@ngage from my pov, your styloid processes are maybe a little longer than absolute “average”, but just barely (I’d say 2.5-3cm give or take). But the upper wisdom teeth, especially the right one, are severely impacted, unless it’s something wrong with how the xray shows it.
Also it feels you might have some atlantooccipital joint issues, as the skull looks tilted a bit backwards on the R side.
Though as you have already read, pano xray isn’t the best tool for diagnosis of Eagle’s.
Obviously, disclaimer – I’m not a doc.
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Yeah, I’d agree. I wasn’t sure if the styloid appeared longer than typical.
If I were to get wisdom teeth surgery (which I intend to) do you know if I need to take any precautions in regards to potential TMJ / Eagle’s?
And if I were to have atlantooccipital joint issues, how and where would I get that checked out? Would the CT scan I’m planning on getting to 100% rule in/out Eagle’s help?
@ngage the truth re “would the CT scan […] rule in/out Eagle’s” is that… No one knows 100% :-/
May it confirm elongated styloids, potential impingements, and if you get it with contrast (CTA/CTV) - potential blood vessel impingement/compression? - yes, definitely.
However, majority of people with elongated styloids have no or very few symptoms, also not everyone gets total relief after the styloids are removed, so it’s always a bit of a “guess”.
The only definite answer perhaps comes after you get under the scalpel and rid of the styloids, and give it enough time to recover after the surgery. If the symptoms disappear - that means it was Eagle’s. If not – it might had been not Eagle’s, or not only Eagle’s, or the surgery was not successful.
Re wisdom teeth extraction – the surgeon who will be doing the extraction absolutely must be informed about the possible conditions (elongated styloid processes, possibly unstable neck) before starting to work. And based on what I see on the panoramic xray (again - not a doctor here), your wisdom teeth are… Really worth getting rid of. That alone might eventually help you significantly.
Will it trigger more symptoms related to the styloids – again, nobody knows. It might make it worse, or it might be the opposite, e.g. your jaw muscles might become much more relaxed after the irritating teeth are removed, and the styloids won’t affect the tissue anymore.
Talking about the atlantooccipital issues – I am just speculating and vaguely guessing, CT in my opinion should show if there is anything very serious, but the MRI would be more helpful to see any soft tissue problems around the atlantooccipital joint.
Just for the record, I had one of my lower wisdom teeth removed back in 2014 without even knowing that I had elongated styloid on that side measuring about 6 cm. The recovery was a bit rough (it took about two weeks until pain subsided, I think), but later I felt better than before the extraction.
UPD: have a discussion with your oral surgeon before the CT scan, they might want to see how the roots of the upper R wisdom tooth grow. They look very strange, either almost non-existing, or growing towards the sinuses/eye socket (but again, I’m not a doc and this is just what I see).
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Many of us have had unnecessary dental work for nerve pain caused by ES, which then exacerbates the nerve pain…I always put my ES pain (jaw pain, glands swollen beside jaw) down to possible wisdom tooth pain, dentists couldn’t agree whether they should be removed or not & I was too chicken so never had it. These symptoms have improved since my styloidectomies, so I’m glad that I didn’t have them removed. We’re all different though, can’t say for definite what works for one will work for another…
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That’s true, healthy, normally developed wisdom teeth are just “normal” rudimentary teeth.
But those who had impacted ones… I bet they know how torturing is to have them – pain, infections, food stuck between the gum and the tooth, swollen gum suddenly covering the tip of the tooth and concealing it again, more infections…
I was begging my dentist to do something about my first one (~2008 I think), and she said – sorry, it’s above my skills to pull it out, it’s barely visible. I think it took close to one hour for the surgeon to get it fractured and pulled piece by piece out from the jaw.
Fun fact, on that side my styloid process ended up much shorter and thinner (though still elongated) than on the one where I postponed wisdom tooth extraction for another six years or so and let it have occasional infections… 
Understandable re wisdom teeth vs Eagle’s.
Unfortunately, mine are not visible at all. My dentist said it would be a very challenging surgery but that he’d be willing to do it, and I believe he’s qualified.
I’m going to get the CT scan and see what’s up with my neck first (if I have proper posture, I get an insanely bad headache immediately), and if that doesn’t reveal anything actionable, I’m going to investigate getting these wisdom teeth dealt with.
I just don’t want to get them removed as I’ve seen many horror stories about wisdom teeth extractions leading to worse pain in people with Eagle’s or TMJ (both of which I have symptoms lining up with).
Thanks for all of your insight. This has been super helpful. I definitely at least feel confident that there’s a way for things to get fixed… prior to joining this forum, I felt very hopeless.
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You’re absolutely right – there are significant risks when pulling out them too, so probably the best is to discuss with a skilled oral maxillofacial surgeon.
