New member with question about SP length

Hi everyone, thanks for adding me. I am wondering if my SP is normal length. Last year, my dentist declared calcifications on my panorex but did not elaborate. My PCP sent me for a carotid ultrasound which was fine so she dropped it. I again asked my dentist last week at my appt and he indicated Calcifications. So, I’m wondering if he is talking about the styloid process? I didn’t have a clue how to read the panorex but have been researching it the last few days I came across elongated Styloid Process. Any advice if my left SP appears normal? I’d like to pursue this as I have pain issues with my left side of my face/neck. Wondering if anyone has an example of a normal SP on a panoramic x ray? I will post my x ray for any thoughts…

The styloid process on the left side is certainly visible (it’s the pointy needle like thing on the right side of the picture pointing inwards), can’t see anything on the left of the image- your right side. We’re not doctors on here though! The best scan to show SP’s and if there’s any calcification of the stylo-hyoid ligament is a CT scan, and radiographers can then estimate the length. But there’s research to show that it’s not always the length which can cause pain, but also the thickness and the angle it’s growing. As ES is not very well known, different doctors (or dentists) use terms sometimes without always understanding them- for example using calcification to refer to an elongated SP, or including calcified ligaments on the measurement of the SP, so it can all get a bit confusing!
The best advice is to have a look through the ES Info section in the Newbies Guide, then go back to your PCP and ask to be referred for a CT (with and without contrast if possible as this would show if there’s any compression of blood vessels), and make sure that you ask for it to be evaluated for Eagle Syndrome. Then take it from there- have a look at the list of doctors familiar with ES and see if there’s any in your area, and if the results show that the SP is elongated then you could ask to be referred.
Good luck, and hope that you can get some help, let us know how you get on!

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Thanks so much for the information, Jules! I am hoping to find out if it is worth bringing up with my GP–she thought my dentist was nutty about the calcifications but obliged and got the carotid scan. So I’m quite reluctant having no idea if my SP looks elongated. I’ve tried to find “normal” SP pics to compare but no luck. I wouldn’t think much of it but I’m dealing with some weird issues so hoping to find some answers. Thanks again for your help!

Your right condyle is higher, you have a malocclusion. before you have any surgery please watch this, I doubt you will get relief from surgery. or

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Thanks Teresa. I appreciate your thoughts but I must admit I am clueless as to what you mean! I have thought I had tmj for many years-is that what you see? My question about the styloid process was only a guess at what my dentist might be referring to in terms of “calcifications on the panorex”. I haven’t talked to any doctors about styloid process, it was just a guess that it might be a little long. Happens to be my left side where my pain is but perhaps it is the asymmetrical condyle? Can you point out the malocclusion? Not sure what that means. Thanks again for your thoughts!

It means your jaw doesn’t come together properly, the condyle (the temporal mandibular joint) Watch those videos I gave you and rule that out before looking for surgery. Calcification is from the friction of your jaw misaligned. Go to an orafacial pain specialist, it’s covered under medical insurance. search for a provider.

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I can see the thin calcified ligament on the left but surgery doesn’t help everyone.

Is the ligament the styloid ligament? or is there calcified ligament near the condyle?

I will definitely watch the videos, thank you. I appreciate you explaining what you see. It will help when I try and talk the doctor.

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Another thing that I found quite helpful was to find online pictures of people diagnosed with Eagles [Panorex for you] and print them to show the doctor an already diagnosed person’s film to compare to yours.

Great idea seamom, thank you!

Would certainly agree with Jules here, the calcification is in line with the Stylo-hyoid ligament. This ligament attaches to the Styloid process on the base of the skull then the hyoid bone central to your throat otherwise referred to as the "Adams apple ". (Level of ear hole down to left of the Adams apple)
The calcification does not necessarily mean a long styloid as it can occur on its own, same risk of becoming symptomatic though i.e Eagle Syndrome.
Anyway, I aim to have surgery for mine. Best of luck whatever you choose to do

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Thanks for your thoughts gra1!

Does anyone have an opinion if this is worth pursuing with my GP? I haven’t mentioned it yet. I’m somewhat reluctant, having asked for the carotid scan that came back perfect, and I don’t know if my panoramic image shows any real sign? Every image I’ve seen online shows a significant or obvious issue with the styloid and/or ligament which causes symptoms and an ES diagnosis.

Wondering what issues present when the styloid is impinging on something? I’m currently dealing with POTS but also have no tears when I cry. Could the elongated styloid/ligament effect lacrimation? Is there any relation between ES and POTS?

Serenapuff - Jules’ comment regarding it’s not the length of the styloid but how thick it is and at what angle it’s growing that can cause symptoms is important to remember. Most surgeons consider a styloid process that is 3 cm (a bit more than an inch) or longer to be ES. Calcified or partially calcified stylohyoid ligaments can also be part of the equation, but aren’t always and vice versa - calcified ligaments w/o elongated styloids - though that scenario isn’t seen much in my experience.

