Hello, Im 49 male who has had a dental problem for the last 10 years. About 2 years ago, I had dental surgery to remove an abcess on my upper left, I also had a crown on the lower left re-seated and the dentist yanked on my jaw real hard where I couldn’t open my mouth for a week afterwards. I woke up a few days after the abscess surgery with a whistle in my left ear that increased in pressure and volume until it was like i was standing next to a bomb that went off on a daily basis (in the last year this volume goes up and down). In the coming months, I would present with jaw pain and facial pain, most of which coming from the buccinator muscle (cheek muscle). I was getting botox shots for TMJ at the time and I wanted to get a shot in my cheek to see if it would calm. That led to the cancer dr, who is also a head and neck surgeon at my local hospitals, and he was quick to diagnose ES, then he sent me for CT and confirmed it on the next visit. He set me up for transoral and left me with no info. Ive been scowering the web for info and running to second opinion appts for months now, only to hear things like “we’ve never heard of that” or the maxiofacial guys that say “that doesnt exist” - which is my favorite. So, i do believe that my styloid process is elongated as it evidenced by the CT, but I cant get any other doctor to confirm or talk to me about this because no one else in Tampa deals with it apparently. The only other guy who does this that I can find is Dr Osbourne in LA who will give me a tele visit for $300, and Im not sure it will be worth it, I just spent $300 x 2 this week to hear 'I dont know". My question for you all here is with the sympotoms and of course recovery. I will be reading lots of stuff on here, but it causes me panic attacks, a nice fun byproduct, so theres only so much I can take.
Has anyone had tinnitus as a symptom?
I do not have any feeling of something caught in my throat
I have no pain or numbness in any other part of my body
I have pain under my tongue for years since I started my horrid dental journey, cant say its from this
I have pain in my cheek, anyone else?
These symtoms are severe for me enough that Ive lost my job, and have kept away from anything social including family stuff. This s ruining my life, which I dont notice for the muscle realxers Im on all the time which seems to kill the cheek pain.
Im new here and Ive seen a couple “day after surgery” posts, but can anyone tell me their total recovery time for transoral? Again, Im sorry if Im asking and its already posted here someplace, theis is a lot of info to go through.
Basically Im just scared and dont have any extra info yet except a surgeon who says it will be fine. In tampa, every doctor says that no matter what and Its not to be trusted.
Looking for any input, and thank you in advance.
O
I am so sorry for your suffering. Most of us have been through the ringer and your experience with doctors is unfortunately the normal pattern until you finally see one that knows what this is and how it affects the body in so many ways.
This group is amazing and will guide you towards the right direction. Do you have any pics of your scans that you can upload?
I did have images, but theyre not working in the portal right now, i can def drop the report from radiology which shows nothing in the meantime
Study Result
Narrative & Impression
CLINICAL INDICATION: Left-sided neck and facial pain.
TECHNIQUE: Axial CT of the neck with contrast. Multiplanar reformations were reviewed at the workstation.
CONTRAST: 65 cc Isovue 370, IV
COMPARISON: None
FINDINGS:
Pharynx and Larynx: There is no infiltrative mass in the nasopharynx, oral cavity, floor of the mouth, oropharynx, hypopharynx, or the larynx.
Parotid and Submandibular glands: There is no evidence for sialoadenitis or sialolithiasis. There are no intraparotid masses or lymphadenopathy.
Thyroid: Normal thyroid.
Lymph Nodes: No cervical, retropharyngeal, parotid or occipital lymphadenopathy is identified.
Brain: Visualized portions are unremarkable.
Orbits: Visualized portions are unremarkable.
Paranasal sinuses and temporal bones: Visualized paranasal sinuses, mastoid air cells and middle ear cavities are well aerated.
Vascular Structures: Carotid and vertebral arteries are widely patent. Jugular venous systems are patent.
Visualized upper chest: Visualized lung apices are clear. Visualized portions of the upper mediastinum are unremarkable.
Osseous structures: No acute osseous abnormality or suspicious osseous lesion. Multifocal dental restorations without evidence of dental caries or periapical dental disease. Visualized cervical spine demonstrates degenerative disc osteophyte complex at
C5-C6 level causing high-grade right and partial left neural foraminal stenosis as well as mild spinal canal stenosis.
IMPRESSION:
No evidence of acute abnormality or neoplasm within the neck. No evidence of sialolithiasis or sialoadenitis. No acute dental disease.
RADIATION DOSE REDUCTION: This CT scan was performed with one or more of the following dose optimization techniques: iterative reconstruction, automatic exposure control, and/or manual adjustment of mAs and kVp according to the patient's size.
After seeing this I thought I was clear, but the Dr came in and confirmed eagles right away. When The portal works again, I can upload images of scans.
Hi & welcome to the site!