By the way, regarding the “proper posture”… The “proper” posture sometimes isn’t what people think it is. The spine usually has three slight curves, it isn’t “straight”, and it shouldn’t be. The intervertebral discs act as firm flexible cushions between vertebrae, and they should be used for that. Otherwise, the whole body’s weight would be placed on the facet joints that are more prone to damage and also might impinge nerve roots.
Posture is another huge topic. If you have access to a good physiotherapist/kinesitherapist, it might be worth having a chat with them.
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I agree w/ @vdm - Your wisdom teeth should be removed by an oral surgeon not a dentist no matter how much you trust him. Your dentist should be able to give you a referral to someone he trusts as permanent nerve damage could be done by someone who isn’t experienced in complex tooth extractions.
Also, please don’t just take the word of whomever reads your CT scan images especially if they say everything is normal. With ES its very important to get a second opinion from a very experienced doctor. I think I mentioned that both Dr. Samji (CA) & Dr. Cognetti ¶ do video consults so ask for an extra disc of your CT images & send it to one or the other to see what they say. Get a copy for yourself as well.
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I actually didn’t know there was a difference. Do you know how I would go about finding a qualified oral surgeon and if it is significantly more expensive?
Also re @vdm on proper posture: My posture is pretty much borked which may be the cause of all these things. How can I find a good physiotherapist / kinesitherapist and are they very expensive?
@ngage In general, oral/maxillofacial surgeons are working on more complex issues that aren’t typical day-to-day problems with teeth, and take longer to do. For example, treating cavities, restoring chipped tooth can and usually is done by dentists.
But extracting impacted bottom wisdom teeth in your case probably will look something like this:
- local anesthesia (for upper teeth, general anesthesia might be needed, but it depends)
- make incision in the gums
- expose the tip of the crown
- perhaps cut away a very small piece of jaw bone (e.g. 3x3x0.5mm) that sits like a cap above the tooth to expose the crown better and improve post-operative recovery
- the roots look small and weak, so probably you won’t need fracturing the tooth, after it’s been exposed, it probably can be taken out in one piece
- drill into the exposed tooth, screw in a special tool
- pull the tooth out
- if roots break (unlikely in your case), use microtools to fish-out the small pieces
- wash, clean, disinfect the cavity and exposed part of the jaw bone
- suture the gums around the incision site
Usually you wouldn’t want a “typical” dentists let do this job in a “typical” clinic. Surgeons have different day-to-day skills and usually immediate access to extra help in case of emergency (jaw bone fracture, excessive bleeding, nerve injury, accidental soft tissue injury during the surgery and so on).
As for the upper wisdom teeth, it might be even more complicated, as they might be growing into the maxillary sinus cavity. And again, you wouldn’t want a dentist to let go into that area – it’s simply not their expertise.
Good website to find surgeons is ratemds.com, also check on reddit.com if there is any thread about wisdom tooth extraction in your area.
Regarding the physio/kinesitherapists, it’s probably not that easy to find, but you might want to shop around (maybe they could give you a free 15 min consultation?) or maybe something on yelp.com would be helpful. I am not sure about prices, but in here in Canada 45 min individual appointment can be 60-120 CAD.
My own recent experience with physiotherapy is quite fruitful (relatively speaking), but it took months and months of intensive work. On the other hand, I’m ~40y young, so my tissue isn’t that elastic anymore as it used to be 20 years ago, I have degenerative disc disease, also a few small protrusions in discs, some arthropathy in spine and other joints, so it’s much more complicated. Back then it would be a matter of a month or two of intense targeted and whole body exercise to restore balance in muscles. Oh, I miss those times 
UPD: use your young age as your advantage. I think bodies up to ~25-30 years old have a lot of regenerative capabilities, so even if you have improper posture right now, you might be able to fix that. Joints and ligaments are flexible, intravertebral discs are fully “wet” (later they start drying out and the spine becomes less flexible), metabolism is optimal, and muscles recover easily and quickly after the exercise.
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Another option for finding a qualified oral surgeon is to check w/ your medical insurance co. They will have a list of oral surgeons & PTs who take your insurance. Once you know who the doctors & PTs are in your area, you can fine tune your search using the tools @vdm suggested. Interviewing a doctor first to learn of his/her surgical technique is important & getting a second opinion is always a good idea where surgery is involved.
Regarding wisdom tooth extraction, in the US, especially for a case such as yours, you would most likely be put under general anesthetic (i.e. all the way asleep). One of our members was diagnosed w/ ES & 2 very impacted wisdom teeth last year. Her ENT recommended having her styloid removed first to see what symptoms would recover. After she was pretty healed from her ES surgery (4-6 mos), she went in for her widsom teeth to be extracted. Though she recovered more quickly (~3 wks) from the wisdom tooth surgery, she said the ES surgery wasn’t as painful.
