Congrats! That seems like a really quick turnaround for surgery and not a big bandage, so hopefully it’s a smaller(ish) scar. Wishing you all the best with your recovery.
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In this pic, can see the right greater cornua is thicker than the left.
Back again. Even though I have had the right styloid out, I am wondering if there are a couple of issues with my greater cornu of hyoid bone and superior cornu of the thyroid. Here are a few pictures comparing the right and left sides. The right is where I have all my issues.
The main thing I see about the right greater cornu is that it sort of protrudes and is almost triangle-shaped.
The right superior cornu seems longer than the left, but the left seems as if it is split in 2 (it is fragmented, or there is some sort of discontinuity.)
The other thing I notice is that the gap between the right greater cornu and right superior cornu is about 1 cm, and the gap between the left greater cornu and left superior cornu is about 2 cm (not exact).
Finally, can see the right greater cornua is thicker than the left.
I will spend some time going through various posts to look at various pics of other people’s structures to get a better idea of what it should look like.
Would appreciate it if anyone has more analysis to give. Also, please ask if you want to see any other angles. Thanks in advance
Is this the image that makes you think your left greater hyoid horn is split in 2? If so, because it looks solid in all the lateral images, I would guess this is a function of the CT scan being done in slices. Even w/ 3D images, things don’t always appear completely accurately. Also, in images 2 & 3 it looks like you have a bit of s-h ligament calcification arising from the lesser horn of your hyoid. I circled it in red below. I don’t know if this is of any consequence.
I don’t know enough about thyroid cartilage to comment on that.
Thanks for giving your thoughts
No. I think the left superior cornua (of the thyroid) is fragmented (split in 2) - I have no left side symptoms, just debilitating right sided ones, so I am a little confused. In this pic, I am trying to show a front on view of the thyroid superior cornua. A lot of the hyoid is hidden in this pic (by my chin).
The sections of the hyoid do not seem fragmented, just the shape of the right is a bit worrying. Good spot on the lesser horn 
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I didn’t think that was the hyoid in the image, but I also didn’t recognize it as thyroid cartilage. Still learning!
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Both greater cornu do look wider than usual…but then in some images the left looks almost flattened & very wide, like when you look upwards from underneath- I’m sorry, I’m not techie enough to annotate your images…
It may just be the angle…
I know it’s hard, but I would try & just concentrate on healing for the time being, and if there’s no improvements in a few months maybe explore other options, but it’s too early to tell for now to know what will or won’t improve
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Hi Jules, thanks for your input. It is very much appreciated. I am trying as best as I can to just focus on recovery. Trouble is this issue has impacted and restricted my life in so many ways, and I just want this issue to heal, even if it’s only 20% that I can speak for a couple of minutes every few hours or so and be able to do light exercise, which would severely improve my life, because for the last few years, I have essentially been a mute, and can do minimal amounts of exercise (and I used to go gym 3 times/wk, play football (soccer) twice/wk etc pre-injury, and now nothing)
I cannot interview for any job, so sorting this out really has become my main focus.
Hence, I need to be prepared for any outcome of my surgery, both positive and negative. This group has helped, and it’s reassuring that many people on this forum, after years of pain and suffering, managed to find a solution.
In fact, I had given up for a couple of years on this issue, because doctors were never any help (and actually did more harm that good - I have been on meds for all sorts of throat related issues, but none were correct - and not only were they not correct, it didnt seem in the slightest to be correct - e…g GERD medicine (I F"$%"$^$ can not swim without excrutating pain- how can it be GERD, and many other meds… countless doctors telling me to say "AAAAHHHHH despite me telling them there is nothing wrong with my voice, but it just severely hurts when I phonate - I rememeber hurting for 2 weeks after 1 docs appointment when being told to do various sounds and exercises) - At least when I came across this group, the fact that my styloid was pushing in to my tonsillar fossa, and part of the pain i get from phonating and exerting is very near that area. So at the very least, it definitely viable that it is the culprit…so I am grateful for finally having a ‘maybe its this’ moment, which I never had over the years.
However, I also have pain more centrally in the throat too, and I am not too sure if that is caused by the styloids or something else. But I am trying to reserach every viable possibilty (e.g intrinsic or extrinsic laryngeal muscle dysfunction, RLN/SLN sensitivity etc.) in case in a month’s time at the post op check up, I am still feeling the same as I am now (which is pretty much same as pre-surgery).
I really hope, however, the styloidectomy can make some improvements as now, all the costs are going to be out of pocket (NHS is just way too slow, and after many many months, they keep referring me to the next consulatnt, and each referral takes about 3 months, which may be ok if your issue is known and confirmed, but all the doctors I saw prior to Dr Hughes all saw my CTs MRIs and none of them saw the styloid as an issue, so they just pass me on to the next one.
