I recently saw Mr Hughes for my ongoing jaw pain, dysphagia, tinnitus, balance issues and the list goes on. I had a ct scan with contrast. I have bilateral styloids measuring up to 45mm. Also my hyoid bone is super close to the external carotid artery.
Mr Hughes looked at the 3d images i had taken and suggested surgery straight away.
He has offered to shorten my hyoid bone from both sides and cut my styloids by about 75%.
My question is, has anyone had this sort of surgery done before.
Will the styloids grow back and start poking in nearby areas?
Anyone recommends Mr Hughes. We found him super quick and did not go into any detail.
Has anyone had this sort of mixed surgery before? Do the styloids grow back or get calcified again? He is saying not to remove the whole styloids as it is a complicated surgery.
We just found the appointment bit rushed and not been asked any proper questions.
Ideally the styloids should be removed back to the skull base, or as far as is safe to do so- it’s not always possible as sometimes the nerves are wrapped around or blood vessels too close. Sometimes if the styloids are compressing nerves or blood vessels right at the skull base symptoms might not be resolved. It’s a balancing act, and nerves are usually monitored during surgery to make sure that they’re not being stretched too much. The styloids can grow back, but it is rare, and we’ve had at least one member who’s styloids grew back even when they were cut back to the skull base.
We’ve had a couple of members who’ve had surgery with Mr Hughes- if you use the search function you can look up those discussions. I’m not aware of anyone who’s had hyoid bone surgery with him though…If both the hyoid processes and the styloids are causing issues, it’s good that he’s spotted this and is willing to do both.
Did you see him on the NHS or privately? It’s more difficult with NHS appts, but if you’re paying privately and feel you have concerns I would definitely ask to speak with him again!
I saw him privately but i didnt like his idea about only partially removing the styloids. Besides i felt that he didnt ask any proper queations and felt very rushed.
The idea of styloids growing back is scary. I spoke to another ent in india and he is offering an intraoral surgery.
Yet another ent friend abroad says get a steroid jab and dont rush into surgery. Mr Hughes said that the hyoid is too close to the carotid artery and doesnt want to do an injection.
Im super confused at this point. Dont know what to do.
Thanks a lot for your reply though. Greatly appreciate it.
Some members have had successful surgery intra-orally, but it’s not the best way as generally not so much of the styloids can be removed, and there’s not such good visibility, which isn’t great especially for vascular ES…If your hyoid bone processes need shortening, then that won’t be done intra-orally either.
The steroid injections can help temporarily with the pain (although they don’t work for everyone), so would give you breathing space to consider surgery, but it’s not a cure, and it won’t help with vascular symptoms…
I wouldn’t worry too much about the styloids growing back- like I said, it is pretty rare…
@Hema -
Based on the report of the dynamic study of your IJVs which you posted , you do not have IJV compression, however, when the greater horns of the hyoid bone are elongated as yours are, they can poke or compress the internal carotid arteries which could be the source of your dizziness.
Since the incision for hyoid bone surgery is essentially in the same area as for ES surgery, it does make some sense to have both done at once, but I agree w/@Jules that having the styloids cut back closer to the skull base would be better. It’s possible that the hyoid bone part of the surgery is aggressive enough that Mr. Hughes doesn’t want to risk cutting the styloids as short as would be most beneficial during the same surgery, but he feels that at least shortening them some would make a positive reduction in your symptoms.
Yes I understand but as the appointment was so brief, we didn’t have time to discuss anything at all to be honest. Maybe I might go and see him again. I understand there is no compression on the Jugular veins and I do not have shooting pain in the mouth or face etc. Does vascular symptoms only appear if there is jugular vein compression right? I haven’t had a chance to read through all the posts. Im just toying with an idea to just have the hyoid shortened and if needed, at a later date the styloids can be removed at the skull base if needed. But im just concerned that the shortened styloids might start poking everywhere. That idea is scary. Thanks for your reply. Is there a test to check the compression on the carotid artery?
Here’s a link to the post in the Newbies Guide Section about Vascular ES so you can see what symptoms you might have, if any: ES Information: Common Symptoms And Possible Explanations For Them - Welcome / Newbies Guide to Eagle Syndrome - Living with Eagle
Vascular ES can be caused either by compression of the IJVs- which would be unlikely given the CT report- or the External Carotid Arteries, or very occasionally both. But it sounds as though it’s the hyoid bone processes affecting the ECA rather than maybe the styloids?
If you were to decide to opt for shortening the styloids, you could ask Mr Hughes if he smooths the tips off, which would make it less likely that they would poke or irritate any structures in the neck.
Yes. Thats the plan. My gut feeling is, its the hyoid mainly. But I will just go through the VES symptoms. Are there any tests to confirm if there is pressure on the carotid arteries. As there is no mention about them on my report.
@Hema - The carotid artery tests would be similar except checking the carotids instead of the jugulars. It looks like only your IJVs were checked. The testing that was done for your IJVs looks pretty thorough though some doctors go another step further & actually measure the velocity of the blood through the IJVs w/ the head in various positions (i.e. dynamic testing). I think the same thing can be done w/ the carotids.
So i was thinking, cant i request the radiographer to look at the same scan and comment on the carotid artery? Or wouil I need another scan? I also seem to have vagus nerve related issues. GERD, dysautonomia etc, can that be measured ot is that only evaluated based on symptims?. Regards.
When the CT with contrast is done they check the timing of the dye through the blood vessels to see them clearly . I think that with a CTA the dye would have to be injected into the arteries to see them, whereas with a CTV it’s injected into the veins, so they won’t be able to see any compression of the arteries from your scans (I think!) So you’d need another scan with contrast, which is more radiation and more dye, not ideal. The Vagus nerve function would usually be measured only by symptoms, I think that according to google the size can be measured by high resolution ultrasound, but I’ve not heard of this being done to any members?
It’s actually in both cases injected into the vein in the arm. The contrast then goes into the heart and is pushed through the arteries. For CTA, the timing of the scan is early, so that the contrast is still flowing from heart and thus the aorta is visible. For CTV there is a delay to ensure that the contrast goes all the way through the brain, is collected by the veins and starts flowing into vena cava. If large amount of lower osmosity (?) contrast is being injected and the scan timing is adjusted, it’s possible to catch both veins and arteries in a single scan.
Injection of contrasts into an artery in arm would be unnecessary as the contrast would flow down towards the hand before being redirected back to the vein, plus in general injecting anything into artery is more complicated as the artery has high pressure vs vein and puncture site would be more difficult to close afterwards.
Ok as far as I remember the dye was injected and i was quickly asked to turn my head to the left and to the right to catch the venous flow, thats all i can remember. But in my scan there was no mention of the greater cornu of the hyoid being close to the carotid artery and no mention of the thyroid cartilage either. At this point i dont know if the thyroid cartilage was scsnned, the radopgrapher said they were asked by Hughes to check from C4 and upwards.
@Hema - I like to say “Asking is free”. I’d say go back & ask for a review of your scan but looking at the ICA & thyroid cartilage if visible. The worst that can happen is your request is refused, the best - your request is accepted.
