I think it makes sense to have a vascular surgeon there to make sure the veins are functioning. Removing the styloid doesn’t always do it. I needed the jugular vein to be ballooned. They went up my groin (like they might do for a heart patient).
There were these 3 drs:
- ENT
- Vascular
- Anesthesia
There was equipment and people (or a person?)just for monitoring nerves. It was a specially equipped surgery room for it. I had monitors placed in my mouth and around my head.
Jugular ultra sound and MRI were done pre surgery. It is tricky to get the jugular ultra sound done right. There are only a few places my doctor sends people. One place, his office trained them. So, it is tricky to get the issues to even show up on testing.
Right and left sides both showed styloids blocking jugular veins.
It appeared that the rt side was more blocked but I insisted on doing the left since that is where I had immense pain.
They went in through an incision on my neck (about 3.5" long when it was measured 1 week post op, so things were still very swollen).
Found on left side during surgery:
Left Jugular was blocked in 3 places (more than the testing showed). Up by the styloid and 2 places by the hyoid bone and thyroid.
The immense pain I had from behind the left ear down the neck was from a smaller vein that was bloated (turned into a varicose vein), trying to compensate for the blocked jugular vein.
The vascular surgeon had to balloon at least one of the places to get the vein to open again.
There was scar tissue around the jugular vein keeping it from inflating. The scarring could have been from: trauma, infection (from sinuses or lymph system), neck strain,?? who knows. The ENT removed as much scar tissue as he could without injuring the cranial nerves.
This is delicate surgery.
From the surgery report re removing the styloid:
"The styloid was identified and skeletonized and eventually removed using ultrasonic dissector through an infratemporal fossa approach, which involved retracting the digastric posterior belly superolaterally, identifying the 9th, 10th, 11th and 12th nerves preserving them and untangling them from the styloid orgin and then removal with the ultrasonic scalpel of the styloid itself. Vascular Surgery service then performed venous assessment by IVUS pressure gradient and fluoroscopy and revealed that there were constrictions of the jugular vein, both high and low. A ballooning was performed to expand the inferior aspect of the jugular vein, which improved visual picture and pressure gradient across it by approximately 3 times."
The testing before doesn’t show everything. Having the right doctors and teams in the room makes sense.
Take aways:
it took a surgery room equipped for nerve monitoring.
2 surgeons (ENT and Vascular)
Surprise! Jugular vein was blocked in not 1 but 3 places. Plus, there was scar tissue to remove.
Styloid was wrapped around and pushing on nerves, vein,… (delicate to unravel).
There were calcified ligaments to remove.
I didn’t have a drain. I went home that same day. I had a large supply of pain meds and ambien for sleep.
I was told: intense recovery for 2 weeks, at least 6 -12 weeks to really let things calm down enough to evaluate (blood flow, chewing, swallowing, taste, voice/singing, neck rotation,…).
I am 5 weeks out.
Hope that helps explain to the insurance company all that might be involved.