In a few days, I have an appointment with an ENT Head and Neck surgeon to review the images and schedule surgery
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I’m sorry that the dental treatment seems to have worsened the styloid angle, but good that you’re seeing a doctor soon for surgery. We do have a list of questions we suggest that members ask a doctor to see how experienced they are with surgery if you’re interested:
- 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!
- We have heard that occasionally doctors use surgical clips which are left in, it’s been suggested that these could interfere with chiropractic adjustments if needed post-surgery, so something to consider, and also we have now seen members who’ve been left in pain from the clips and needed further surgery to remove them, so do ask if they might be used.
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Hi TML how do you get 3d images like this, Ive had multiple ct and mri scans here in Toronto canada but for some reason the doctors are saying I have to get the CT or MRI to be rendered as 3D images, Im still looking into this, I recently did an MRI early March and CT scan mid last year
Today I visited a Head and Neck ENT at a ‘high-reputation’ hospital in my country. He performed an intraoral palpation of the tonsils, but only checked the right side, completely omitting the left. When he applied pressure to the right side, I felt sharp pain. I showed him all the imaging data I had, but he ignored it completely—he was only slightly intrigued by the 4.32 cm styloid process and the ‘bone fracture’ (segmented ossification) visible on the scans.
He claimed that ‘if there is no pain, it isn’t Eagle Syndrome.’ When I brought up Vascular Eagle Syndrome, he didn’t seem to understand what I was talking about. He ordered yet another CT scan with IV contrast of the neck, refusing to navigate the DICOM files I brought from my previous contrast CT (head and neck) from a year ago.
I found out he has only performed four styloidectomies in his career, and he provided no data regarding their success rate. Furthermore, his surgical protocol only involves a partial resection rather than removing the styloid process up to the skull base.
I feel lost. It seems no one in this country truly understands Eagle Syndrome or how to treat it properly. He told me that if the new CT shows nothing, he will refer me to a neurosurgeon for the ‘foreign body sensation’ in my tonsillar area.
This is incredibly frustrating. I’m at the point of giving up. If a stroke happens, let it happen; I am exhausted from fighting against my country’s medical system.
Only Clinical finding: Asymmetry and hypertrophy of the right tonsillar fossa upon palpation.
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@Orlandohyoid - That’s ridiculous that the doctors are requesting 3D images. All of them should be able to read & get even better information from the axial CT slices. 3D images give us the “big picture” but the CT slices show the minute details slice by slice.
I saw that @Jules gave you the RadiAnt link in another post. RadiAnt works well for PCs, but if you have a Mac, you’ll need to use Bee Dicom Viewer App.
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@Deggui - I’m very sorry for the disappointing appointment you had today. Since you did feel pain when your right side was palpated, you do fit his definition of having Eagle Syndrome i.e. pain upon palpation. Very odd that the doctor wasn’t interested in your imaging, but I think it’s good he ordered a new CT scan as things can change in a year (such as the angle of your styloid after your molar was pulled) which can be significant.
Perhaps this doctor will be more convinced when he sees your new CT results & will be less arrogant about diagnosing/helping you. Maybe at that time you can have a discussion with him about how doctors in the US & Europe are getting the best symptoms resolution using the transcervical apporach & by cutting the styloids of as close to the skull base as possible while monitoring the facial, glossopharyngeal, trigeminal & spinal accessory nerves at the very least.
From the symptoms you’ve mentioned, it doesn’t sound like you have IJV or carotid compression so those might not need any attention, but it’s been a while since you’ve mentioned the things that are bothering you that you think are related to ES. Do you mind listing your symptoms again?
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I’m sorry that you weren’t taken seriously; it might be worth sharing research papers about IJV compression or presentations by different doctors with your doctor after your new scan, some doctors might be willing to listen?
Otherwise it might be worth researching skull base surgeons/ head and neck cancer surgeons as often they remove the styloids to get access to tumours, maybe if there are any you could contact them to ask if they would do surgery?
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My symptoms vary, but currently, I am not engaging in any physical activity because it triggers other symptoms I don’t want to deal with. My current and permanent symptoms include a sensation that the right side between the retromolar space and the tonsil doesn’t function properly when swallowing (as if the tissue were fibrotic). I also have tinnitus, ear fullness on the right side, a sensation of fluid in my right ear when making voluntary throat movements, tightness and mild pain in the right side of the neck, and back of the neck, tightness and mild pain in trapezious and scapular levator( this might be something else not realted with ES) and Middle Ear Myoclonus (MEM) on the right side. My most concerning thing, is that TML marked ICA compression in my CT with 0 mm space. Maybe this new CT with better technology might give a better view of the anatomy.
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Depending on what the new contrast-enhanced CT scan shows, I will decide on my next step. If it confirms that the carotid artery is being indented by the styloid process, I suppose I will seek a consultation with a vascular surgeon or a neurosurgeon to see what they think. To be honest, I feel there is a lot of ignorance regarding this condition in my country, and I am afraid of undergoing surgery with surgeons who are not experienced in Eagle Syndrome and ending up worse than before.