Apologies for the long reply!! Sometimes its nice for me to write all these things down once in while, as i never speak (as I can’t) to any family or friends about how i am feeling or about the actual medical issue as its just so complex and long to explain, so I figure there’s no point in telling them, even by text).
So I am so grateful that I have found this place and have a place to write down my progress/lack of progress and just how I am generally feeling. As I am sure most of you are aware, it’s not just the physical pain that affects you; it’s the mental side of things too (in my case, the feeling of worthlessness, as I can’t properly interact with kids or family, so I feel that I am a failure as a father, as I can’t pick them up and do those physical activities with them, nor can I read them a bedtime story), my earning ability is also severely impacted by this injury)
So that’s why I am trying to do as much research as I possibly can before my post up follow - up appt. But you are correct; I do also need to take it easy and relax to help with the healing. I do take some time out each day to consciously do diaphragmatic breathing (it helps relax the throat) .
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I’m not sure if this has been suggested, but getting a FIESTA MRI of the area of your neck where the vocal cords are & where you have pain might get you the diagnosis you need. I would expect there is someplace in London that does those. They show the nerves where other types of scans don’t & can reveal where a nerve(s) is/are compressed or damaged & what is causing the problem. It would be a huge step toward healing for you to get one of these scans if the styloidectomy doesn’t end up helping.
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Well done with all that feedback and more images. SO interesting - though an academic exercise is not the object in itself. I notice the thyroid has been mentioned a couple of times in above comments. Funnily enough I’d been looking at that myself on my scans and the thryoid ligament horns can cause issues and the thyroid ligament itself if damaged can definitely affect the larynx. Here’s another paper dealing with the hyoid-thyroid interactions: Variants of the hyoid-larynx complex, with implications for forensic science and consequence for the diagnosis of Eagle’s syndrome | Scientific Reports
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I understand where you’re coming from, I can’t imagine not being able to talk without causing pain to yourself…and to be missing out on being a Dad too must be awful
If it doesn’t improve, quite a few members have sent images to Kjetil Larsen at MSK Neurology as he seems to be very thorough looking for abnormalities, so that might be a possibility?
Home - MSK Neurology
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That link is so good! Thanks so much
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Hey @virenlondon, I’ve been following your progress as I’ve also just had surgery 15 days ago. I just wanted to let you know (if it’s any consolation) that my pre-surgery symptom that troubled me the most was my high heart rate (I’m talking 120-150bpm min while resting or just watching tv etc) and generally feeling like I couldn’t get my head into a position that wouldn’t set this symptom alight. From what I understand this is largely triggered by irritation or damage to the Vagus Nerve, though my ECA was also being touched and pressed by my calcified ligament. I had a host of other symptoms too (most of the ones I have read about to be honest - though not pain when talking, just loss of sound/quality of voice when talking after only 10-15mins but pain in most other areas).
I am still very much being troubled by the symptom that bothers me the most and just thought I’d reach out about it. I too was hoping that I would see a change immediately but have come to realise that this will be quite a long road unfortunately. If the nerve is severely damaged I may not know if the surgery helped for months, if not years.
When my increased heart rate returned 3 days after surgery - I think the anaesthesia and pain meds reduce heart rate - I thought maybe its my hyoid causing the issue. In CT imaging the greater horn on the same side is about 1-1.5mm from the Carotid artery in neutral head position and imagine it’s closer when I move my head/look down etc. and likely very close to the Vagus Nerve too. I was very disappointed and felt like I wanted surgery then and there to reduce the length of the hyoid! I’ve had time to process things a bit more and with that, realised I wasn’t prepared for my worst symptom to linger - I’d really hoped I’d wake from surgery and that particular one be gone, but it’s not the case. Its difficult thinking it will be here for the foreseeable future considering it limits everything that I can do - even looking slightly down, talking, looking at someone while they are speaking or the smallest head movement sets it off. I too have a young family and it’s sad…to not only miss out on time with them but also to hinder what they can do because of my own limitations. I can completely relate and wish you all the best as you recover!
Keen to check in at 2 months post op to see how you’re going 
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@BraveKat - I’m very sorry your heart rate is still being problematic. As I said to @virenlondon - at 2-4 months post op if there haven’t been any changes in your worst symptom(s), it’s worth revisiting the hyoid situation & having a discussion with your surgeon about that. I think for both of you, it’s possible that the hyoid could be playing a role in the symptoms that aren’t resolving, but that’s my non-medical, non-professional opinion.
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Hi BraveKat, feel for you very much with all you said here. How frustrating and disappointing. Sincerely hope things can improve for you & hope you can post more when you can. I have episodes of tachycardia, also very limiting, so can empathise, but it’s not the whole time like you. Take care.
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Thank you @Blodyn for your message. I’m sorry to hear you’re also living with tachycardia. Do you notice anything specific sets yours off.