There is alot of info to trawl through, I agree, but you can get questions answered…here’s links to a couple of info pages which might help your search: ES Information: Common Symptoms And Possible Explanations For Them - Welcome / Newbies Guide to Eagle Syndrome - Living with Eagle ES Information- Treatment: Surgery - Welcome / Newbies Guide to Eagle Syndrome - Living with Eagle
Tinnitus is a common symptom & there have been quite a few discussions about it- this often lessens after surgery but doesn’t always go completely…
Not everyone has the sensation of something stuck in their throat, I never had that one. But did have facial and tooth/ jaw pain. The Facial & Trigeminal nerves are commonly affected which can cause pain in the teeth & cheeks, numbness or tingling. There are some nerve pain medications like Gabapentin, Lyrica, Amitriptyline which can help, it might be worth trying one of these while you wait for surgery?
Transoral surgery isn’t the best method for ES, as the surgeons can’t always remove as much of the elongated styloid process as needed to ease symptoms. It’s also a harder surgery to recover from and has a greater risk of infection.
We have a list of doctors familiar with ES, is your doctor on our list? here’s a link: Doctor Lists – no discussion - Symptoms and Treatments / Doctor Information - Living with Eagle
We do also have suggestions of questions to ask your surgeon, it’s worth checking, especially how much the doctor will remove, as you don’t want to have a surgery and it not help!
How many ES surgeries have they done and what was the success rate?
Whether they’re going to operate externally, or intraoral- through the mouth. Whilst some members have had successful surgeries with intraoral, external is better for seeing all the structures, to be able to remove more of the styloids, & also there’s less chance of infection.
You need to ask how much of the styloid he’ll remove- as much as possible is best- & anything left needs to be smoothed off. The piece needs to be removed too- some doctors have snapped it off & left it in! If the styloid is only shortened a bit it can still cause symptoms.
If your stylohyoid ligaments are calcified, then any calcified section needs to be removed too.
There’s usually swelling after surgery; you could ask if a drain’s put in to reduce swelling, or if steroids are prescribed. It’s not essential, but can help with recovery a bit.
Will it be a day case surgery or will you need to stay in?
Obviously ask the risks- we know from experience on here that temporary damage to the facial nerve is quite common, and also the hypoglossal nerve and the accessory nerve. These usually recovery very quickly but in some cases members have needed physiotherapy. There is also the risk of catching a blood vessel or having a stroke, but these are very rare.
Ask if the surgeon monitors the nerves- this should be done to see if there’s stress on the nerves to avoid damage as mentioned above.
What painkillers will be prescribed afterwards.
Ask about recovery- most doctors either down play it or are genuinely unaware of how long the recovery can take.
As for recovery, with intra-oral, you’re unlikely to be able to eat solid food for a couple of weeks, recovery does vary, but you’ll be quite tired for a while too…
It’s worth having a look at the doctors list and maybe getting a second opinion depending on how experienced your doctor is. Hope this helps!
he says he has done many with no one returning after first follow up and all getting relief
transoral, because its less invasive and its easier to get to the styloid he says
He says he will shorten the ligament and remove the bone. Will not answer me on whether I will be able to move my tongue or swallow after bone and ligament piece are gone!
2nd opinion doctors who dont do the surgery insist there is no calcification, but to have the surgery and trust my surgeon :facepalm:
He said no swelling, sore throat for 2 weeks and then back to biz as normal. I dont trust that.
Outpatient, 45 min surgery
Asked about the nerves of all types. Says since its transoral, there isnt much threat to these nerves and it wont be a factor since where he goes in sis so close to the styloid. He said much worse with external.
Not asked after above answer, not thought about until this post
He will give me ‘sometihng’ for pain and I shouldnt have to take it for more than the first day.
2 -4 weeks full recovery, says foods are no issue from the second I wake up
I saw your doctor list, do we know of any folks who have seen the doctors at Advent Kissemie Florida? That is closest to me. Chands hospital I called, they dont have Eagles surgeons as of last month, so Im wondering fi that list needs some updates.
@Oman first welcome and I hope you really choose the method of operation wisely as intraoral operation is sometimes riskier than transcervical as all the cranial nerves are not fully visible through that method. Also, the recovery could be longer and getting all the styloid and calcified stylohyoid ligament could be difficulty. The transcervical approach is the best choice as it is difficulty to remove calcified stylohyoid ligament through intraoral approach. The transcervical approach is also widely performed nowadays so I would choose that over the intraoral one.
Anyways, your case reminded me of research paper I posted in here a while back (see below) where a 51 year old lady had 3 teeth removed and had sinus surgery as she thought it could relieve the pain. So Eagle syndrome is known to send people off to wrong path for years before it gets diagnosed since it mimics a whole host of other diseases. I call it the great imitator.
Here is her clinical finding before the operation which relieved her oral pain.
