external is better for seeing all the structures, to be able to remove more of the styloids, & also there’s less chance of infection.
You need to ask how much of the styloid he’ll remove- as much as possible is best- & anything left needs to be smoothed off. The piece needs to be removed too- some doctors have snapped it off & left it in! If the styloid is only shortened a bit it can still cause symptoms.
If your stylohyoid ligaments are calcified, then any calcified section needs to be removed too.
There’s usually swelling after surgery; you could ask if a drain’s put in to reduce swelling, or if steroids are prescribed. It’s not essential, but can help with recovery a bit.
Will it be a day case surgery or will you need to stay in?
Obviously ask the risks- we know from experience on here that temporary damage to the facial nerve is quite common, and also the hypoglossal nerve and the accessory nerve. These usually recovery very quickly but in some cases members have needed physiotherapy. There is also the risk of catching a blood vessel or having a stroke, but these are very rare.
Ask if the surgeon monitors the nerves- this should be done to see if there’s stress on the nerves to avoid damage as mentioned above.
What painkillers will be prescribed afterwards.
Ask about recovery- most doctors either down play it or are genuinely unaware of how long the recovery can take!
Thanks for all the info. It seems like Dr. Osborne is generally considered the best. Is that correct? I am willing to travel to get the best treatment. Here are the images.
Your styloid looks pretty long, & there could be a couple of sections of calcified ligament just above the hyoid bone too which could contribute to symptoms if they’re compressing nerves…
Dr Osborne is very experienced, yes, I think the only reason that more members don’t have surgery with him is because he doesn’t accept most insurances I believe. Dr Nakaji in AZ is very experienced as well, if you want to travel further across country Dr Costantino in NY, Dr Cognetti in PA, Dr Hackman in NC & Dr Hepworth on CO too, although I think probably Dr Osborne has shorter waiting lists…
@dwg176 - You need to be aware that whichever version of ES surgery you have, it can take up to a year for nerves to recover fully. Most people are feeling pretty good by 2-4 months post op, but as @Jules said, you won’t want anyone yanking your head/neck around for quite a while after surgery, if ever.
If Dr. Osborne notes you have vascular compression, especially of your IJV, you should consider a consult w/ Dr. Nakaji or one of the other surgeons, Jules suggested.
I’m glad you’re willing to be patient about recovery. That in itself is HUGE! Doctors often give patients unrealistic healing timelines post op when it comes to ES surgeries. We try to set the record straight here based on our collective experiences.
Dr. Samji in San Jose, CA, Dr. Cognetti in Philadelphia, PA, & Dr. Costantino in White Plains, NY (does IJV decompression surgeries if you have that problem w/ ES). There may be others but those are the main 3 we’re aware of. Dr. Cognetti is booking into Jan. next year so you may want to try the other two who aren’t booked so far out.
•Dr Hussein Samji, Camino ENT Clinic, San Jose 408- 227- 6300 Camino Ear, Nose & Throat Clinic (one of the most experienced ES surgeons in the US, does external surgery.) Does do online or phone consults.
•Dr David Cognetti, Thomas Jefferson University Hospital, Philadelphia 215- 955- 6760 (Has done many successful surgeries on members). David M Cognetti MD | Jefferson Health Does do online or phone consults.
