Thank you for accepting me to the forum. I’m new here. And relatively new in this topic.
Long story short, I’m planned to have a double jaw surgery soon. They will cut my jaws in few places and move it forward because I have an underbite.
Recently, however, just two weeks before the planned surgery someone hinted that I might have Eagle Syndrome. My symptoms are:
Occasional stabbing pain in the throat, ears, back of the mouth, under the tongue
Drilling pain inside the ears, behind them
Feeling of clogged ears, fullness inside as if water trapped in after swimming
Short stabbing pain in my temples also in other part of my head
Before that I thought these pains come from having braces or from joints. Pains are mild and I don’t take any painkillers. But they are worrysome.
I quickly did a contrast-enhanced CT and the results show that my styloids are 3.9 and 3.01 cm long. They say:
“Elongated styloid processes on both sides. On the right side, it shapes the internal jugular vein and is adjacent to the ICA for a short distance. On the left side, it shapes the internal jugular vein.” (‘shapes’ meaning ‘presses’, I guess. This is Google-translated)
What type of ES is it? Vascular? To my understanding my symptoms are not stroke-like. At least not yet.
I’m worried because I waited for my jaw surgery and now I’m afraid that the swelling that immediately comes after the surgery and lasts for several days could further press veins and arteries that are already pressed. Would it be a health hazard? I’m speaking of risk of stroke etc. In general, it’s difficult for me to estimate the seriousness of the situation because I can’t make out the 3D images that I have.
Hi & welcome!
There have been a few, very rare cases of styloids causing strokes, it can happen if they compress the carotid artery. It sounds from your symptoms as if the styloid is compressing the IJV, which can cause raised intracranial pressure, the clogged ear feeling is common with that. (There’s more detailed info about vascular symptoms in the common symptoms & possible explanations section) So it does sound as if you have vascular ES, as well as possible nerve pain.
If it was me I would postpone the jaw surgery, and try to find a doctor with experience to get an opinion. We’ve had quite a few members who’ve had dental surgery which has really increased their ES symptoms, possibly from all the pulling & tugging on their teeth? So from the sound of your jaw surgery, this could potentially cause quite a flare in ES symptoms. Depending on the angle of the styloids, it could potentially move them into more contact with the blood vessels, although that’s just a guess, I don’t know for sure, but having ES surgery sometimes has altered people’s jaws so that they find if they have a bite guard it doesn’t fit properly afterwards, so it could happen the other way round too?
And your concern about swelling is a valid one too, so I would certainly want to discuss this with your jaw doctors, it needs careful thought.
I’m not very good with tech stuff, I don’t know if these are any help to you with your imaging: Making Your Own 3D Images from CT Scan- 3D Slicer Tutorial - Living with Eagle RadiANT DICOM Viewer tutorial - General - Living with Eagle
Thanks. I read that section. It was very informative. I can confirm that this part describes my posture:
“This results in a forward head posture, which seems to alter the styloids in relation to the IJV. This is can be due to looking at phone or computer screens, but could also be a subconscious way to create space between the styloids & IJVs.”
If it matters, I had scoliosis and had an operation on my spine. I still have a forward head posture.
Please tell me. If I have vascular type, then why don’t I have neurological symptoms, like ischemia, faintings etc? Or are they yet to come?
Lastly, I may add that recently every morning after working out I had headaches that disappeared during the day. It was only the day after the gym. Can they be attributed to ES?
Hi @Arb! Welcome to our forum! Here are some answers to your questions above:
You’re welcome to upload your 3D images here & we can look at them & give you our non-medical opinions i.e. we are not doctors but we can sometimes provide information that isn’t in the radiology report that you can discuss w/ a doctor.
Forward head posture in your case may be a result of your scoliosis, however, if it’s caused by looking down excessively at your phone, computer, books, etc., then it is correctible with gently physical therapy exercises. It takes quite a while to restore the curve in the cervical spine & consistency in doing the exercises. We recommend not starting the exercises until ES & vascular decompression has been taken care of.
It is typically carotid artery compression that causes ischemia & fainting whereas IJV compression causes more of the symptoms like you have. Headaches can be caused by both carotid & IJV compression.