I did not have POTS as a symptom of ES, however, I did have a BIG problem during & after strenuous aerobic exercise. I’d get very light-headed & my blood pressure would drop. I’d feel very winded & wouldn’t recover in a timely fashion. This suggested to me that my styloid was pressing on some vascular tissue or other during certain physical/head movements. My left eye had a huge amount of pressure behind it (like to pop my eye out of the socket) on some days but no lack of tears. I don’t know how long my styloids were (they’re both gone now) but having them removed has stopped all my oddball symptoms. I am 2.5 years out from my first surgery & almost 2 years out from my second one, so I feel like I have a pretty good idea of my long-term surgical results.

Since POTS is related to heart rate, & the vagus nerve which affects heart rate can be compressed by the styloid, it is a possibility that POTS-like symptoms could occur w/ ES. The disclaimer, already mentioned, is that we are not doctors thus can only tell you what we’ve experienced and learned as we’ve negotiated the twists & turns in the ES journey. I doubt there’s any research demonstrating a relationship between ES & POTS as ES is rare enough that it hasn’t grabbed too much research attention.

I hope this info gives you more food for thought.


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Thank you for all the helpful info Isaiah! I do have many weird symptoms but I am guessing they are from the POTS. I have a geneticist appt in October for an EDS evaluation (mother has classical EDS) which might help explain where my POTS is coming from. Not sure if Ehlers Danlos can cause ligament calcifications–I know ligaments are extra stretchy in EDS. I might bring it up with my GP when I see her in August, unless things get worse. I will try to learn more on this site, too. Everyone is so helpful, thanks so much.

We’ve certainly noticed over the last year more members joining who have EDS aswell. I don’t think the EDS causes calcifications, although I’m not an expert, but maybe if the ligaments get looser it could be that everything shifts about more in the neck, which could bring an elongated, wide or angled styloid process into contact with blood vessels and/ or nerves? (One of the suggested causes for ES is ageing, because the ligaments become less flexible, meaning that the position of structures in the neck alter, so maybe the reverse could also affect things with EDS?)
There have been a couple of other members with POTS as well, but don’t think it was related to ES.
I have very dry eyes- there is an autoimmune disease (Sjogrens Syndrome) which can cause dry eyes and mouth. Maybe as you’re seeing your doctor and going through all this you could ask for blood tests for an AI disease- there’s markers they can look for- and get it all sorted in one go!!
Good luck!

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In support of both Isaiah and Jules the above post represents a well considered and reasoned approach to your circumstances. The fact that we are not Doctors is understating the fact that we are all suffering the effects of something that should not be there, being there.

We may not be medically qualified but we are, at least, aware of the condition and most, I believe that you are at the beginning of the process, have done a large amount of research into the variety of symptoms ES is probably/ possibly responsible for. A Medic, on the whole, will side with the possibility of links and, even then, only if they have heard of ES in the first place. Those who haven’t rarely display an interest in researching the condition and dismiss it with a shrug of the shoulders. This is why we should all be grateful for the few sites like “Bens Page” where I have been very impressed with the calm, informed and caring advice given.

My final comment is, I feel this is a case where size really does not matter and what used to be a flexible and elastic structure has become more solid and fixed which is much more likely to affect surrounding structures and become symptomatic. The images you have seen are, for the main part, going to be the more obvious cases understandably so for clarity and demonstration purposes. Do not allow this to put yourself down as not worthy of further help. I have been told that it only grows slowly(?) but the fact that it grows at all is good enough for me. I am fairly certain that your calcification is really not the worst demonstration of the problem, and no one could deny its existence. Your biggest challenge is finding a Doctor that will listen to and understand you. Eagles type calcification was first noted at Post Mortem and a lot of Doctors probably wish it had remained that way to get us all off their necks, oops!! I meant backs.
Once again take care, and remember, pestering your G.P. is the only way to go, your " normal " ultrasound should not deter you as postural effects are difficult to reproduce, I bet you are rarely symptomatic lying flat on your back with your head turned to one side or other.

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Thank you both. I will continue to look into ES and perhaps consult my dentist first since he is the one who pointed it out though did not seem to want to explain exactly what he was seeing. I should get used to bugging my GP, you are right, considering my POTS (and possible EDS). Thank you for the reminder to be proactive!

Jules, yes my rheumatologist ruled out Sjogren’s. No doctor can explain my very sudden inability to cry. I guess it’s just part of dry eye disease. All my weird symptoms began one day two years ago. Lots of testing, all “normal” reminding me I am perfectly healthy…except for the POTS and other weird stuff!

Hello Serenapuff, I’m hoping you can share with me what POTS stands for. Thank you. By the way, I hope everything works out well for you.

Hello Donihue! Thank you for the kind words and I hope too that you are well. POTS stands for Postural Orthostatic Tachycardia syndrome. It is a type of dysautonomia–a glitch with the autonomic nervous system. It presents with mild to debilitating symptoms and is recognized by an increase of 30 beats in heart rate (40 in children) from supine to standing. I am learning that there is often an underlying cause–it is just often difficult/impossible to figure out for some individuals. That is why I wondered if there is any connection between ES and POTs. Hope that explains a bit for you. Dysautonomia International has a very helpful website for more info!