New user, here’s my story

[Tyler]

This might be slightly long winded, but here we go. Right around 10 years ago I had (and still have) a small lump on the side of my neck. As far as I know it’s a swollen lymph node that never returned to normal size. Anyways I go to the doctor and in the end, get a ct scan to get a better idea of what it is.

My primary doctor at the time makes a follow up appointment and reads the results for the ct scan and mentions I might have a not so common issue called eagles syndrome (completely unrelated to the previously mentioned lump) - at the time I have 0 symptoms for eagle syndrome and brush it off as nothing. Years go by and every once in a while I’ll have an ache type pain in the left side of my throat/under my jaw. Fast forward some more and I can feel what I would describe as a bone under the left side of my jaw.

This persists throughout the years and still today I’ll have an ache maybe 2-3 times a month in the left side of my throat. At this time I realize that the pain is directly related to the “bone” under my jaw. Within those 2-3 times a month it might ache for around a day or so and go away. What really highlights the pain is physical activity involving my neck as I would be in “jiu-jitsu” based training for work once yearly, after these trainings my neck would be in a lot of pain for anywhere between 3 weeks to a month. The pain from this is bad enough to wake me up from a sleep multiple times a night. The pain radiates from the same “bone” which I realized is what my primary doctor years ago described as eagle syndrome. My left styloid is palpable by pressing my thumb under my jaw.

I did some follow up and made another appointment around 6 years ago which they confirmed again stating my styloids were calcified and elongated. The specialist at the time had never done a surgery involving styloid resection and I opted out of having an inexperienced surgeon operate on me.

Fast forward to 2026, again had a yearly training with jiu jitsu based workouts where you’ll place and get placed into chokeholds, my neck had constant pain on the left side for 20+ days, bringing me out of a sleep at night. Tylenol/ibuprofen wouldn’t touch the pain. I made another follow up appointment.

This time the follow up was referred to a surgeon who primarily specializes in cancerous tumors of the neck. He orders an updated CT scan and observes the left styloid at 3.5 cm and the right around 3. Mind you I’ve had 0 symptoms or pain from the right.

He has assured me he is able to do a styloid resection surgery with a nerve monitor in place and seems very confident in the outcome. This surgery would take place in Illinois and is not a current surgeon listed for eagles syndrome.

My symptoms are probably on the mild side compared to a lot of the members on this forum due to not having constant daily issues with pain and irritation.

I currently have the surgery scheduled for one month from now but am wondering if it’s going to cause more issues than it’s worth. I’m pretty nervous and looking for some answers from anyone who’s had symptoms that aren’t present all the time.

I’ll attach a dental xray if possible.

[Jules]

Hi & welcome!
You should be able to attach any imaging if you want? Just make sure it’s anonymous first…
The choke holds etc you’re doing in training could be quite risky with ES as there’s a chance the styloid could break, which could then damage nerves or even a blood vessel, so if you could avoid that I would, but it sounds like it might be essential for you?
The decision whether to have surgery is a personal one, weighing up the risks (as with any surgery risks of bleeding, & specifically with this surgery risks of nerve damage to the facial nerve, glossopharyngeal, hypoglossal and spinal accessory nerves). So for most of us, we decide that the symptoms are affecting quality of life enough to take those risks, but only you can decide that. But the risks are obviously minimised by choosing an experienced surgeon who monitors the facial nerve especially, and it sounds like you’re aware of this & you’ve done your home work! In case you haven’t seen it, we have a list of questions we suggest that members ask their doctor to help them decide about whether they are experienced with the surgery in this section:
ES Information- Treatment: Surgery - Welcome / Newbies Guide to Eagle Syndrome - Living with Eagle
It’s also worth bearing in mind that sometimes even if only one side is causing issues, after surgery the other side can ramp up with pain & might need surgery too at a later date…

[Tyler]

[Tyler]

I’ve been reading a lot through the older posts and am looking for more info on getting one side removed and that causing issues to flair with the other side.. hard to come by when everyone’s cases differ so much.

I’ve definitely felt a cracking sensation before during those previous trainings which is usually the first sign I’m going to be sore for close to a month.

