L Styloidectomy via transcervical approach

[jobby99]

Here is Dr. Ludlow’s (Ohio ENT) transcervical approach to the styloidectomy:

Procedure:

1. Left styloidectomy, transcervical approach

Attending Surgeon: David Ludlow, MD

Anes: GETA

EBL: 5cc

Complications: none

Findings:

1. 4cm elongated and thickened styloid process

Operative Indications: This is a 44 year old male with a history of Eagle’s syndrome. He had an elongated styloid process as palpated on exam and as seen on CT scan. We discussed styloidectomy as a way to treat his symptoms. Risks and benefits were discussed and he elected to proceed.

Procedure in Detail: The patient was taken back to the operating room and placed in the supine position. Anesthesia provided a general anesthetic and the patient was turned over to ENT.

A timeout was performed and the patient was prepped and draped in the usual fashion. A 4 cm neck incision 2 fingers width below the mandible was designed and 3 cc’s 1% lidocaine with epinephrine was injected. A 15 blade was then used to make an incision through the skin. Monopolar cautery was then used to get in a subplatysmal plane. A subplatysmal flap to the mandible was elevated.

The submandibular gland was palpated and then the cervical fascia was incised below the gland and dissection proceeded to the posterior belly of the digastric. The posterior part of the gland was exposed and the facial vein was clipped. An army navy retractor was used to lift the gland and the soft tissue posterior to the gland. Blunt finger dissection was used to palpate the styloid hyoid and the styloglossus which were followed up to the styloid process. The styloid was isolated and the muscular attachments were released with a periosteal elevator. Once the bone was exposed a rongeur was then used to remove the bone as close to the base as possible. 3.2cm of bone were removed. There were no sharp edges to the remaining bone that were palpated. Irrigation was performed and hemostasis achieved.

Fibrillar was placed in the wound bed. The neck was then closed with 3-0 vicryl and a running subcuticular 4-0 monocryl. Mastasol and steristrips were placed over the incision and the patient was cleaned and dried and turned over to anesthesia in stable condition.

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The area is filled with fluid (seroma) probably from the dissection. Rongeurs were used to cut out styloid not the piezio tool (latest technology). The throat pain, swallowing difficulty, and ear pain were immediately taken away when I woke up. I had full use of my face and voice. Later on in the day, my voice was scratchy and I had a sore throat. The day after surgery was fine. I can swallow just fine and talk, but there is definitely a lot of fluid for my body to deal with now. It is not painful at all, but I can feel it sorta pushing on structures but not irritating them that much. I think this surgery is a good first step and probably would be a homerun if I had a drain to collect the excess fluid for a day.

[Isaiah_40_31]

Thank you so much for sharing your surgical information, @jobby99! It sounds like the surgery was very straightforward which bodes well for good healing. Your neck looks great so soon after surgery! I will add Dr. Ludlow to our Doctors List for Ohio as his surgical description is right on target with how we’d expect a non-vascular ES surgery to be done.

Some doctors put in a drain that stays in place for 24-ish hours after surgery to help prevent the problem you’re having. My surgeon didn’t use a drain, & I had a significant amount of edema under my chin on the right side after my first styloidectomy (right styloid). It looked pretty odd. In addition to pain medication, my surgeon also Rxed a tapering dose of prednisone which helped a lot to reduce the swelling sensation in my throat & neck over the first 10 days post op. You could request that if you’re too uncomfy. I’d recommend asking for dexamethasone instead of prednisone as it has less side effects.

Please keep us posted as to how your recovery is going as more time passes. I’m glad you’re feeling optimistic about your recovery. I’m also optimistic for you.

[Jules]

Great that you’ve noticed improvements already! Try & sleep upright a bit & use ice if you can for the swelling, if it’s still an issue later on there are massage techniques which have been suggested by members , but the incision needs to heal first. Take care, it’s easy to overdo things if you’re not in much pain!

[jalexy12]

Hope it went well, it actually seems fairly rare to have an ENT go transcervical like this, seems like he knows what he’s doing based on the procedure.