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.