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Ah…I had forgotten about TML annotating your imaging. The good news is that the styloid doesn’t necessarily need to be cut close to the skull base for the ICA to be decompressed, however, if it’s not cut back enough, even if the ICA is decompressed, your nerve based symptoms might not go away.
It sounds like in addition to the carotid issue, you also have glossopharyngeal, trigeminal, & spinal accessory nerve irritation.
I also have MEM which I’m not sure is related to ES but could be. In my case it’s my stapedius muscle contracting that causes it. My MEM developed several years after my styloidectomies.
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I have the results of my new CT scan with IV contrast:
FINDINGS NECK WITH CONTRAST: A mild elongation of both styloid processes is observed, along with partial ossification of the right stylohyoid ligament. This ligament is in contact with the right internal carotid artery, though it does not alter its caliber or course. These findings should be correlated with clinical data. The structures of the tongue and the floor of the mouth show no abnormalities. Submandibular and parotid glands appear normal. The cavum and oropharynx show preserved patency and normal walls. Laryngeal cartilaginous structures are preserved. Submandibular and sublingual spaces are symmetric and preserved. No pathological post-contrast enhancement is observed.
CONCLUSIONS / RECOMMENDATIONS Mild elongation of both styloid processes with ossification of the right stylohyoid ligament, which is in contact with the internal carotid artery. Correlate findings with clinical symptoms. The rest of the examination is unremarkable.
Final note: The bone/ligament complex measures 46mm.
I cant download the dicom archives, so i will have to ask for them.
I’ve been connecting the dots on my Eagle Syndrome case and I’d like to share a theory. My right styloid is now confirmed at 4.6 cm with carotid artery contact, whereas my left side is a normal 3 cm.
I’ve had three acute molar infections (including an abscess and trismus) on that same right side. My theory is that this was a process of reactive heterotopic ossification. The chronic inflammatory load from the infections likely triggered a calcium response that didn’t just affect the jaw, but also ‘calcified’ the styloid ligament by proximity.
It makes perfect sense: the side with no infections is normal; the side with major dental trauma is elongated and in an ‘L’ shape hitting the artery. I also realized that previous doctors were underestimating the length by measuring in a straight line, but the 3D CT clearly shows the curvature making it longer.
Has anyone else experienced an ‘acceleration’ of symptoms or elongation following dental infections or abscesses? I feel like the inflammation was the ‘fuel’ for the bone growth.
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@Deggui - First off 
for getting validation from the radiology report that you were right on target regarding what’s going on in your neck. Second, I think your theory about what has caused the styloid elongation & ligament calcification makes total sense. That’s one more theory we can add to our list of things we speculate can cause styloid elongation/s-h ligament calcification/ES.
We’ve had quite a number of members whose symptoms started after dental work & many whose symptoms were exacerbated by dental work so you are now a part of that “club”. 
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I’m glad that you have confirmation of VES, and your theory of what may have caused the calcification sounds plausible. I would just say though that the left side at 3cm is still a bit on the long side!
So, now it’s confirmed, are you able to seek treatment abroad do you think? Is there any way forward to get treatment abroad paid for by your country if there’s nobody in Argentina to do this?
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Thanks for the confirmation. Honestly, the medical system here has already failed me many times and I’m currently dealing with several health complications. My energy levels are very low right now to even think about international treatment or legal battles for funding. I’m just trying to get through the day.
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I’m very sorry for your suffering. I hope it eases up enough for you to consider what to do for your next step, @Deggui. Can you request a prescription for a blood thinner to see if that helps some? Are you sleeping/resting w/ head elevation? Icing your neck for 15 min. several times a day can also be helpful. Be sure to protect your skin from the ice pack so you don’t get an ice burn. If ice makes symptoms worse, try heat.
I wish I could help you more. 
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The biggest deal is the weird feeling in my throat at the right side with the weird feeling when swallowing food water or saliva , and also that dull constant neck pain on the right side and now the fact that i know that the ica is in contact with the bone. Beside those things im also dealing with lingual paresthesia bc of the ES misdiagnose and the wisdom molar extraction followed, i think this tingling in the right side of the tongue will be permanent.Thanks to you all for all the atenttion and support. Lots of love for u all.
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Have you tried getting a prescription for a nerve pain medicine, @Deggui. I know you’ve been on our forum for quite some time, & I don’t remember all your discussions. A nerve pain medication could help reduce those very uncomfy nerve symptoms which might give you more “fight” to seek a surgeon to help you.
@Jules wrote this post on pain relief. You may have collected all the information in it over the time you’ve been here, but it might contain some good & helpful reminders.
ES Information- Treatment: Pain Relief, Medications and Alternative Therapies
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