I’ve had mine since I first noticed symptoms 10 years ago and while it bothered me, it was tolerable at first. It came in episode and I wouldn’t know what was setting it off. But over the years it became more frequent. Aside from getting the very high heart rate during exercise, I’d also have a difficult time just talking about things that I was excited to discuss - literally I would get attacks at work or home when talking in an energetic way. I have no idea why but it feels like when I want to do something that will make me happy it happens. And I’m sure it’s a physical reaction which is so hard to get anyone to believe me about. As I say, I know for certain moving my head to the left and tilting my chin affect it. It wasn’t until 6 weeks ago though that it became constantly high and aggravated more by the slightest head movement (that was pre-surgery). I woke from my sleep with a HR of 150bpm that wouldn’t go down afterI had accidentally been sleeping on my left side (I’ve tried to avoid this for years as I’d noticed in the past was a no-no from a symptom point of view).
If it’s not something directly in my neck affecting the vagus nerve (like the hyoid or calcified ligament/new swelling) then all I can think is that it’s somehow muscle related.
Maybe my scalene on that side. In the Ct, to me it looks like the jugular vein is dilated through the length of the neck and I get what feels like TOS and a lot of muscular neck pain. Maybe the muscle and enlarged jugular are compressing the carotid space and the nearby nerve.
Or maybe I just need my right side removed… I don’t know. Will wait it out and see if anything improves after a few months. Maybe try some acupuncture in a few weeks too.
Do you get arm/shoulder pain?
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Hi BraveKat,
That’s all so interesting! not quite the same as me. Sounds like something is compressing somewhere with you when exert yourself, when you’re excited or stimulated with adrenaline etc. (I’m no expert!). What’s important, I reckon, is that you’re so clear about your symptoms - what exactly affects the tachycardia & when eg. the left tilting etc. & the affect sleeping on the left side. So that really should help the ‘experts’ with diagnosing the exact cause, one would think! Your theories all sound very plausible. I’ve had a load of very painful muscular neck pain in the past (from whiplash & when the rheumatoid arthritis was raging), but now it’s chronic discomfort, never comfortable holding the head in any position etc. I don’t get chronic pain down the collar bone/ first rib/ shoulder/arm areas, it’s all neck/throat/head. I’m not sure what TOS feels like. I really am no expert, but on that CT slice above it looks like your left jugular is your primary one (shown on the right) and the hyoid horn that side, although not against it in that particular angle, looks like it could push ahead into the side of the carotid artery if your head changed angle, or looked down? (Isaiah & Jules could help there better I’m sure!) . I find tachycardia is irregular with me. I’ve had unexplained bouts for days without any exertion or any apparent trigger to bring it on, just sitting or lying down etc. Then it’ll be better for a period . Then, again, irregularly, when I do small exertions and bending down etc, it can come on, though I try not to do things to bring it on. If I exert more, then things just feel like death coming on with throat constriction, head pressure, weak knees , breathlessness & feelig like passing out. Again, I try and avoid that scenario, but that means being pretty restricted physically & unable to do anything aerobic. Your 150bpm lying down sound so high! but as you say, lying on your left side…I’m not sure how it can be shown that the vagus nerve is affected? I’ll have to research it more. Whatever the case, it’s a huge drawback that scans are in one straight position of head and neck. I found some papers online where they try and simulate different angles and one where a scan was done at 2 different angles, but it’s very rare. But, as it is, it makes the dynamic movement situation of the head/neck really difficult to examine and diagnose these things. Sorry, I’m rambling! I think your theories definitely need looking into - but there lie all the other problems of expertise, tests, interpretation, action blah blah. I need to re-read your previous posts again & will respond further. Take care.
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On this forum, over the years I’ve been here, most of our members w/ bilateral styloid elongation &/or vascular compression have needed both sides taken care of to get the best end results though I do agree with what @Blodyn sees in your scan so perhaps you will eventually need to have the left greater horn of your hyoid reduced to stop the left side of the vagus nerve from being irritated which could in turn stop your tachycardia if that’s what’s causing it.
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Hi @BraveKat and @Blodyn just read some of your posts here. I also suffer from tachycardia. I have my story posted check that on my profile.
I have 4 months from post-op bilateral styloidectomy and C1 shave, still getting episodes of tachycardia unfortunately but I think I got some improvements, they do not get as crazy as before surgery like 180+ bpm. So I am expecting more improvements in next upcoming months. I never was able to understand what is triggering it exactly! But most likely when lying down my left side while sleeping. People here mentioned to me that I have large hyoid bone but my surgeon did not agree, also I am not able to replicate any pain if I press my hyoid bone. @BraveKat are you able to replicate anything by pressing your hyoid bone?
Also @BraveKat I get some pain below my collarbone now post-op and some tingling/weakness on my left arm time to time
I think we guys should keep in touch and try to help each other with our findings. Maybe we can open a thread/story were we can discuss our issue there?
P.S I apologize to @virenlondon for mixing our issues here in his thread, I am sure he understands though.
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