Hi all,
I finally got my images back of my 3DCT. The radiologist noted bilateral ossification of the stylohyoid ligaments but did not say anything else. Images are below.
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The side that is symptomatic is my right side the one with the connected ligament that looks curved or angled like a “little harpoon” as Dr. C called it. They aren’t terribly long looking however I can now see why he called it that looking at these images. Could the angle be causing me to have such bad pain?
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The angle, the curve on the bottom half of the right styloid & the thickness of the left styloid & the calcified piece of ligament are all most likely contributing to your symptoms @Donoel.
Were you able to schedule surgery!
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I agree with @Isaiah_40_31 , also the right side looks like it’s quite pointy at the end…
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Yes its interesting that one side could be so much more problematic. That’s why I wonder if I got one side done (my right) would I start to notice more issues on the left.
Last night my dog got excited and hit me in the neck when he jumped on me. All day I am having worse clicking and gurgling in my throat when I swallow. The globus sensation is also much worse. I am scared now that it made it worse since it already is such a sensitive area with thing going on?
I feel like im just so anxious and don’t know if I am overreacting or if its even possible to make it worse just from that. I don’t have any bruise or swelling. I am not sure how hard you would have to be hit in the throat to cause damage but as you have mentioned people can fracture their styloid just from laughing or yawing.
Also one more thing to note a few years ago when I heard the pop and I went to the oral surgeon and he said it looked fractured is that something you would be able to see on these images?
Thank you all!
Emily
Also I have not scheduled surgery, I still need a follow up with Dr. Constantino after her reviews my images. I got the radiology report back but all it said was.
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My main symptoms are throat and tongue pain. I am taking Lyrica to help with some and it seems to be taking the edge off of the nerve like pain. Its only on that right pointy side that I have pain and feels like it harder to swallow. I feel like the other side with the floating piece i have no symptoms besides tinnitus and sometimes I can hear my pulse in that ear but not constantly.
Your dog most likely only caused the nerves that are already irritated to become more irritated which is what increased your pain/symptoms. Your styloid is protected from outside stresses by muscles & other soft tissues so I’m guessing your body’s reaction is from angry nerves.
It’s hard to tell exactly which styloid is causing which symptoms until one is removed. During healing of from the first surgery, symptoms from the remaining styloid often ramp up. They can even cross over to the side that’s already been removed.
I’m interested in what Dr. Costantino says when you have your consult. He pretty strictly works with patients who have vascular outflow obstruction (translation: compressed internal jugular veins).
Based on this statement you made, it doesn’t sound like you have IJV compression. If he doesn’t offer you surgery, we can refer you to other doctors in NY or more local to you or you can check our Doctors List.
It’s hard to tell whether your styloid is fractured or if it’s just jointed. There are 3 classifications of elongated styloids & yours looks to be to be Type 2 - Pseudo articulated which mostly means where the styloid process meets the calcified stylohyoid ligament, it looks like it’s jointed rather than being one long smooth elongation as in Type 1:
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Thank you so much for sharing this image. I will follow up with Dr. Constantino and I might try and get a second and third opinion with Dr, Amino and Dr. Cognetti. They aren’t that far. Unless there are some other god doctors in the NY-CT area that I missed.
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We have at least a couple of other doctors on our Doctors List for NY but haven’t heard much about them on our forum.
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@Donoel - Was reading ur post. Looks like you might have Eagles Syndrome. If u haven’t had a CT of your facial bones, I would suggest getting that done as that test I had correlated to ES. I also saw a TMJ Specialist who did numerous tests on me and radiology report said same. I googled ES and found Dr. Ryan Osborne in Los Angeles who specializes in treating and doing surgery for ES. You might want to call his office (310) 657-0123 and send medical records to him. He would be able to tell you if you have ES.
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Hi @Cheryl48
My first stop was a TMJD specialist who had no idea about ES and my 2 visits cost me $500 each with really no answers. I know I have TMJD but ive had that for many years and its never cause me this nerve pain.He gave me a temporary orthotic to help with my bite. He basically dismissed ES and said I should try going Gluten free and and dairy free. Said I just need to tape my mouth to stop mouth breathing. I was given no explanation or advice about my horrible headaches and neck pain and painful swallowing. Very discouraging consider I spent as much as I did.
I am currently seeing Dr Constantino who is on the DR’s list in my area for ES. I came in with both an MRI and CT scan with Contrast and he sent me for a 3DCT (images above) to get a better look at the stylohyoid ligament and styloid and what interactions it could be having with the surrounding structures. I have m follow up with him in the 13th.
I have seen good things about Dr. Osborn but I know he does not take insurance and financially that would not be doable for me at the moment. I also and east coast based so finding a doctor closer would be ideal.
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Just had my follow up apt yesterday with Dr. Constantino who said my styloids were very big especially for someone of my size and stature for context I am only 4’11" he said both of my stylohyoid ligaments are calcified. He said from my scan he sees no venous outflow obstruction and that this looks like classic eagles and I would only need a styloidectomy He feels confident I would fall in the 80% who would get relief from the procedure. He said he would no more when he gets in there might send some lymph nodes out for testing but has no reason to believe anything would come back. He said the one giving me issues looks like it was bent at some point and gave me the example of bending a credit card it does not go back into place when you un bend it because its hardened.
He said im welcome to get a second opinion as he always recommends that. He said if/when I am ready he can book my surgery in 3 weeks.
He did palpate an area in my mouth and it didnt hurt or trigger any symptoms which didn’t seem to make him think any differently. I said its more of a dull ach pain when I retract my tongue towards the back of my throat and pain when I push my jaw forward, I get the pain right under my jawline and up into my ears. I also am on Lyrica 75 mg 2x daily so my pain has been dulled down from what it was drastically.
Just wondering if thats normal that he couldn’t trigger my symptoms. I also still have tonsil intact and sometime the pain feels like its almost behind them.
I don’t know why I should feel so relieved but I am scared I haven’t ruled everything else out yet. I am scared if getting this surgery only to find out I have GPN or some other issue.
I still have an apt with Cognetti in July I plan on keeping.
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Another thing to note Dr. Constantino also confirmed it is NOT about the styloid size that matters. He confirmed that he has seen small styloids still cause problems for people that resolved after they were taken out. That it is how they interact with the surrounding areas and the anatomy. He also said it was concerning how elongated and calcified the ligaments were for someone of my age.
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This could be telling that your styloids aren’t the problem but that your calcified stylohyoid ligaments are since they’re lower in your neck & wouldn’t be able to be palpated in your throat. I’m glad Dr. Costantino acknowledges that styloids don’t have to be long to be problematic. That’s great news as I suspect he’s one of very few doctors who believe that.
Calcified s-h ligaments can cause GPN so getting your ligaments removed could solve that problem. Dr. Costantino has a good reputation for checking around for other things that may be causing the potential symptoms so it’s possible that if you had surgery & he saw other points of impingement on your GPN or other nerves he would try to deal with those, too, so the nerve could be free from irritation.
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Given the other symptoms you have ( migraines, neck, shoulder, jaw, ear pain etc) it does sound as if even if the styloids don’t cause all your symptoms they could well be causing quite a few of them! And may well be the cause of the GPN- we have had a couple of members I think who have opted for MVD over styloidectomy to help with GPN & it didn’t, so they still had to have the styloids out.
Surgery is never an easy decision, so you’re wise to take the time to think it through 
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Good observations, @Jules!