Clinical findings
The patient reported a foreign-body sensation in the oropharyngeal region, and painful chewing and swallowing, mostly with solid foods, which had worsened over time. The pain was experienced almost every day, sometimes spontaneously, and it was enhanced by rotation of the head to the left. It could also be elicited by palpation of the tonsillar fossa. The pain was described as “aching during mouth opening” and “dull as a pharyngitis,” and was associated with a noise in the ispilateral ear. Pain quality was assessed by the DN4 questionnaire for neuropathic pain [7], which revealed only mechanical allodynia. The severity of the pain was rated 5/10 using the Numeric Pain Rating Scale (NPRS), and was partially relieved by acetaminophen (1000 mg, p.o., t.i.d.).
Orofacial evaluation according to DC recommendations [8] revealed a slight tumefaction at the left angle of the mandible without any modification in the appearance of the skin. Digital palpation revealed painful left masseter, mylohyoid muscle and the posterior part of the digastric muscles. Ear and nose examination was unremarkable. A left deviation of the mandibula during mouth opening was also observed. Intraoral examination revealed an asymmetry at the level of the palatine tonsils. The ipsilateral (left) tonsil seemed bent inside, and palpation of the oropharynx highlighted the left voluminous styloid process visible on orthopantomogram (see below).
First thank you for everyones posts, 100000x. Here are a couple of pics from my CT. I hope I did the rotation correctly so you guys can see what you need to. Heres my new question:
In moving through this site I have seen some gorgeous 3d scans, talks of MRI, things like that. My surgeon made my diagnosis and is (as far as I know) ready to do this surgery from just this single CT. Do I need the digital imaging? Should I be seeking more radiology? My worry here in florida is that doctors send you for radiology you dont need most of the time. Go to a diff office for another opinion, they want a new scan. Go to the next office, they want the same CT done again, even whenits within a month. I messed up mythumb a couple years ago, had xrays at urgent care, went to ortho for it and his office wouldnt take this dics and wanted me to pay for more xrays at their in house facility. I told them you cant read the disc, no co pay and walk out. Magically, they could now read my disc. I have no barometer for this at a new office and while I need help. Should there be more than 1 piece of radiology before i let them cut? Thanks in advance.
I think since the Dr. feels that he has enough evidence from this CT to do the surgery, I would say, another imaging is not necessary. You do not need unnecessary exposure to radiation if you do not have to.
Although the images you posted are limited, they show thick styloid (red arrow) with bigger diameter. The second image shows that the left one is bit bigger & longer than the right styloid (red arrows).
Not sure if the second coronal image slice captures the whole styloid. If you want to see the whole styloid and measure it, you can do so with 3d slicer software. You will need to download your CT and use 3D slicer or equivalent 3D rendering software to see it in 3D. If you want to learn how to quickly do that, see the link below on how to do that quickly. Please also note that the link tutorial is based on older version of 3D slicer (4.xx), the new version is (5.xx) but not much has changed in terms of installing it and rendering the 3D between the versions.
You can use the search function on the site to look for old discussions about individual doctors…doctors must have done at least one successful surgery to be included on the list, but the original list was compiled a while back so thanks for letting us know about Chands hospital, we update as soon as we hear anything different…
Dr Jeffrey Scott Magnuson, Advent Health Medical Group Otolaryngology and Head & Neck Surgery at Celebration, 410 Celebration Pl, Suite 305, Kissimmee, FL, (407) 303-4120 has been mentioned a few times, he does do intra-oral surgery but does robotic surgery, I think with good outcomes…
I would definitely be skeptical about your doctor’s post surgery info; most members find swallowing extremely painful & eating solid food is impossible! Some doctors remove the tonsils to get better access to the styloid, so if you google recovery from tonsillectomy as an adult it’ll give you a more realistic idea of what to expect! I would be wary too of his dismissal of risks to nerves in surgery; there are nerves close to the styloid, that’s why you’re getting symptoms! And that’s why the external approach is better as it gives better visibility…
Sorry if we’re confusing you etc with giving you this info, but want you to make an informed choice.
replying to both posts befoe the site blocks me for posting too much lol:
Thanks Jules, yea I had my tonsils out when i was little, does that diminish the swallowing pain after intraoral? I recall the tonsillectomy pain like it was yesterday even though I was under 5ys old!
@Kooldude, my portal actual comes with neat new software that allows me to rotate. Im attaching another pic. Are my arrows are the styloid as well? If so, I can see where the left one (pictured on right) is much longer than the right. Can you confirm Im pointing at the right thing?
Having had tonsils out might make the surgery a little easier, depending on the doctor’s technique…awful that you can still remember the pain though!
It’s a spam control feature on here that sometimes doesn’t like new members posting too much I think!
