I made my scan 3d tell me you think

Even though your styloids aren’t excessively long, they are longer than normal anything beyond 3 cm is considered elongated. They are also very thick - especially your left one. We have learned that the measurements a radiologist takes are often not accurate because there are little spaces between each CT slice that aren’t accounted for in a 3D image, thus, in reality, they’re often longer than measured.

It looks like your left side is starting to press your IJV against C-1 based on how wide your IJV is below C-1 & the tip of the styoid (compare the IJV below the right styloid - the IJV stays a uniform side above & below the styloid). If it continues to grow at its current angle, I think your IJV will become more seriously compressed. It’s the angle of the image that makes it look like the IJV has moved to circumvent the styloid, but in reality, to me it looks like the IJV is on the early end of being squashed by the styloid. It’s definitely worth pursuing Dr. Bunnell for a conversation about surgery.

I hope this helps.

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Yeah I figured that maybe they’re little longer maybe not. It hard to tell where to measure. I’m having a buddy make a 3d stl model for me

I think we’re talking about centimeters (cm), not millimeters (mm). 1 cm = 1- mm. That image shows the first styloid as being 37.19 mm, which is 3.719 cm. 1 cm = .4 inches. So 3.7 cm is about 1.45 inches, which is right smack in the middle of the symptomatic styloid elongation range requiring surgical attention. One recent study, and I’m sorry I don’t have the citation, examined the styloids of over 70 ES patients who had ES symptoms and required surgery. They experience relief of some or all of the symptoms post-surgery. The average styloid length of the patients was 3.4 cm.

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Thanks for the correction, @Larisam! That was definitely a lapsis lingua or whatever it would be called when it happens when writing not speaking. :joy:

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How did you make your scan 3D? I sent my CT Cervical Spine to Dr. Osbourne for a cobsultation, and he said the software he uses was able to make a 3D version, but my nor.al ENT doesnt seem to have that capability.

@jschronce

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Can you tell if that is the software Cazmagic used?

This is 3d slicer. There’s a blog on here that explains how to do it.

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@jschronce - A word about Dr. Osborne - he does good work but has turned away some of our members who hoped to see him. He either felt they didn’t have a severe enough problem or that their symptoms weren’t related to ES even though they had elongated styloids. We were disappointed in his mindset. If you get less than a warm welcome, there are several other excellent ES surgeons on our forum who are potentially closer to you. He has however been good about removing calcified stylohyoid ligaments (where ligaments calcify from the hyoid bone up toward the styloid processes vs the styloid elongating). There aren’t many doctors on our doctors list who will do that surgery.

Dr. Osborne agreed to do the surgery, and they sent me the estimate and explained the way payments are made basically up front with no refund of any portion of my part if my insurance covered more than their estimate. I’m so used to most of my doctors and facilities being in-network, this all seemed unusual. I didn’t proceed with him yet, but still could. He’s booked until February, and I had hoped to get surgery much sooner. I do like what I hear about Dr. Hepworth, and I contacted his office as well, but he is booked into April, and they require an in-person initial consultation, which I could do. All the while my symptoms are getting worse and more concerning. I think I may pursue this with my most local, in-network Head & Neck surgeon, Dr. Douglas Sorensen. He seems to have a good reputation, and his scheduling/nurse confirmed that he does have some experience with styloidectomies. I have an initial consultation this week, and I have a lot of important questions to ask, many of them as a result knowlege gained from this great forum! I really appreciate that this resource exists!

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That would be good if you could have surgery with a local, experienced doctor, and in network! Glad that the forum’s been useful, & if you do opt for surgery with Dr Sorenson, it would be good to add his name to our list, I don’t think I’ve seen it on there?

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Thanks for that. I downloaded it and tried it, but the latest stable version is layed out much differently, so i had some trouble following the step-by-step details. I think i got close, but the image was three flat planes woven together, not a 3D like expected. Anyway, I decided to try the RADIANT Diacom Viewer too, and it seemed simpler and showed 3D very quickly. I’m going to see my doctor today, so I’m glad I will ne able to show him these images! I’ll give the 3D Slicer another try later.

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I had the same problem, there’s a eyeball or something on the top left in the volume rendering tab you gotta click.

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@jschronce - Thanks for the news about Dr. Osborne accepting your case. I’m glad to hear it, but I think it’s terrible that he wouldn’t refund an overpayment. That just doesn’t seem right! However, I can understand his motivation in that insurance usually pays far less than the doctor charges (i.e. most docs bill excessive amounts to get the top dollar insurance will pay for a given procedure) then the patient pays their portion which still doesn’t give the doctor the total (s)he would like to receive for the surgery/procedure. I guess by keeping the extra from the patient’s payment, it brings the total income for a given surgery to an amount that’s closer to what the doctor would like to receive?

I’m excited about the prospect of a local doctor helping you & also that you can let him know what you expect from him surgically (i.e. styloid removal as close to skull base as possible, etc). I hope he’s willing to listen to what you know & hope to achieve w/ surgery so you two can have an educated discussion rather than him blowing you off because he’s the doctor & you’re just the lowly patient (who is NOT a doctor). We’d love to have a good ES surgeon on our list for your state because we currently don’t have anyone.

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Interesting that not many doctors on the list will remove calcified stylohyoid ligaments. Wonder why that is, since it is a well-identified variation described by Mr. Eagle long ago. What I don’t know is whether Dr. Sorensen or Dr. Osborne will remove the entire styloid, which many members here feel is important, especially if the styloid angle or thickness might be the real vascular problem rather than the calcified section. I just saw my regular ENT yesterday to look over some imaging (CT CERVICAL SPINE) he had not seen (different medical group), but the arteries and veins are not really visible, so we haven’t confirmed where the stenosis exists. I read one report (Internal jugular vein stenosis associated with elongated styloid process: five case reports and literature review (Internal jugular vein stenosis associated with elongated styloid process: five case reports and literature review | BMC Neurology | Full Text)) that indicates the best imaging for diagnosis and cause of stenosis, and I shudder at the thought of someone pressing an ultrasound device on my neck, but perhaps MRV and MRA would be helpful. I’ve had a lot of CT’s, especially this year, so I’m hesitant about a CTV unless that is the one to get to see it all, which this article seems to suggest. At this point, perhaps a little more radiation is not significant, considering the ongoing risk of a vascular event.

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@jschronce Why so hesitant about ultrasound against the neck? The neck muscles are already pressing everything maybe ten times harder than the technician with the ultrasound device head.

Even sleeping on side and putting the head on the pillow letting it press the neck is probably two-three times worse than the ultrasound device head…

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Good point! I am finding fewer good positions for sleeping almost daily, trying to leave a gap where the side of my neck contacts the pillow. So they dont push very hard during ultrasound? Then it may be okay. Can’t bear the thought of dissection or dislodging a clot, even though it’s very unlikely.

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@jschronce the ultrasound scan is usually as gentle as washing your neck with a sponge. Maybe a bit harder but that’s it…

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Doesn’t sound scary. Good news, i nabbed a cancellation, so I’m seeing a Head and Neck Surgeon tomorrow! Hope he agrees with the sense of urgency i feel.

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