I edited your files to hide your personal information. As far as your styloids go, I also annotated a couple of the slides w/ arrows pointing to things I noticed about your styloids. I will put the link at the bottom of my comments.
First, it was noted your right styloid is segmented. It doesn’t appear segmented to me but appears to be in two pieces. In my non-medical opinion, this could either mean your styloid process has broken, & the lower piece is the dislocated tip of the styloid. Another option is, the lower piece is actually not styloid process but a section of your stylohyoid ligament which has calcified. Either way, this is not normal & could be causing ES symptoms. Your left styloid appears thick at the top then tapers into a very thin almost invisible line at the tip. I believe this is either the beginning of elongation, or again, calcification of the stylohyoid ligament (which extends from the tip of the styloid to the lesser horn of the hyoid bone). Because the image doesn’t show the area down to your hyoid, there is no way to tell if you have further calcification on your stylohyoid ligament(s) closer to the hyoid bone.
Other things to look at w/ the styloids are how thick, pointed, twisted or angled they are. Even normal length styloids w/ one or more of those features can cause ES symptoms.
Calcification of the stylohyoid ligament(s) alone, without elongation of the styloids, is also Eagle Syndrome. I believe you should still try to get a CT scan of the area between your skull base & hyoid bone to get a better look at the styloids & stylohyoid ligaments. The ligaments won’t be visible if they don’t have calcification on them. If you can see them then there is calcification, & they can surely be causing the symptoms you have. Seeing a doctor who is familiar with ES would also be a good idea. If you haven’t done so yet, take a look at our doctors’ list.
2.5cms is generally used as the ‘average’ styloid length, but measuring them from scans is often not that accurate. As Isaiah says the angle & width cause symptoms too.
Thank you @Jules. Appreciate it.
How to measure them then if not measuring them from scans? Any other way to check the length?
I don’t know about the width. It was not mentioned in my scan report.
Thank you so so much @Isaiah_40_31 for reading these reports. Appreciate it.
I haven’t seen any ent yet. I have only one eagles ent provider in my place. What does it mean ct scan of area between skull base and hyoid bone? Is it ct of neck or ct of head?
So, the segmented styloids indicates eagles? How about the length? Is it considered normal or higher?
Tmj specialist who took this cbct scan said he couldn’t see any calcification. I got the report from a radiologist. He couldn’t see any calcification too.
If you see an ENT doctor he’ll know the right area to recommend for a CT scan of the styloid process & stylohyoid ligaments. It’s the neck between the hyoid bone & the base of your skull. Your hyoid bone is a very thin bone that sits where your neck meets the underside of your chin. Both styloid process & hyoid bone are noted in the link below.
It is my opinion that your “segmented” styloid process could be giving you ES symptoms. Your styloids don’t look especially long but the extra information I gave you about them indicates to me that you may have calcification beyond what your pictures show & that would be seen in a CT scan. A CT scan is what is used to diagnose ES. It seems radiologists & doctors don’t always use the same method of measure the styloids so the actual styloid lengths can be based on the opinion of the person measuring them.
I’m not sure what calcification, the TMJ specialist was looking for - extra length on your styloids or calcified spots on your s-h ligaments or both.
Thank you so much @Isaiah_40_31 for the detailed response with images.
I am not sure what did tmj specialist look for in the cbct scan. I don’t have much knowledge about eagles too. I didn’t ask further. He said he couldn’t see any calcification and I can take eagles out of my mind.
So, as you mentioned there are 3 things to be seen for eagles. I am just trying to understand about it.
length of styloids process(should be less than 2.5cm)
calcification of stylohoid ligaments( will be seen on ct scan if calcification present)
length of hyoid bone( how much is normal)
Are these three things considered for eagles diagnosis? Are my understanding correct?
In my cbct, nothing mentioned about stylohyoid ligaments and hyoid bone. I don’t know if they were not covered on that scan.
They do measure them from the scans, but it’s not 100% accurate, because of the medium; we often see members have longer styloids than estimated when they’re removed.
My CBCT scan was done at a major oral health dept of university. They overlooked the calcification of the stylohyoid ligament and even though I came back 5 years later as asked for them to look for it, they claimed it should not cause any issues. It appeared segmented and was not measured from the styloid process. They only measured the segment. The CT scan of neck showed segmented as well. The radiologist measured from the styloid process. Everyone measures the length differently. When I saw Dr. Samji and he read my scan in front of me, he explained that these scans only show slices of the neck and interprets in between the slices which is often inaccurate and only an estimate. He said the scan showed the calcifications longer than what radiologist measured. He also indicated that it is not that common for them to be segemented. When he operated on me, it was all connected and longer. Parts were narrow and thin, almost razor like edges.
The CBCT is not ideal for looking at these areas in any detail. Even the CT Scan of Neck is only giving you a window or estimate which is considered “gold” standard for detection of Eagles.