When your IJVs are compressed, the rate of deoxygenated blood flow out of your brain becomes limited & can’t occur at the same rate the carotid arteries are bringing freshly oxygenated blood into the brain thus a situation of intracranial hypertension occurs which is high pressure inside the brain. That leads to symptoms like you have plus others such as pulsatile tinnitus (hearing your heart beat in your ears), brain fog, derealization, & feeling drunk when you’ve had no alcohol to drink, and other symptoms can also occur. IJV compression doesn’t present the risk of a stroke because the blood is flowing out of your brain through the IJVs, however, carotid irritation or compression can cause TIAs or, as @Jules said, very rarely a stroke, because if a clot develops in the carotid artery, it goes into the brain thus causing the stroke or TIA.
As I mentioned above, headaches are very common with the vascular type of ES.
Thank you @Isaiah_40_31 I like your Bible reference. Very applicable in our situation. I wanted to present screenshots from my 3D and 2D imagining but an error pops up saying I can’t embed media.
Do you think if I did my planned jaw surgery it’d be a serious health hazard? Pain is one thing (I’d have it after the operation anyways), but having a stroke due to swelling and compression is something completely else. Also, how do clots form? Do patients with ES have them? My angiography say that my blood vessels are in good condition otherwise..
I’ve done an admin fiddle so hopefully you can upload any images now! It’s just because you’re a new member…
Clots can form if an artery is compressed, you can sometimes get blood caught up behind the compression, which can then form a clot, & if these eventually come loose it can block a blood vessel in the brain. Very rarely an artery can get pierced (or if it got completely blocked by a styloid) which would cut off the blood supply to the brain & cause a stroke. It is very rare for ES patients to have them, but we have had a couple of members who have had TIAs- transient ischaemic attacks, or mini strokes, so it is unusual but possible.
My concern with your jaw surgery would be that the altered position of your jaw & the surrounding muscles & ligaments could cause a shift & might make vascular compression worse. It’s worth discussion with your surgeon, and possibly taking some info, a printed out research paper for example, with you to show them about vascular ES, as many doctors are skeptical! There are quite a few research papers which are about carotid artery or IJV compression, here’s a link to that section: Latest General/Research Papers topics - Living with Eagle
Thank you @Jules. Yes, I’ll speak to my surgeon about it. Meanwhile, I present you some screenshots from my results. It bugs me that they don’t show a picture with blood vesels and bone structures in one picture. Very annoying. Can you see something specific?
@Arb - Your styloids are significantly elongated & the right side is pretty thick. The left is very thick at the top near the skull base & a bit thick toward its terminal point. In the image of the right styloid you included, it looks like there is ok space between styloid & C1 though it may be a bit narrowed. Since there’s no similar image of your left side, I can’t comment on that. Both styloids also look quite pointed at their tips which can be problematic.
I think what @Jules is saying is that there is a chance your symptoms will get worse once you have your jaw surgery & your lower jaw shifts forward. There is no way we can tell you for sure whether that will create a dangerous situation for you. It would be best to discuss your styloid elongation & possible jugular vein compression w/ your jaw surgeon prior to surgery so you can get a professional opinion.
In the photo of your jugulars, I don’t see any compression, but I had a very similar picture of mine & was told I didn’t have compression. When I had 3D images made by dicomlibrary.com, it was clear that I had left IJV compression between styloid/C1 & on the right, possibly compression by soft tissues. That is to say, the type of image you have of your jugulars isn’t terribly helpful when trying to ascertain whether or not there is compression.
I agree with @Isaiah_40_31 about your images- I’m not able to label them, but the 3rd image which also shows your hyoid bone, it looks as if the hyoid process is quite long too, you can’t see any blood vessels to work out if it’s affecting any, but quite often with elongated hyoid processes they can irritate the carotid arteries. Obviously can’t tell from this image though, & doesn’t sound like you have any symptoms of that, but it’s another thing to ask about when you’re considering jaw surgery…
@Jules@Isaiah_40_31 Today the called ne from the clinic. My jaw surgery has to be postponed until I’m done with ES. They sadly couldn’t recommend any surgeon but I already know who I’ll contact.
Your jaw problem is somewhat cosmetic, but the styloids/IJV compression is a medical problem that should take priority. I’m glad you have a surgeon in mind to help you. When you get an appointment, please let us know how it goes. We have a list of questions we suggest our members ask at their initial consult w/ an ES surgeon. It’s toward the end of this post about ES surgery that @Jules wrote:
Thanks. This is my left side. A shorter one (3.02 cm reportedly). Interestingly, I have more symptoms on this side rather than on the right (the longer) one.
It can seem strange that symptoms are worse on the shorter side, but it may well be the angle of the shorter one is irritating nerves, or it might be thicker.
