Hope everyone is going well. I’m getting surgery on my left side in around 4-6 months. He’s not allowed to use the TORS robot this time around (I had right out intra oral last year by Tom Milner in Glasgow) - so I have a choice for what surgery to go for, I can’t remember what’s best, I’m sure I read about this before. I’m nervous he’s now not using the robot lol!
I’ve also uploaded images of my CT scan, the first is right that has been removed, the second is left.
R: 5.5
L 5cm
Can anyone see compression?
WOW! Your styloids are SUPER LONG! I’m so glad you’ve gotten the right one removed or mostly so! Looking at your images, you seem to have a good amount of space between your styloid & the transverse processes of C1 on both sides which reduces the chance of compression. However, on your left side, it looks like the tp of C2 may be pressing on your left IJV. Your right IJV appears to be dominant as it’s larger than the left IJV. It’s not uncommon for a person to have a dominant & non-dominant IJV.
I’ve annotated your second image to show where my concern is, but you’ll need to get your surgeon’s opinion about this. If he agrees that there is some compression, the transcervical (through the neck) approach is the only way to do a vascular decompression surgery. It may be that he is opting to do your second surgery w/o the TORS robot because he feels it’s safer. It would be good for you to ask him directly why he’s choosing a different type of surgery for your second styloid.
If you do have the choice, external/ transcervical surgery is felt to be better than intra-oral which you had last time. This is because it gives the surgeon better visibility of the structures in the neck, it’s easier to remove the styloid further up which gives a better chance of success, and also there’s less risk of infection.
Thank you for your message. Dr Milner doesn’t seem to recognize anything other than throat pain, and feeling like something stuck in throat, anything I have brought to the table was dismissed. I’m totally clueless why, he calls it eagles syndrome, not elongated styloids, I’m sure with what I read this means compression of some sort. I’m pretty certain I’ve IJV compression, I have a strong pulsing sensation right at that area, periods of vertigo, my heart is constantly racing, I also feel my vagas nerve is underestimated, my gut does not work well.
Can I ask, you say T2 tip may be causing a little compression, is this separate to eagles syndrome? Also I’m really unsure how I can approach this surgeon about this. I don’t think saying someone on a forum suggested compression l would work, anyone any ideas what to do? I feel I need to speak with him before the surgery. I might also opt external. He’s not using the ToRs because it’s now only kept for cancer patients. Thanks again Ali
It’s a shame Dr Milner isn’t better informed about ES. I printed off the post @Jules wrote about symptoms & their causes & took it to my ES surgeon along with the one she wrote about vascular ES symptoms. Both of these are in the Newbies Guide under the Welcome category on the home page Nearly everything she wrote about she had medical references for which makes the info less disputable. There are also a lot of research paper links with info about IJV compression under the Research Papers link under the General category on our home page. We’ve recommended taking physical copies of research papers or others ES info to doctors who seem ill informed - not enough to overwhelm them but enough to educate.
This is a good question. In your case it might be a separate situation because it doesn’t involve the styloid or stylohyoid ligament. We have had members w/ C1 & C2 contributing to IJV compression which was taken care of during ES surgery. You may need to consult a vascular surgeon. If you can print off the image I’ve annotated, & take it to Dr Milner, & ask his opinion of what he sees i.e. does it look like IJV compression, that would be best. If he says yes, ask him whom to see for help with that. If he says no ask if he can refer you for imaging that would be more definitive.
If the external approach is an option, definitely choose it as Dr M can see everything that’s going on in your neck better that way. He can also potentially cut the styloid closer to the skull base than with the intraoral approach which could give you better results & will certainly prevent the horrible situation you had w/ your throat after your first surgery.