So, do you mean that CT scan of neck is also not show the accurate measurements and findings related to eagles. Only way is to check with eagles doctor?
I don’t know if my cbct covered it properly. I am planning to see an ENT and see if he can order neck ct to check it out. Do we need to say anything in specific to check during the scan?
How long were your styloids and calcification? Stylohoids?
I don’t know what should be my next best step. My dentist suspecting a tooth root fracture which doesn’t show up in the x-ray and he feel that this could cause my pain and symptoms. He wants me to try extraction and see if it helps. I am stuck with this now. I had a rct on that tooth 4 weeks back to see if it helps. I don’t have any pain on that tooth though. Dentist suggest to do RCT to see if it helps and Endo couldn’t spot any fracture after opening the tooth. But the dentist is not doing crown on it and want me to try extraction.
Even the CT scan of neck doesn’t necessarly reflect 100% accuracy because of the nature of the scan re: doing slices (pictures) of the area. Chances are there is more in there than what is reflected in the scan. In my case and often it shows segmented but was not. The software interprets what might be there between the slices. This was explained to me by ENT surgeon who specializes in neck surgeries. Usually they have a cancer sub specialty.
The CBCT is not ideal for these purposes and rarely gives full coverage of the neck area. A CT scan of neck with order for radiologist to evaluate for Eagles is what you need to rule in or out Eagles. My scans shows 3.2 and 3.5cm. The 3.2cm side that was operated on was longer however surgeon didn’t note actual length in the operative report.
I would tend to go for root canal before doing an extraction.
Thank you @Snapple2020. My length was mentioned like 26.51mm on right (symptom side) , 27.01mm on left. I am not sure if these are normal length. These are measured by oral medicine radiologist. So he check with respect to all dental scans radiology.
I am stuck with this tooth issue now. I went to dentist to get temp crown and he want me to try the extraction to see if it helps. I don’t want to do extraction of molar #30 without knowing a definite diagnosis. He suspect a probability of fracture.
Well in my opinion and others here on list, Dental radiologists seem to overlook this and are not knowledgable on Eagles. They do not have the expertise to diagnose eagles. If they do, it would be very rare. I had the head of the oral health department tell me the calcifications shouldn’t be problematic. Well I had to push my PCP to order the CT scan and proved them all wrong. A dentist probably wouldnt be willing to order a CT scan of the neck. You need to find a doctor who will so you can rest assured you don’t have Eagles. I read your report and it is pretty extensive…at least what I understand. Id have to research some of the terms to understand some of the root issues. I do understand the the tmj joint because I have similiar findings. The right styloid process being segmented is suspicious. As what you were told by Isaiah, the CBCT doesnt go down far enough to follow this.
Your styloids are close to normal length though anything longer than 2.54 cm can be considered elongated. Yours are 2.65cm & 2.7cm so very slightly elongated. Again, the side that shows up in two parts could be causing ES symptoms because the second piece lower in your neck makes the styloid “act” like it’s elongated.
As far as your tooth goes, you’re very wise not to get it pulled out especially if the endodontist doesn’t see a fracture in the root. The trigeminal nerve is often irritated by ES & many of our members have had teeth pulled & unnecessary dental work done because of tooth pain because of the trigeminal nerve causing them to hurt & not because the teeth themselves had anything wrong with them. Once the styloids were removed, the tooth pain stopped. It may be worth it to get a crown on the sore tooth, but if there’s no cavity or crack in the tooth, then getting treated w/ nerve pain medication like Gabapentin or Amitriptyline would be helpful until you find out if you have ES.
As Snapple2020 said, an ENT cancer specialist is usually the type of doctor who does the type of surgery necessary to end ES symptoms. I recall you said there is an ENT near you who knows about ES (is it someone off our doctors’ list?). It would be wise for you to see that doctor.
Thank you @Snapple2020. Appreciate it.
Yeah I understand that cbct doesn’t cover much. My PCP is also not seeing the ct scan. Once my dentist said I have to rule out eagles,I immediately contacted my PCP to ask about it. I asked her because she is the one who ordered me neck ultrasound last month since I have neck pain and she see a small lump on the neck. But no abnormalities found in the ultrasound.
I asked her about eagles and she didn’t reply anything about it. The reply was, she think it could be trigeminal neuralgia and sent me a referral to neurologist. I didn’t see a neurologist yet. I didn’t contact my PCP after that.
I have to get an ENT or neurologist to check this out. Whether anyone from the group get diagnosed with neurologist?
Thank you @Isaiah_40_31.
Yeah, I need to check it out about the segmented styloids. I have only one doctor who about ES in my city. I have seen bad reviews for him and few members from the fb group said the same and didn’t recommend to go there. So it will be of no help.
