I found your forum today after reading my cone beam report. I had an extensive scan done due to some tooth issues. The scans read by a radiologist it states that the right stylohyoid ligament processes are calcified and elongated relative to the left. The doctor did not seem concerned about it and asked if I had any pain in my neck or throat of which I do not. Nothing at all.
So that lead me here. I am concerned with this finding. Should I see a specialist to get this checked out further? If so, who would I see? I also have a few images from my cone beam scan I can post if someone can guide me. Thank you again for having me and allowing me to ask some questions.
Eagles Syndrome is classed as having one or both elongated styloid processes, and/ or calcified stylo-hyoid ligaments which cause symptoms. ES can cause facial pain, as the styloid processes can irritate the facial nerves or the Trigeminal nerves which could cause the sort of pain you’re getting, if it was the side of the elongated styloid then it would definitely be worth getting checked out. Very rarely, the symptoms can cross over & be felt the other side, but this is unusual. It might be worth looking at the scans to see if the right is elongated- and also the angle of the styloid plus the width can cause symptoms. Doctors use different ‘average’ measurements to see if they’re elongated, anything from 1.5-4cms have been used! It’s also worth looking at the section on common symptoms in the Newbies Guide if you’ve not looked already-neck & throat pain aren’t the only symptoms, you might find there’s others you have but weren’t aware they were ES?
There aren’t many doctors familiar with ES- I’ve sent you a welcome message with a link to the list we have if you do feel you’d like to see someone for their opinion. And feel free to read up on discussions about surgery- there can be risks, and recovery can be a bit slow, so its not something which you should rush into. Some doctors inject lidocaine/ steroids into the styloid area, so this could be worth a try to see if symptoms are crossing over?
I’m not very technical about posting scans, have you tried using the download icon which comes up at the top of the discussion box when you post? or is it a more technical problem with the software?
Hi Jules thank you. I did get your message and i’ll take a closer look at the site later this evening. I will try and upload the cone beam scans that show the area in question. I would love some input. Thank you so much.
If you have trouble w/ the upload of your scans, I can step you through the process via private message. It is pretty straightforward though. It will be interesting to see your cone beam scans. Thank you for sharing them w/ us.
Thank you. I just logged back on. I will upload a few photos of each side and get some of your thoughts/ideas.
Edited to say I figured out how to load pics.
So here is the right side that the radiologist commented on. Ignore the cursor arrow that was my mouse I forgot to move the cursor. Below is the left side as well.
Here’s my non-medical opinion - Right side is definitely long, & it looks like you have some ligament calcification as well (see the two dots off the tip of the styloid in the second image). Your left side looks a bit long but also pretty thick & maybe broken or segmented. It’s also got a bit of an inward curve to it. In the absence of excessive length, a very thick, curved or pointed styloid process can produce ES symptoms. You might have some ligament calcification associated w/ the left side as well. I can’t tell if it’s an artifact on the scan or something that’s significant. If you want, I can annotate the pictures & repost them.
BTW - Good job figuring out the uploading process.
Isaiah yes thank you if you can do that for the photos that would be great. The only symptom I have had is tooth pain on the left. He was more concerned about getting an MRI scan of the head to check for a tumor or something causing dental pain.
I agree with Isaiah about the left side- strange that the radiologist didn’t comment on it as it looks longer than average & the way it curves could possibly be causing symptoms. It’s definitely worth getting an experienced opinion on that! In the Newbies Guide Section there’s info about how the angle of the styloid can cause symptoms & references to research papers. Hope this helps!
Your trigeminal nerve has 3 branches one of which runs across the lower jaw & is often the cause of tooth pain. If you have other symptoms that might point toward a tumor then by all means follow-up w/ an MRI. If not, I suspect your elongated styloid is irritating your trigeminal nerve & which in turn is causing tooth pain. This is very common in ES.
I like the particular image of the trigeminal nerve I’m including because it also shows the zones of the face & head that are affected by each branch of the nerve. Even though the picture makes it look like external pain it can also cause internal pain like headaches, eye pain, toothaches & nose pain among other things.
Here are two of your scans which I annotated w/ arrows. The first one has an arrow pointing to what looks like stylohyoid ligament calcification to me (the two white spots). These could also be artifacts on the scan, but their position & appearance is very suspicious in my non-medical opinion.
The second scan is your left styloid w/ an arrow pointing at a shadowy line that could be very low grade ligament calcification or an artifact on the imaging as I said before. The second arrow is pointing at what looks like a junction between two halves of your styloid. Again, not sure if this is indicates a fracture or just unusual bony styloid growth. The fact your left styloid is quite curved is obvious when compared to the right one.
Be thankful the radiologist who was reviewing you cone beam took notice of this as most of these cone beam tomography that goes thru dental radiologist ignore these findings and blow them off. It happened to me in 2015 and 5 years later (in Dec 2019) after several years of going to specialists and worsening pain (and numerous MRI’s), I had a doc who was giving me injections mention eagles to me in December. I do have neck pain that radiates to ear and jaw but also have TMJ. I have had years of dental issues mostly hypersensitivity and had numerous root canals. I have often begged for a root canal to make the nerve pain go away. I then call the oral health department and asked for them to review my cone beam for ES. Low and behold they sent me some screen shots showing the calcified ligaments.Oral health doc didnt think it was of any concern. I then proceeded to get CT scan w/o contrast which is the preference by many ES docs for further evaluation. I sought our specialist and did find this is of concern contrary to dental specialist at a major university dental dept.
