Need some WHY Info

Hi All, I have been living with many of the symptoms I read about here and am not ready to consider surgery. I have been wondering after all the reading, why is it not a problem to remove the stylo-hyoid ligament and styloid process. I get why it’s a solution of sorts but how is it that having them gone is not a problem in some other way. Don’t these aspects of our bodies have functions? I know that with ES, especially with a calcified ligament, they can approach non-functional but I’d love to be pointed in the direction of knowing what are the possible risks of these parts being gone (besides symptoms possibly not clearing up or recurring). I’m not sure why I’m obsessing about this lately, my appendix and Gall bladder have both been gone a good while and all seems well so I get it in theory, I just can’t find what I need to learn about life without these parts. So, how band can it get if it just goes on without surgery? Thank everyone for all you caring and supportive entries. I’m so grateful this forum is here. -Sarabeth (VA)

We get asked this alot! The answer is that although the styloids & ligaments serve a purpose, removing them doesn’t seem to make any difference! I’ve had styloids completely removed both sides, & noticed no difference with swallowing, talking etc! The risks of surgery are more about nerves being damaged during surgery, which isn’t that common & this usually improves with time. A stroke is a very rare risk of surgery too. Nerves are monitored during surgery which helps reduce risks.
As for what happens if they’re left, some members have managed without surgery, & lived with symptoms, but others have found symptoms worsen with time & become unbearable. Personally, I had some pain which was bearable & I didn’t think was enough to risk surgery, but later I started to get vascular symptoms which made me feel pretty ill, so the decision was a no-brainer then!
The styloids can sometimes keep growing- there’s one picture online, I think of someone in India, of styloids actually breaking through the back of the throat & growing into the mouth. But obviously this is very rare!
We can’t say exactly how bad it can get, it depends very much on the angle they grow, which nerves they irritate & compress, & whether they compress blood vessels. It has to be a personal choice balancing the risks of surgery with quality of life & how bad symptoms are.
Hope this helps a bit!

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Hi RevSB,

I asked the very question you are pondering before I had my styloidectomies (Dr. Samji did both of my surgeries). He said the the styloid process is just an attachment point for the stylohyoid & stylomandibular ligaments. The stylohyoid ligament plays a very small role in helping w/ swallowing. Its absence makes an insignificant difference in the ability to swallow normally. I’m not sure of of the s-m ligaments’ function, but I will tell you that I had both of my styloids & styloihyoid ligaments removed (thus the s-m lig is disconnected) & have noticed nothing untoward going on in that area. I had swallowing issues before my ES surgery, & those have never fully resolved. I believe it comes from vagus nerve damage that may or may not have been related to ES.

As Jules noted, surgery for ES is not mandatory if you can live a comfortable, productive life w/ the symptoms you have. Unfortunately, for most of us on this forum, because the styloids do continue to grow/thicken &/or s-h ligaments continue to calcify, symptoms generally worsen w/ time as the nerves/vascular tissues become more irritated/damaged from those bony structures. There have also been people who had strokes from ES apart from surgery when an elongated styloid process actually poked/eroded through the internal carotid artery of the patient. This is a VERY RARE occurrence, & we have only had a couple of people on this forum over the years who have reported a stroke or stroke-type symptoms possibly related to ES. If you are not having any type of vascular symptoms then you have nothing to worry about.

What I’ve written is not meant to scare you but to help you assess your situation with more complete information.

Thank you both, so much. Which type of scan/doctor do I see to assess the vascular status? I feel like I am already having some symptoms and know they should be assessed. I met with a surgeon at UVA but didn’t ask. I told her I would be getting back to her with some questions.

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You’d need a CT with contrast to show up the blood vessels. If the possible vascular symptoms are worse in a certain head position, it’d be helpful if they could do the CT like that, but it’s not always possible. occasionally doppler ultrasound of the blood vessels can show if there’s compression too. Any doctor familiar with ES should be able to help with the scan results.

Thank you!!!