If you go to the axial view of the CT with contrast you posted and go to the level of C1 I can help you see if your IJVs are compressed. You posted the view for me a while ago but I think it was one of your other CTs without contrast.
1 Like
Omgoodness! Wow. Thank you. I didn’t know what that was.
2 Likes
Hi- I will try to find it on the CTA- I won’t be able to until tomorrow morning, but I will see what I can find.
2 Likes
It’s not possible from the images to see if your IJV is being compressed by the styloid, but the symptom you mentioned perhaps could be that, there’s more info about vascular ES symptoms in the Newbies Guide Section… As well as the calcifications @Isaiah_40_31 mentioned, I do think it would be helpful to ask your doctor about the hyoid bone- it does look as though the greater horns/ cornu are a bit long & pointed at the end; this can cause choking or strangling sensations as they interfere with nerves. Your thyroid cartilage looks quite calcified too, although I don’t know much about that, whether that’s within normal limits or not, it’s showing up more on your scans than we often see. Don’t want to complicate the situation for you, but it’s worth doing some more reading up on it all & having questions ready to ask your doctor! As you say, you don’t want to have unnecessary surgery… We have had quite a few members who’ve had symptoms start after dental treatment, I’d guess that wither keeping your head in an unnatural position or maybe the pulling & tugging with having teeth removed has aggravated nerves in the area around the styloids…
2 Likes
@Pain-in-the-Ear - Here are 2 posts @Jules wrote that will help inform you about ES symptoms:
And a final one about ES surgery:
Thank you all for such a wealth of information. I tried to get better images, but don’t think I succeeded. I did not know about the thyroid calcification. It does appear the my left styloid is piercing through the SCM muscle which may be why is is so enlarged—maybe it is inflamed? I also see that appears that the mastoid bone is overgrown and calcified somehow. That is where those nerve bundles branch out from, so I may have more than one thing pressing on my nerves.
There also appears to be some bony alien protruding from my left upper jaw—do not know if that contributes to my misery.
I do have some questions:
- I cannot see my stylohyoid ligament on my left side. What kind of scan would help me see this?
2). What type of scan would help me visualize the cranial nerves and where they are possibly compressed?
- What would I need to see if the IJV were being compressed?
Much Appreciation
1 Like
@Pain-in-the-Ear to see if your IJVs are compressed, the axial view is the best way to visualize the compression.
You can see compression in 3D but it’s difficult sometimes to tell what’s compressing what. Looks like they are compressed against C1 but I won’t know until the axial view. They also look like that may be compressed lower too since they disappear.
@Pain-in-the-Ear this is perfect. See attached your annotated imaging below.
You right IJV is compressed between your right styloid and C1. Pretty significantly I’d say. You left IJV is also compressed against C1 but your left styloid has nothing to do with it since it’s not long enough to reach the level of C1 like your right styloid.
In between the IJVs and C1 is the vagus nerves. So if your IJVs are compressed so too likely are your vagus nerves. I’d be quite surprised if your right vagus nerve isn’t compressed specifically. I think a styloidectomy on your right side could do you some good.
I’m curious as to what your IJVs look like further down since they lose contrast lower in the imaging in your 3D models. I think they may be potentially compressed between your SCMs and anterior scalenes down below.
Now that you know where your IJVs are you can follow them all the way down to the heart. I’d suggest doing so and seeing where else they get compressed. Hope this helps.
2 Likes
Omgoodness! Thank you - that really helps.
2 Likes
@Pain-in-the-Ear - With this new information regarding the fact you have IJV compression & possibly compression of your IJV lower down, Dr. Hernandez is possibly not the best choice for your surgery. You will likely have a better surgical outcome if you see one of the surgeons on our Doctors List who do styloidectomies w/ IJV decompression. Unfortunately, none of them are near you.
•Dr Peter Costantino, 4 Westchester Park Dr, 4th floor, White Plains, (914) 517-8056
http://www.nyhni.org/find-a-physician/Peter-D-Costantino-MD,FACS .
Does do online or phone consults we believe.
•Dr David Cognetti, Thomas Jefferson University Hospital, Philadelphia 215- 955- 6760 (Has done many successful surgeries on members). Only removes ligaments if calcified. Works with Dr Heller now to do C1 shaves
David M Cognetti MD | Jefferson Health Does do online or phone consults.
•Dr. Edward Hepworth, Denver Sinus Care, 3150 E 3rd Ave, Denver, CO 80206 (720) 899-9489, FAX (720) 953-5151, email: info@denversinuscare.com or for initial consults - kcurry@denversinuscare.com
•Dr. Peter Nakaji, https://www.scottsdaleclinic.com
Scottsdale Neurosurgery Specialists - 602-313-7772
Works w/ vascular ES, has also done a research paper about shaving C1 process as well as styloidectomy. Does not do online or phone consults.
In answer to your other questions, the stylohyoid ligament only shows up on a CT scan if it’s calcified. The non-calcified portion is soft tissue so isn’t visible.
The only way to see specific nerve compression is to get a FIESTA or CISS MRI. It can be challenging to get a referral for one of these, & the facilities that have the programs to run that type of MRI are few & far between. Most of our members get relief of symptoms caused by nerves irritated by the styloids once they have their styloidectomies so it’s rare that anyone has truly needed to have a FIESTA/CISS MRI.
2 Likes
I am so grateful, you have no idea- I wish I had another word, because grateful feels oddly mundane for something so enormous- it doesn’t begin to be expansive enough. I have wondered many times if I was going to be able to live throw this and I know that others who have experienced this kind of pain, probably wondered that too.
I am grateful that Dr. Hernandez even spoke the possibility and grateful my ENT is just so very meticulous and figured things out to get me to this point. It sure has been a long haul.
I guess it was a blessing that my surgery did not get approved until the day after.
3 Likes
The others have covered everything so can’t add anything to that! Sometimes just having the styloid out if there’s compression between it & the C1 can make enough space for it to expand, so your surgery might well have helped, but now you know the full picture it would be better to see one of the doctors @Isaiah_40_31 mentioned to see if the C1 process needs shaving too… I’m so glad that @TML & @Isaiah_40_31 have been able to label your scans & work out what might be causing your issues…
2 Likes
Thank you–it is such a huge deal, I’d rather go with the best bet of having relief and not a half-bet.
3 Likes