It’s my opinion that you shouldn’t make a decision about your wisdom teeth removal until you have a definitive diagnosis about ES & have some good CT images of your styloids & a suggestion as to how long, angled, thick, ect., they are & if you have additional s-h ligament calcification. Once you have that info, you’ll be able to make a more informed decision as to how to proceed.
Getting a good CT scan with contrast of the head and neck is definitely the first step to sorting this out and the ENT should be the quickest way to get one. If you cannot get one of your doctors to order a CT scan, there are on-line options for self-pay consultations and CT-scans. I googled self-pay CT scans in Texas and there were multiple option. You need a head and neck CT with contrast to evaluate for elongated styloid processes. I found very few doctors who knew what Eagle’s Syndrome is, but more understood the concept of elongated styloid processes so I stopped using the word Eagle’s and got better results. There is a chiropractic specialty that focuses on upper cervical issues - C1 and C2 alignment. I found one after my styloids were removed because my cervical spine is totally skewed from years of holding my neck in a way to minimize Eagle’s symptoms. Surprisingly, the upper cervical chiropractor I found has very sophisticated imaging equipment that produced very high quality 3D images at a very low cost. Search for NUCCA doctors in your area. If they have the imaging equipment it will be on their website. Wish I had known about this before my frustrating search for help. These chiropractors do not fix styloids but they can see styloids and measure them with in-house equipment. No contrast, though, but you will have a good start with the length and angle of your styloids. You might get some good help with alignment issues, too.
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I totally agree with @Catmd in your pursuit of diagnoses. I just wanted to add that contrast CT helps to identify if vessels are being irritated or compressed by the Styloid process. Unfortunately, the regular CT won’t make vessels clear as well so I suggest you do contrast CT of Head & Neck to see both an elongated Styloid process and vascular compression if any.
The problem is finding a doctor to order a CT with contrast. I don’t know why there is such a reluctance to order them, even with really good health insurance, but I had to really work at it and saw many different doctors in the process before I could get one ordered. After 10 years of trying to figure out what was causing dizziness and near fainting spells, an orthodontist found my elongated styloids with a sophisticated mini CT scanner with 3D rendering. I paid extra to have it sent out to a neuro-radiologist to measure the styloids and write a report. This might be an option @ngage - ask your dentist if he/she has an external radiology service available to read the panno x-ray and prepare a formal report with styloid measurements. Armed with images and a report I visited multiple doctors who knew nothing about Eagle’s or thought it was not an issue, until I found this group and the list of surgeons with Eagle’s experience. Finally got a surgeon at an area university medical center to order a CT Scan with contrast and confirm the Eagle’s diagnosis, but I had to ask for it firmly because he was not a believer in vascular Eagle’s. If I had not had the written radiology report from the little CT scan from the orthodontist identifying longer than normal styloids, I am sure the surgeon would not have helped me at all. There are self-pay options for on-line consults to get orders for CT scans with contrast now, which is also an option if local doctors won’t help. My dentist was no help at all with styloid identification and could not see them on his standard x-ray panno, but the orthodontist knew instantly what they were and what the symptoms were - all through a free consultation using more sophisticated scanning equipment. If not for a late-in-life desire for straight teeth, I would still be dizzy, in pain and twitching!
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@Catmd Ok, I see your point. It could be that Doctors usually avoid it as a first line of screening due to the fact that it might trigger a rare allergy for some or adversely impact your health if you already have kidney issues (they sometime demand kidney function blood test prior to it). Sometimes, Styloids do not have to be elongated to cause health issues as is the case for the classic ES. In my case, my left Styloid is roughly ~1.8CM and is compressing my dominant jugular vein along with C1. So a normal ENT doctor will simply decline to remove it for the fact that it is not elongated enough to warrant an operation since they are not trained as Neurovascular doctors, they do not believe it is pathogenic (disease causing) if it is less than 2 CM. I had to prove that it was messing with my Jugular Veins to be considered for a candidate for operation. That means a vascular surgeon had to recommend it in order for the ENT to consider it. So I think it was mentioned here a multiple times that it is not only the length but also the angle orientation and the thickness.
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Welcome! I’m sorry you’re struggling! Your symptoms sound familiar to me as someone who had vascular ES and had my right styloid removed in October. I also second, third, fourth the recommendation to find an experienced surgeon as that can make all the difference. Regarding the wisdom teeth, I had impacted wisdom teeth and had mine removed by an oral surgeon when I was 24 or so. Mine were painful as they erupted through the gum but the pain I experienced was nothing like my ES pain – headaches, neck ache, shoulder pain, throat pain, dizziness, pulsatile tinnitus. The wisdom teeth pain was more localized to my gum/jaw around the tooth and kind of throbbing in that area. I agree with @KoolDude and others that length is not always the only issue, can also be thickness or angle or the anatomy of your neck in that area.
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