Yes, your arrows are correct, the left styloid does look pretty thick…
yea, im all too familiar with what it is. I am a programmer of over 23 years, until the eagle took my last job away - reasons? They noticed my lack of concentration and willingness to participate/speak in meetings. This thing makes my tinnitus worse everytime i utter a sentence out loud (or talk to myself). Any plosive or percussive words just make it worse. Especially my fav 4 letter word, which I use alot since I got diagnosed. Grew up in Brooklyn public schools, cant hardly help it :). Thank you for confirming my arrows.
Yes, that is right, they are pointing to your styloids but even your left styloid does not seem that long. It is thick but short so I could be wrong, but we might not be seeing the full length of styloid or yours are thick and short. You need to scroll through a series of slices to get an idea that is why 3D rendering makes easier to visualize the length of the styloid.
Since you suffer from classic Eagle syndrome, I was hoping the styloids would be bit longer than your image show.
Here is an image from the internet showing long, calcified styloid impinging Carotid artery. I am attaching so you can see the typical elongated styloid though this particular image might not be the ideal one but you get the idea.
Yes, I see it now. I can say your both styloids are elongated and fit Classic Eagle Syndrome but I even see dangerous issue although the CT artifact band is not making it easier. your left Styloid is very close to the Carotid artery. Not sure if it is irritating it. You would have had fainting spells (syncope). Are you symptoms more on the left side? See below, do those symptoms sound familiar on the left side?
Red arrow point to Styloid and blue arrow is the area of concern (potential contact between Carotid artery and Styloid)
5.1. Classic form
The classic form of Eagle’s syndrome commonly presents as pain/
paresthesia in the neck, jaw/face, head, throat, ear, teeth, tongue, globus
sensation, eye twitching (Waters et al., 2019), hoarseness or change in
voice, and/or cranial nerve injury/irritation (Kawasaki et al., 2012).
Many providers believe this neuralgia is a type of entrapment syndrome
involving the cranial nerves, commonly after tonsillectomy (Shin et al.,
2009).
5.2. Vascular form
The vascular form of Eagle’s syndrome commonly presents as pain/
paresthesia in the neck, jaw/face, head (Eagle, 1948), shoulder ‘coat
hanger syndrome’ (Thoenissen et al., 2015), tinnitus, ear muting/fullness (Waters et al., 2019), facial droop/palsy (Galletta et al., 2019),
slurred speech or difficulty speaking, extremity tingling/numbness or
mono/hemiparesis, visual changes, amaurosis fugax, aneurysm, carotid
artery dissection, stroke (Ogura et al., 2015), TIA, syncope/presyncope,
dizziness (Todo et al., 2012), and pseudotumor cerebri (Ho et al., 2015).
Production of these symptoms can occur from injury or compression of
the periarterial nerve plexus, blood vessels or a combination (Eagle,
1949).
Sigh, so, I do have a tingly sensation in my cheek, jaw is just painful in a couple of spots, no tingles. If we want to get technical, after consulting with many, that seems to be the digastric muscle attachment, its where the jawline comes to a point. From there I have soreness down my left SCM. Teeth are the issue that starteed this whole thing and I still have random root canal-ish pain where ive already had root canals and the dentists cant see problem, not one, on any radiology. All dental is on the left. Tongue feels like the root of the issue and feels strained underneath on the left side. I spent alot of time pushing against some ill fitting crowns on the left and assumed that this is what it was from. I have ZERO feeling of anything stuck in my throat. about a year ago I had some eye twitches, not a normal everyday occurrence. All of the above are things Im listing as I read the definition for classic in 5.1 above, and again, everything is on the left side. From 5.2 tinnitus is ever present on the left. I had fullness for a long time but that feeling has been gone for 6 months or more. Nothing else from 5.2. I can mention that the left cheek seems a little swollen all the time and no one can tell because its my cheek (and now its under a beard). My left neck has hurt since the early 2000’s thanks to a couple of wreckless drivers, so i have a herniated c1-c3 and L1-L3 just for extra fun, I attribute neck pain to that, but could be wrong.
then that is good. you do not have any Carotid compression. You might have some of the classic form of Eagle from sound of it but see what resolves when the styloid is removed. that is the only way one can know.
Thank you. And Ill ask because Im not sure where else to ask and you seem to know your stuff. From what Ive read, this styloid is one of the ligaments that enables you to move your tongue. I dont see anything about loss of speech on here, do you have any info on that?
Ligaments, particularly stylohyoid ligaments are not nerves so they do not produce loss of speech if they are pinged or calcified. Nerve issues such as palsies can produce speech loss particularly the ones the innervate the tongue or vocal cords.
According to google, the function of Stylohyoid ligament is:
The stylohyoid muscle connects the hyoid bone to the base of the skull, and it pulls the hyoid bone upward and backward, resulting in elevation of the base of the tongue and elongation of the floor of the mouth. This movement helps in deglutition and this muscle functions in association with other suprahyoid muscles.Jan 30, 2023