I’m sitting those out for the time being so nothing outside of normal workouts or cardio

[Isaiah_40_31]

@Tyler - I discovered my elongated styloid in the same way you did! I could feel the left one under the left side of my jaw. I eventually found I could feel my right one behind my ear. My earliest symptom was choking on food, but the one that got me to investigate was pain down the front of my neck.

I’ve annotated your image & can suggest why your left styloid might be more symptomatic than the right side: If you look at the styloids (right is on the left & left is on the right) you can see that where the left one is attached to the skull it’s very thick. That extra width at the skull base could be impacting the nerves that exit the skull close to that area more significantly than those on the right as your right styloid is narrower at the skull base. Though your styloids arent’ excessively long, both appear reasonably angled downward which can also cause them to irritate nerves further from the skull base.

Regarding having one styloid removed (most doctors will only remove one at a time due to throat swelling post op), you may find you don’t need the second one done. We have some members who had bilateral styloid elongation but only one symptomatic side & getting that taken care of was sufficient. It’s just that we feel it necessary to let our members know that sometimes the symptoms we have, even though seeming one sided, actually are coming from both styloids which becomes more apparent when one styloid is removed but some symptoms don’t reduce or resolve. Thus, your situation would require a “wait & see” approach post op.

The other thing to be aware of is that surgery usually doesn’t provide a quick fix for symptoms. Throat & neck swelling post op can initial make symptoms feel worse & even add some new ones temporarily. It can take from several week to a number of months for symptoms to gradually resolve as nerves heal slowly.

The surgeon you’re seeing who deals w/ cancer of the neck has most likely done styloidectomies relative to tumor removal, so the fact he hasn’t necessarily done surgery for ES doesn’t mean he’s not experienced w/ styloidectomies. The key is how much styloid he’s willing to remove & that’s what you need to clarify prior to committing to surgery. With the symptoms you have, I think surgery, to at least resect your left side, would be advisable, & I think you’d get good results if the surgeon cuts your styloid as close to the skull base as possible.

[Tyler]

i recently had a follow up with the surgeon to discuss his plans as far as surgery. He did advise he would remove as much as possible and would make the incision under my jaw line. I wanted to confirm they were not looking to operate through my mouth as I’ve read it’s a worse experience.

he put pressure near my tonsils during the visit and advised he wasn’t able to feel the styloid this way and suggested the extra oral approach. He did advise I would have a drain put in place initially.

The surgery is currently scheduled for march 19th but I am slightly stressing the entire situation and trying to confirm what I want to do

[Isaiah_40_31]

What he’s proposed sounds good, @Tyler. He does seem experienced w/ this type of surgery especially as he’s advised the transcervical (through the neck approach). You’ll be amazed at how well that heals & how invisible the incision becomes as it heals. Most surgeons will put the incision in a neck crease which helps hide it.

Some doctors use drains post op. They’re usually only in place for the first 24-48 hrs. A question you should ask is whether he uses surgical clips or not. Some doctors do & others don’t. These are used to permanently clamp a blood vessel closed that may need to be cut during surgery to more easily access the styloid. They’ve become a bit controversial here as some people have had too many put in, or they were placed such that nerves have continued to be irritated by them. They’re not easily removable so if you think they would be an issue for you, it would be good for you to find out your doctor’s philosophy re: surgical clip usage.

I have one surgical clip on each side of my neck now & have had no problems with them. I believe that is the most common scenario but just needed to alert you about this practice.

[Jules]

The left styloid is certainly an unusual shape!
It is a difficult decision whether to opt for the surgery if symptoms aren’t too bad normally… Other things to consider are your age- often ES symptoms can worsen with age as ligaments/ connective tissue weaken, so you might find symptoms take longer to go or even don’t go in the future…and also surgery is easier to recover from when you’re younger… It does sound as if your surgeon does know what he’s doing, another thing to consider is that if you have someone you feel confident in now, that’s not to say he would still be doing the surgery in the future if you needed it really badly (we find that some of the doctors on our list are no longer doing surgeries when members approach them), and if your insurance now covers the surgery, might that change in the future… More questions than answers for you though, I’m sorry!