I don’t have any ent cancer specialist. I have been to an ENT who is a sinus and allergy doctor on june to check my sinus and ear when this pain episode started. I had nasal congestion and bad ear pain. So, I went there to check it out. He did an Endo and no Infection in sinus and ear. He ordered sinus CT to check if any persistent infection and I didn’t do it yet.
I still have ear pain.
I am planning to see him again and ask for CT. I don’t know if he knows anything about eagles and it will be a waste of time if he didn’t say anything about it. He wants me to come back to check the sinus again with another endo. I don’t want to do Endo again( it was so discomfortable) , so I was dragging to go to him.
Actually the cbct scan did cover up some sinus and I see the report mentioned about paranasal sinuses. So I am planning to take that to him, because he is concerned more on the sinus issue rather than my neck pain. I contacted him through patient portal and he told me to come back to evaluate sinus again. So I don’t know if I should go back there or to a new ENT.
Talking about tooth, I don’t have any cavity or pain in that tooth even prior to root canal. Dentist and Endo said it’s minor fracture line on the tooth part and told me to do a crown. Endo did find that tooth is little sensitive to cold and to bite on one spot, suggested to do RCT. And said if she could open the tooth, she can see the fracture properly. So I did root canal just to rule out if that tooth is not the issue / cause of my pain. Now my dentist see some fracture in my tooth cbct scan and want me to extract it and see if it helps with my pain. I have to try a crown on it, dentist won’t agree to it. Don’t know how to move on with this.
And talking about nerve medication, I don’t have any prescription for those. When I asked about eagles to my PCP, she didn’t reply back anything about it. She told me to go to a neurologist and check out if it’s trigeminal neuralgia. I don’t know if I have it.
And one thing I noticed is, during the root canal procedure, all the lower jaw area is numb. But during the end of procedure,I felt the same pain in the jaw under ear. It was so sharp and burning pain. I told this to Endo last week when I went for follow-up. She said might be the nerves linked and she is not concerned about it. Prescribed me antibiotics for the inflammation. I don’t know if it indicates neuralgia or eagles or that tooth issue itself.
It was a neurologist who brought up the possibility of Eagles to me. I have trigeminal neuralgia also and as I have shared many teeth and root canal issues. You can have multiple issues occurring at once. My major pain flairs started with the sharp nerve pain below ear in the neck ending in the ear. I’m not sure why doc would give you antibiotics for inflammation? If your ENDO ordered a CT scan of sinus and you have not gotten it yet, I suggest asking (strongly) him to amend RX order to also include the neck for evaluation of Eagles. Perhaps explain that you don’t want to go through the cost of extraction, bridge or implant before knowing for sure this pain is not caused by ES. If you are already have a CT of sinus, seems reasonable to add the neck in easily.
Yeah. I have to go back to the same ent and ask for neck ct. Only thing is, he want to do another scope to evaluate my sinus in that visit. That is the only thing which is very uncomfortable. No other way. Have to deal with it.
I am thinking of getting a crown on it and think about extraction later. I don’t know if I can delay the temporary crown so long after root canal. It’s been 5 weeks after root canal now. No temporary crown done yet. Anyway it involves a cost to get the crown. But I can delay the extraction and see an ENT and neurologist for TN and eagles diagnosis.
And talking about CT scan, is that radiation ok for our health? I don’t think much about these. I have a cousin who follows natural and functional medicine and she has been talking to me about radiation. I am 34yrs old. She was telling me that if I go to ent and neuro, I will get orders for mri and ct which includes unnecessary radiation to our body. I couldn’t argue with her and didn’t continue talking about it.
Do anyone feel that ct scan radiation is more ? Mri doesn’t have radiation right? Getting an mri would be ok? Any thoughts on this anyone?
And my pain is the same spot as you mentioned. Started one day suddenly in the spot exactly under ear where the lower jaw ends and sharp ear pain . Mine started after I chew more than usual one day and next day I heard a pop in the jaw and this pain episode started in may.
After a month and a half of this jaw pain under ear, pain in neck started in July. It’s so tight and stiff. Have a small lump pea size which hurts a lot and burning. Feel like someone is crushing the neck only on that side. It hurts only under the ear and side of the neck till collar bone. Constant feel of something stuck in throat. Don’t know if it’s because of that tooth fracture or eagles or nerves.
I have complained for years about a bump in the location under my ear. It was sore to touch and hurt on and off. I asked my surgeon what it was and he didnt know. What I do know is that after surgery, it was gone. I also complained of feeling like a bone in my throat when I swallowed. That can be a “classic” sign of Eagles. I doubt a tooth fracture would cause these. The CT scan is the tool of choice for Eagles. An MRI would only show soft tissue in general. There are always risks for radiation, some are bothered more than others by the risk. Is it possible to call ENT and ask for him/her to amend the CT scan order rather than go in for OV? Its worth a try.
