Jugular compression on 3D images

So I finally paid someone to create 3D images for me. The resolution isn’t great, apparently because of the way the files were formatted. But he said he could see the IJV compression on both sides. And also that my styloids look like a normal length. Both under 2.0. Along with all of the normal disclaimers that he’s not a doctor and not diagnosing me. So wanted to hear what you all think, again not diagnosing me. I always assumed it was a ligament – stylomandibular or stylohyoid or whatever – that was causing my symptoms. But he seems to think it could be the transverse processes of the C1. I’m still kind of an amateur at all of this anatomy. Could this be causing the ear pain and weird facial neuropathy. I see Hepworth again next week. About ready to schedule surgery, even though I haven’t been terribly symptomatic. He’s a busy guy, so I don’t get a lot of time to ask a lot of questions, so I want to know as much as I can going in.

I have more images, but these are the two close ups.

CT page 17
CT page 16

Hi Bopper!
Certainly looking at the second image it does look like you’re right & it’s possibly the C1 processes causing the compression. Am I right in thinking that you’ve seen Dr Hepworth, I can’t remember where you’re at exactly? We’re seeing more people with cervical processes causing compression…

Yes, I’ve been seeing Dr. Hepworth for nearly 2 years. Been dragging my feet to schedule surgery, which he has been ready to do for quite some time. But what is the fix if it’s the C1 process? Styloidectomy is not going to make any difference in that case, is it? I believe he said he saw a calcified ligament on the left side. How would that play into it? There’s still so much I don’t understand.

And probably dictated.
Please excuse typos, misspellings and just plain weird, inappropriate words.
I like to think I am relatively eloquent.
But Siri is often a drunken, blathering idiot.

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Your compression definitely looks worse on the right than the left, Bopper. It looks to me like you can’t see the full styloid on the right i.e. part of it is blocked by the enlarged jugular vein. It’s possible that the stylohyoid or stylomandibular ligament are calcified & pinching the jugular against the C-1 transverse process, but due to the angle of the scan the styloid/ligaments are fully visible (I think we’re looking at it from the back instead of the front?). If there is a calcified ligament involved, then removing it will take the pressure off one side of the jugular which will allow better blood flow even if the IJV doesn’t reopen fully. That’s my opinion. It will be interesting for you to learn what Dr. Hepworth sees/thinks.

I’m not an expert at reading images but the way dr h described it to me it’s a very very crowded area with blood vessels, nerves, muscle, ligaments in there… so removing your styloid may actually free up some room even if it’s not compressing the vein directly. He described the styloid as “like the mast of a ship” and a lot of stuff is tied to it. Also, he found scar tissue was my big problem when he went in there and we didn’t really know that was there until surgery. It’s hard not knowing everything before he goes in but he’s very thorough so I’m sure he will find something and a solution.

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That is so interesting. I never pictured it that way. What was your scar tissue from? Had you had previous surgery?

And probably dictated.
Please excuse typos, misspellings and just plain weird, inappropriate words.
I like to think I am relatively eloquent.
But Siri is often a drunken, blathering idiot.

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No I haven’t had any surgeries, he thinks it was from a previous whiplash injury. The scar tissue was on my omohyoid muscle so a bit farther down my neck from the styloid.

Ha! I responded from my phone, and just saw that my message included my iPhone signature. Sorry!!! Probably made no sense in this context!!

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@Isaiah, that is so interesting. I have never understood exactly how the ligaments fit into all of this. And the really interesting part is that I am more symptomatic on the left, and I THINK that is the side he wants to operate on first. I had no idea what I was looking at with the styloids. Here is the shot where he measures them, but I can’t for the life of me see what they are measuring.

@Bopper the last rendering looks weird. Of course it might be just the low quality CT image rendition, or some “cut” of the view in the image, or wrong angle, or “artefacts”, but it looks like the styloid “goes through” the left jugular vein. There are many possible anatomical variations of the jugular veins, e.g. some people are born with only one of them and have no symptoms etc, so in your case it might be (disclaimer: I’m not a doctor) the jugular vein branching into two smaller veins, going around the styloid, and connecting back into one. But probably it’s best to discuss that with your surgeon.

As for the right vein, it seems to be non-dominating (very thin along the whole length and likely carrying significantly less blood in its default state, unless there is extra demand to drain more blood), so probably even if it is compressed, it might be asymptomatic.

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@vdm, I think I see what you are talking about, kind of. I hate that the resolution is so bad. But now I think I see the styloid itself, what the green line is measuring. Before I couldn’t even figure that out. And yeah, it kind of looks like it rams right into it.

When I had right side symptoms, it was pressure and pulsitile tinnitus. I believe the theory was that the left jugular was significantly occluded, forcing all that blood through my tiny right jugular, which was clear not equipped for the job.

Thanks for your insights!!

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Not having seen Dr Hepworth myself so can’t comment myself about him, but what I’ve read on here he seems very thorough, genuinely caring & seems to be keen to get answers for every patient. I’m sure he wouldn’t do surgery if he didn’t think it would benefit you.

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Hi Bopper,

Honestly, I’m not sure if I’m looking at the back or front of your head in the images above. My assumption was that the images were from behind, but if they’re from the front, then it is the left jugular that is more distended. I suspect your symptoms are the worst on the side where the jugular is most compressed. I really can’t see the styloids either. I’m glad Dr. Hepworth is more knowledgeable!

Just take heart that you’re seeing the best possible surgeon for your situation. :relaxed:

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@Bopper , @Isaiah_40_31 might be right here, somehow on my tiny screen I also assumed the view was from the back. But the description of the image says “front”, and now after taking the second look it seems like that. So regarding my comments above, in that case it’s the right jugular dominating and wide albeit comoressed, and the left one is tiny non-dominating. If there is any compression on the right side, it makes sense to have more symptoms on the right side, and possibly on the left too as the left one takes more blood.

The measurements apparently show the bright tip of the styloid process and it’s imaginary path to the skull base. It seems the full view is missing due to the angle of the image or because how it was rendered.

Sorry about the fuss…

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I think you are in the best capable hands with Dr. Hepworth! He is super compassionate and only wants the best for his patients. He was super highly recommended by hospital staff, when my daughter had other procedures. Apparently folks worldwide seek him out for his expertise. He has been very helpful in answering any and all questions we have had, just talk with him about your concerns and the C1 issues. Thanks so very much for sharing. I love how supportive this community is, when we are all battling such rare and serious health challenges. It really gives me hope!

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