I don’t know your age, but this seems to worsen as we age. If your neck isn’t bothering you now, it may in the future as the calcifications in your neck increase.
Isaiah gave you some great info on trigeminal nerves. Also the glossopharyngeal can be impacted. I just had surgery on one side about 7 weeks ago. Aside from removal of usual culprits, they did a decompression of the the glossophaynhgeal nerve. My suggestion is to get a consultation w Eagles specialist if further MRI’s dont show reason for tooth pain.
As an FYI, my doc told me my TMJ would kick up after surgery and it has and it is taking its sweet time to calm down. I have a upper molar that sits right below the jaw joint (2nd one from back) that is giving me fits now. I dont know if its referred nerve pain from TMJ or if its time for a crown and I have some hair line fractures. I have alot of old dental work that is deteriorating. You didn’t mention the location of the tooth pain. Upper /lower, back,etc? I know before surgery I was having pressure in sinus area next to teeth below eye. I am assuming this is is nerve compression and fits with the trigeminal nerve area.
I didnt get to read all of the posts but Jules can also refer you over to the facial pain blog too. Good luck on your journey. You so lucked out a radiologist picked this up.
Hi Snapple thank you for your reply. I am 51. My tooth pain is upper left but it get’s tricky. I think it could be a combo of nerve and dental issues going on together. tooth hurts in the apex when I push up on the upper gums it shoots down the tooth that’s had the root canal. I am going to investigate this further. I am concerned that it worsens with age. I am going to consider this before I ever have another root canal as I think that really was just gasoline on a fire. I am thinking it could have been a nerve issue then I had the root canal that just aggravated it. I often think I need to get it pulled and go with an implant but concerned that would cause more nerve pain. I will be sure to mention this to the oral surgeon. I pulled up an old cat scan from years ago. I will try and snap a few pictures of the images for your opinions. I also got different angles of the cone beam scans for you all. I guess one question is: Do we all have ligament tissue in this area and if so, is it just the calcified ligaments that are the issue? Thank yo for sharing your story and info on your tooth pain. I just had a strange feeling all along with this dental issue.
I get some tooth pain still, one of the molars bottom left, but it does move around at times It has improved after surgery, but not gone. It was one of my 1st symptoms- the dentist re-did the filling as he though that was the problem, luckily no root canal work!
Not everyone has calcified ligaments, some have elongated styloids, some just calcification on ligaments, some have both problems! It’s important to clarify whether you have one or both issues, & to make sure what will be removed.
I have always questioned when the dentists told me I cant feel pain in a tooth that has had a root canal. They always claim its referred pain. As I aged, I went to an endodontist to make sure root canals were done properly after a few botched ones. In my late teens, I had a massive amount of cavities (Im 64 now) and they were deep ones. Alot of my molars are essentially shells and slowly I am getting them all capped. Back in those days (boy do I feel old), they did a thing over the roots (in deep fillings) called pulp capped and then did filling. Apparently there is problems with these old pulp capping causing problems down the road. Every dentist or root canal specialist comments when they get in there and find the old pulp capping. I have had hyper-sensitive teeth for decades, so much so they cannot spray water on my teeth (unless warmed) or when they do dental work, they need to cover my other teeth from the cold air coming from the drills. I really have wondered about all the metal in my mouth and the negative impact on my overall health. Ive even considered having it all removed and replaced with ceramic or other better materials. Alas, that is very expensive so unless I come up with a chunk of cash and make a trip over the border into Mexico, I doubt that will ever happen. I know I have a combo of both dental issues,tmj - osteoarthritis in jaw and the eagles. A trifecta for pain.
Im 7 weeks out from surgery now and just got the ok from surgeon I can get injections (steriods / nerve block) in my jaw and likely I will get some botox in my temple to get this to calm down. The steroids really helped in my styloid area before surgery when I was in alot of pain. I luckily have appt on Monday to get a tune up injections. Ill see how this all affects the TMJ and problem upper molar pain.
Hope that the injections help!
Welcome! I had tooth pain early on, although it did seem that I truly needed a root canal in addition to having ES, so of all my many varied ES symptoms the dental part turned out to have a different cause in my body than all the rest. I will add to the growing non-medical consensus here that on your imaging your styloids do look too long and too wonky. A tricky piece is that a lot of people have long styloids on imaging, but only a small subgroup of those (albeit likely many more than are correctly diagnosed with ES) have symptoms from the elongation. So my take would be that your styloids are certainly long enough and angled in a way that could potentially cause tooth pain. Also though, I think it is always important to confirm that the cause of your symptoms is not something other than ES, in your case maybe dental. Now that you are reading more about ES, I am wondering whether you find you are having additional subtle symptoms that you think might be related to ES.
If you ever had a bad sinus infection, you may have had horrible upper tooth pain. Since all these nerves so close to these upper molars, im not surprised I have this upper tooth pain. I didnt notice it so much before surgery as I had more pain in neck. Based on our discussions, Ive decided to go in and see dentist to confirm I dont have a cracked tooth and its pretty much non-stop aching. Ive been putting off a few crowns and may have pushed it too far.